Monday, December 31, 2007

Elderly Suicide Increases with Age

Reviewed here.

Air Force Like Program at U of Illinois and at Cornell Reduces Suicide Rate by 40%

Referrals of students threatening suicide to just 4 sessions helped reduce the rate. Presumably, those with serious disorders stayed in treatment after the first mandatory four visits.

Here, and here.

Thursday, December 27, 2007

Another Suicider Kills First


$13 Million To Brothers of Woman Who Committed Suicide Day After Refused Treatment for Lack of Insurance

Mentioned in this article, toward the bottom. I don't know how treatment would have prevented a suicide the next day. Only long term treatment can prevent suicide. I would like to get more facts about the case.

Wednesday, December 26, 2007

Hunt for Suicide Gene

Suicidality likely gets transmitted independent of the transmission of depression.

Efforts to find this gene reviewed here.

Tuesday, December 25, 2007

FDA Warning Decreases the Diagnosis and Treatment of Pediatric Depression

The sole effective prevention of suicide is adequate, long term treatment. As a result of the irresponsible FDA warnings, diagnosis of depression in kids decreased by a third. The use of anti-depressants dropped by over 50%.

The Black Box Warning the FDA Failed to Put on all Anti-depressants

There is a valid black box warning to put on all anti-depressants. Naturally, the craven academics have failed to put it on. It supercedes their idiotic, PC, and cowardly warning about suicidality.

All anti-depressants, including the most sedative, amitriptylline, cause about 5% of patients to get agitated. This applies to dosage increases as well, even no agitation took place on lower doses.

This is a form of akathesia, from the inhibition of dopamine by increased serotonin tone in the first 24 hours.

All patients require this warning. It worsens over time, in the vast majority of people. If agitated the first or second day, stop the anti-depressant. Return to get another anti-depressant.

If someone is very depressed and suicidal, add very uncomfortable restlessness and agitation, some may injure themselves to seek relief.

A tiny number of patients, such as 1 in a 1000, reported an onset of suicidal ideas after a specific anti-depressants, long before this irresponsible warning. All in my practice, stopped the anti-depressant on their own, returned for an alternative.

Put a Black Box Warning on Families of Suicidal Youths

According to this study, youths have a greater and earlier chance to have a suicide event if members of the family were suicide attempters, had a greater parental incidence of being sex abuse victims. Earlier onset of suicidal behavior stemmed from having impulsive aggression and a baseline mood disorder.

Monday, December 24, 2007

Ideal Performance Wrongly Called Minimal

Reviewer criticizes long list of do's and dont's for suicide assessment and management as not minimal standard, but ideal standard, impossible to meet.

I would have added, garbage science, as worthless in the prevention of suicide.

Sunday, December 23, 2007

Suicide Attempts Timing and Anti-depressants

The highest rates were among psychiatry patients, lower in psychotherapy, lowest in primary care. Among all these three groups, attempts were highest prior to anti-depressant prescription, lower in the month after treatment, and declined thereafter. Reported here.

This finding supports the sole method to lower the suicide rate, long term treatment.

Again, I call for the entire FDA Psychopharmacology Committee and the FDA Commissioner to resign for their irresponsible black box warnings and caving in to political pressure. These PC, craven, academic traitors to clinical care caused an increased rate of suicide in pediatric patients, especially boys under 15. These incompetents no longer belong in any responsible position.

An interested reader submits this great YouTube video. It depicts the overheated bullying of the FDA Committee by scapegoating parents, left wing ideologues, and biased partisan hacks. It lacks any rebuttal of the effects of the Committee's craven, bonehead decision. No one mentions the hundreds of deaths the decision caused, by deterring the use of anti-depressants in adolescents.

Alleged Abuser of Suicider Sues Hospital for her Suicide

The judge in the case should be immediately impeached.

Celebrity Suicide increases Depressed Patient Attempts

Media coverage perhaps reminds depressed people of suicide as a coping skill.

Traumatic Brain Injury Associated with More Suicide Attempts

Especially if emotional distress is found.

Another Long Term Treatment Program Reduces Suicide

In an area of Hungary, training of family practitioners to use more anti-depressants reduced the suicide rate of women by 34%, compared with increases of 90% in comparison areas. Alcoholism was a factor in 75% of male suicides and 21% of female suicides. The program succeeded despite its not addressing nor affecting the rate of alcoholism.

John Edwards Won a Judgment for Suicide Malpractice

See Estate of Fuller v Mazzaglia for $2.3 million. A prominent suicide expert testified for the defense. If anyone knows who testified for the plaintiff or has deposition or trial transcripts, I would appreciate hearing about them.

Beyond Daubert or Frye to Reality

Daubert web site.

Let's stick to a standard of care testimony. The expert may properly cite studies. These are authored by academics, most often. Clinicians spread advances by word of mouth, and they get accepted or rejected within weeks. Strong remedies will become self-evident at the gut level. Weak or ineffective remedies will fail to impress and get dropped.

If the expert proposes some standard of care, e.g. heart decelerations this many times require C-Sections, should we settle for academic studies? Shouldn't we demand the expert provide his own records on the management of similarly situated patients? If the expert can only provide 3 such records, does he qualify as an expert? Can one be expert after 3 repetitions of decision making? If he can provide a dozen such records, are they the totality of the records of similar patients, and not cherry picked records agreeing with testimony? One should demand all the records of the expert, and sample them. If a record is found that contradicts the testimony, a mistrial should be called, and the legal costs of both sides should be obtained from the lying expert's personal assets.

And, yes, experts should feel intimidated. With the absurd arrogance to dictate practices to the doctors of the entire state at the point of a gun, they should take the consequences of their lying prostitution to the land pirate.

Saturday, December 15, 2007

Low Risk of Medmal in Psychiatry

Reviewed here.

This program has Lilly as a sponsor. They make Zyprexa. Perhaps, sales have dropped from fear of litigation. Lilly would be interested in getting this message out.

I have been sued several times. In every case, I had given superior care, and achieved the aim of treatment.

I made mistakes that injured patients. I would have settled in those cases had I been sued. Never sued for any real mistakes.

This lawyer is not making the obvious point. The vast majority of cases are weak or frivolous. She would go out of the legal defense business if someone were to deter the land pirates, or made them do their job properly.

Jail and Prison Suicide Rates Decline

The graph is here.

Friday, December 14, 2007

Alcoholism in Bipolar Disorder with Suicidality

Elevated risk of substance abuse and suicidality in bipolar disorder with alcohol abuse reviewed here.

Tuesday, December 11, 2007

Clueless FDA at it Again

This time they are going after a smoking cessation medication for causing a small number of users to experience agitation and passing suicidal ideas. By deterring family doctors again from its use, they will kill 10's of 1000's of patients by the consequences of smoking.

Prison Suicide Reviewed in a Series in this Left Wing, Biased Newspaper

The left wing view sympathizes with the criminal.

Wednesday, December 5, 2007

Mass Murder by Suicider, Robert Hawkins, On the Loose Thanks to the Criminal Lover Lawyer

Here, here, here , here. Some history here. This mass murdering suicider broke up with girlfriend, and lost a job, recently. Thank a lawyer for having this unstable, repeat offender, criminal, mass murderer on the loose. These needless, tragic deaths are the fruit of Supreme Court takeover of psychiatric decisions for the sole aim of lawyer job generation and rent seeking. The lawyer has no competence to make psychiatric treatment decisions. The Supreme Court requires a trial to get someone in treatment involuntarily. The patient must commit a dangerous act to qualify. Now, Hawkins qualifies for involuntary treatment. More here. The video pic and note. He is certainly correct about himself. The criminal has the total protection of the criminal lover lawyer. One day, the criminal lover lawyer will be neutralized and removed from the control of the three branches of government. Those with antisocial personality should then be affirmatively strongly encouraged to commit suicide to prevent the massive costs they generate by their devastating aggressiveness.

A pro-criminal judge set this drug user, mass murdering suicider loose to kill. This judge should immediately resign, or be impeached. It is not expected that a judge will predict the future behavior of a disturbed person. It is that the judge has no competence to make psychiatric decisions about the management of present mental disorder. What is the name of the judge who set this mass murderer suicider loose on the public?

Naturally, this judge who caused this mass murder, has criminal lover, self-dealt, legal immunity. I bet 10 cents, the mall and store will get sued for premises security liability. The innocent victim of this mass murder has to pay ruinous settlements, the guilty party, the criminal lover lawyer gets off free.

I strongly urge cross claims by any defendant against each of the parties that set this violent criminal drug user loose to do what he did. I strongly urge a claim against the most responsible party, that criminal lover judge. His immunity is unconscionable, and violates the defendant's procedural due process rights. On policy grounds, piercing this horrible immunity would deter other criminal lover lawyers from endangering the public by setting loose their good pals, the violent criminals.

Monday, December 3, 2007

No Criminal Charges for Suicide After Cyberbullying

Reported here. Social consequences of cyber bullying reviewed here.

The defense should demand all electronic communications to review them for cyber-bullying. The defendant should file a cross claim against any cyber-bully and any enabler. The insurance company lawyer may refuse to attack back. The private lawyer might have to defend the rights of the defendant when the insurance defense lawyer refuses.

Sunday, December 2, 2007

Long Term Use of Anti-Depressant Reduces the Suicide Rate by Two Thirds

As we have been arguing, only long term treatment reduces the risk of suicide. Arch Suic Res 11:163-175, 2007.

This doctor argues the risk of untreated depression for suicide dwarfs any risk for suicidal ideas from anti-depressants. NEJM

The irresponsible, dangerous members of the FDA Psychopharmacology Committee must resign immediately. The FDA Commissioner should be fired for failing to supervise these dangerous peddlers of garbage science, and enemies to clinical care.

Friday, November 30, 2007

Statements or Acts of Acquaintances as Unforeseen Intervening Cause of Suicide Attempt

This example (and here) illustrates the necessity of discovering every conversation and interaction between the last contact of the defendant with the suicider, and the attempt. Those are the more proximate and the legal causation of the death or injury. They interrupt the chain of causation and end the claim.

Discovery should explore acts and statements of people in all the settings of the suicider. Trivial adverse events may set off an impulsive person. These do not have to be frustrating to the reasonable person. The suicider is not a reasonable person, by definition. In half the cases, the suicider is intoxicated.

The defendant cannot reasonably foresee, nor control the statements of others, cannot control the over-reaction of the suicider, most of whom have a psychiatric disorder, half of whom are intoxicated.

Intoxication, and its adverse effects on relationships, conduct, and reactions to others, is itself, an unforeseen, intentional, uncontrollable intervening cause.

Wednesday, November 28, 2007

Lawless Clinician Haters on Licensing Board Should Be Removed by the Governor

The case of irresponsible, tyrannical licensing board conduct is reviewed here. They felt free to ignore settled US Supreme Court holdings.

I urge all doctors to sue the members of any licensing board for any intentional interference with the contracts the doctor has with patients, insurance carriers, and any employer. These clinician haters should be sued as individuals in Section 1981 claims, if the doctor qualifies for any of its protected classes, including age, sex. For example, it is possible the hunt is on for the white male, by the lawyer on these licensing boards.

Saturday, November 24, 2007

Center for Suicide Prevention at U Penn Med School

It focuses research on the effectiveness of cognitive therapy in the community. I hope it will not restrict itself to subjects that have mild urges to commit suicide. Its results will not apply to population of people with urges severe enough to go through with them.

Friday, November 23, 2007

Rage as Motive for Murder-Suicide

Yet another suicidal, angry man decides to take little kids with him.

Another Peddler of Garbage Science in Suicide Litigation

In this review, the lawyer on the defense side,

1) fails to state the vast majority of suicide claims are weak or frivolous, and the defense bar is doing nothing to deter the plaintiff bar;

2) there is no correlation between the quality and extensiveness of records correlates with harm to patients. The sole aim of these lawyer rules and regulations is to intimidate the clinician;

3) the standard assessment in articles, guidelines cited are garbage science. No promulgator of such assessment has been able to provide evidence they have ever prevented a suicide.

Many Bizarre Deaths Self-Inflicted

Some are suicide, others involve pointless risk taking, amounting to suicide.

Words Precipitate a Tragic Suicide

This law likely violates the Constitutional. This deeply tragic loss shows that rejection by words, even from a stranger, spoofing a boy, can cause a suicide. Such words have more power to induce suicide than anything a clinician does or fails to do.

Saturday, November 17, 2007

Japanese Suicide Remains High

I guess the government has yet to learn, long term treatment of psychiatric disorder is the sole path to decreasing the human toll of suicide. This article reviews the statistics.

Suicide of Child After Internet Criticism

In this article, the mother of the child wants prosecution for causing a suicide, induced by remarks on the internet. The legislative body will violate the Free Speech Clause to remedy a risk caused by genetics, or other environmental factors.

Saturday, November 10, 2007

Prof. Jan Fawcett on Black Box Suicide Warning for SSRI

The effect of these warnings was to decrease the prescription of anti-depressants. Decreased long term treatment resulted in an increase of suicides after years of steady decreases.

In girls ages 10 to 14, suicide increased 76%, and in girls 15 to 19, 32%, in 2004 after the above FDA black box warning.

Sunday, November 4, 2007

Court Cannot Settle a Clinical Controversy

The imposition of one side of a clinical controversy at the point of the gun of the court violates the procedural due process due right of the defendant to a fair hearing. The Supreme Court, the top of the hierarchy of the criminal cult enterprise that is the lawyer profession, has granted its witnesses in bogus litigation absolute immunity. Defendants and other victims of these bought off witnesses need the protection of Federal legislation allowing them to sue these witnesses for imposing their wrongful testimony.

In this review, the always even handed, up to date, and reasonable, Dr. Henry Nasrallah calls the assessment of suicide rick, controversial. Once that word is used, all litigation involving assessment are frivolous per se. The court has no competence to settle a medical controversy. That settling requires scientific data and not the fairy tale spinning, and overheated persuasion of a trial.

Saturday, November 3, 2007

Hesitation to Sign a Safety Contract Not a Basis to Keep an Inpatient

In this case, the patient was not sure about contracting for safety. He committed suicide before his outpatient appointment. The plaintiff expert second guessed the release. Vengeful wife claimed a wrongful death. In such a claim, the plaintiff would get what the deceased should have were he alive to sue. Because the deceased killed himself, in general, in the common law, wrongful death claims are not logical. The appellate court reversed the verdict.

"... discharge team had departed from accepted standards of psychiatric care by failing carefully and competently to evaluate decedent following the discussion of the contract for safety at the March 8, 2001 discharge meeting. They concluded that such departure deprived decedent of a substantial possibility of avoiding suicide on March 14, 2001. Specifically, plaintiff testified that during the March 8, 2001 meeting, decedent "hesitated" when asked whether he would contract for safety with her. In its verdict, [*2]the jury found that the failure to reevaluate the discharge plan following decedent's "hesitation" constituted a deviation from accepted medical practice. We disagree."

Then, ""The prediction of the future course of a mental illness is a professional judgment of high responsibility and in some instances it involves a measure of calculated risk. If a liability were imposed on the physician or the State each time the prediction of future course of mental disease was wrong, few releases would ever be made and the hope of recovery and rehabilitation of a vast number of patients would be impeded and frustrated." (Centeno v City of New York, 48 AD2d 812, 813 [1975], affd 40 NY2d 932 [1976].)"

Where is the evidence from the plaintiff expert that any reassessment, or that keeping the patient an inpatient for weeks or months more would have prevented this suicide? The trial court permitted garbage science. It is unfortunate that the court fails to name the experts, so they may be held accountable.

Monday, October 1, 2007

Example of Motion to Disqualify an Expert

This case motion involves asbestos. The rules and doctrinal arguments have application to other cases, worth a review in suicide cases.

Lawyer Takes Flying Leap from Hospital Window

The lawyer made numerous attempts before this one, according the article, and here. One reminds any lawyer contemplating taking this case, it defies public policy to reward the federal crimes with a civil judgment.

Wednesday, September 12, 2007

Gun Ownership Does Not Correlate with Suicide Rates

This article reviews multi-national comparisons of gun ownership and suicide rates, finding no relationship.

Friday, September 7, 2007

Suicidality Correlates With Quality of Life Rating

This study tested the hypotheses (1) middle aged and older patients with schizophrenia, depressive symptoms and suicidality would exhibit worse quality of life and worse everyday functioning, social skills and medication management relative to those without suicidality; (2) higher levels of suicidality would be significantly associated with worse functioning, worse quality of life and older age.

It showed only quality of life scores predicted suicidality, but not performance skills, social skills, nor medication management skills.

Thursday, September 6, 2007

Suicide Rate Increases for Girls

This sharp increase coincides with the deterrence of anti-depressant use by the totally irresponsible black box warning. I demand the FDA Psychopharmacology Advisory Committee and the FDA Commissioner resign. I demand the two members who voted against the warning resign as well for failing to stop their irresponsible co-members.

Tuesday, September 4, 2007

Survey Shows Black Box Warning Deters 40% of Clinicians

The August, 2007, Neuropsychiatry Reviews, (p. 1, 24) reports on a survey conducted by Tim Petersen. About 40% of psychopharmacology clinicians, treating children and adolescents felt discouraged from prescribing anti-depressants, directly because of the FDA black box warning of 2004 and of 2007. On the other hand, 60% felt anti-depressants helped with suicidality. Although this survey was informal, and unscientific, it still indicates the adverse impact on specialists.

Monday, August 27, 2007

Articles on Suicide

Psychiatry Drug Alerts reviewed three studies, with a combined total of 109,000 patients. Attempts increased prior to treatment, peaking in the month prior to treatment, dropping steeply after the start of treatment, and continuing to decrease as treatment continued. This conclusion contradicts the FDA Psychopharmacology Committee black box warning, and makes it garbage science. The same conclusion resulted from a separate VA study of adults, that SSRI anti-depressants do not increase the risk of suicide. (Psychiatry Drug Alerts 21: 57-58)

Decision making in suicidal patients was tested with a standardized gambling test. Subjects learn to defer immediate rewards to get long-term rewards. Their score correlated with interpersonal difficulties in the affective domain. (J Affect Disord 99:59-62, 2007)

Patients over 50 with major depression had more impulsive suicide attempts with cognition problems, disability, and impaired self-care. They prepared for a suicide more often when older, isolated or living alone. (J Affect Disord 97:123-128, 2007)

Blacks do not have lower rates of suicidality. The lifetime prevalence of attempts was 4.1%, for suicidal ideas, 11.7%. In the first year of ideas, 77% progressed to an attempt. Increased risk associated with a younger cohort, lower educational attainment, living in the Midwest. These rates are those of the general population, and not lower. (JAMA 26:2112-2123, 2006)

Compared to depressed controls, adult patients with depression and a history of child abuse more often attempted suicide, got rated as impulsive and aggressive. Those who attempted suicide (71% v. 43% in the control group), had higher scores for impulsivity and aggression. (Am J Pscyhiat 158:1871-1877, 2001)

Of over 3000 female twins, ages 13 to 19, 4% reported attempting suicide before age 17. About half the attempters and a twelfth of the non-attempters had depression. Other risk factors included childhood physical abuse, social phobia, alcohol dependence, being black, and having conduct disorder. Risk increased 4 to 10 fold if a relative had died of suicide. The identical twin concordance rate was 25%, and 13% for dizygotic twins. Aside from psychopathology association with suicide, a familial link exists. (J Am Acad Child Adol Psychiat 40:1300-1207, 2001)

The highest levels of suicidal ideas take place in bipolar patients during the mixed phase. Age and depth of depression predicted suicide attempts. Anxiety did not. Patients did not make suicide attempts during mania. (J Affect Disord 2007; 97:101-107)

Among depressed patients, 16% reported prior suicide attempts. These were less educated, less likely married, more likely unemployed, with more substance abuse, co-morbidities, and PTSD. They had earlier onsets, increased severity, more episodes, and greater risk of suicidal behavior than the other depressed patients. (J Affect Disord 97:77-84, 2007)

A quarter of elderly depressed patients had suicidality. In half the suicidal patients, suicidality resolved after a month. In a quarter, it emerged late in treatment. About a quarter never experienced suicidality at any time. Suicidal and non-suicidal patients had equal severity of depression. The suicidal group has more anxiety, earlier onsets, more low self-eateem, and partial or no response to treatment. (J Affect Disord 2007; 98:153-161)

Anxiety symptoms associated with suicidal ideation in bipolar patients. It was ruminations, especially, that best linked to suicidal ideation. (J Affect Disord 97: 91-99, 2007)

At risk youth endorsed maladaptive coping strategies, increasingly more often with increasing risk factors. They avoided help seeking behavior. Such thinking requires persuasion during psychotherapy to change coping reactions. (J Am Acad Child Adol Psychiat 43:1124-1133, 2004)

Suicide rates peak in May, are lowest in February. Season represents a risk factor for suicide. Sunspot activity and geomagnetic field change did not. (J Affect Disord 81:133-139, 2004).

Among very depressed patients, these features predicted a higher risk of suicide attempt: a history of suicide attempt, subjective ratings of depression severity, cigarette smoking, aggression or impulsivity. (Am J Psychiat 161:1433-1441, 2004).

Dating Violence Increases the Risk of Suicidal Behavior by Girls by 60%

Girls suffer dating violence at a rate of 11%, and boys at 10%. Such female victims had a rate of suicidality 60% higher. Boys subject to dating violence did not have an increase in rates of suicidal behavior.

Defendants in a suicide malpractice lawsuit might consider a cross-claim against any dating abuser for increasing the risk of suicide of the victim.

Dr. Andrew Leon and the Rest of the Irresponsible FDA Advisory Committee, Resign Now, Take the FDA Commissioner With You.

Dr. Andrew Leon tries to justify the ineffable repetition of the mistake his FDA Advisory Committee made. In this Perspective Article, he describes the low rate of suicidal ideas or behaviors, not any suicide, just ideas and gestures.

He fails to adequately address the catastrophic deterrence of family doctors and general practitioners from prescribing SSRI's. With the sole measure that reduces suicide being long term treatment of the underlying condition, fewer people will get treated, and more will commit suicide. He dismisses the excess of 100's of children and adolescents who committed suicide since the irresponsible warning issued in 2003. "The public health experiment has just begun," he retorts. Nice to know the families that needlessly lost a loved one thanks to his irresponsible vote were participating in an experiment.

Thursday, August 23, 2007

Gastric Bypass Surgery Tripled the Suicide Rate

In this article, the bariatric surgery markedly decreased overall mortality, especially from cardiac and cancer causes. Suicide increased in the surgery group by three fold (0.9/10,000 person-year in the control group of 7925 people, vs 2.6 in the matched surgery group of 7925). The rate of the control group would be average for the general population, with 1% of people dying, and 1% of the mortality being by suicide. The implication is that weight loss tripled the suicide rate.

In the prior article on the mortality results in a Swedish sample, suicide was not addressed specifically. There were fewer non-cardiac, non-cancer deaths in the surgery group.

The finding of excess suicide should be confirmed in other studies.

Friday, August 17, 2007

Why Patients Sue

Findings without comment here. These motivations represent a checklist of questions to be posed during depositions of the plaintiff.

As reviewed in Physician Protect Thyself, by Alan G. Williams, JD, Margol, Denver, CO, 2007. Pp. 23-30. They felt deserted. They felt their concerns were not taken seriously enough. Providers failed to convey information well enough. They felt the provider did not understand them. They cited poor communication after an adverse event and an attempt to cover it up. They filed a lawsuit to find out more.

Arch Phys Med Rehabil. 2007 May;88(5):589-96. What patient attributes are associated with thoughts of suing a physician? Fishbain DA, Bruns D, Disorbio JM, Lewis JE.

RESULTS: The highest percentage (11.5%) of patients affirming the S-MD statement were those involved in workers' compensation and personal injury litigation, compared with only 1.9% of community-living subjects. Stepwise regression of BHI 2 variables produced a 13-variable model explaining 38.04% of the variance. A logistic regression of demographic variables (eg, education, ethnicity, litigiousness) explained 20% of the variance. CONCLUSIONS: Anger (P<.001), mistrust (P<.001), a focus on compensation (P<.001), addiction (P<.001), severe childhood punishments (P<.001), having attended college (P<.001), and other patient variables were associated with thoughts of suing a physician.

N Engl J Med. 2006 May 11;354(19):2024-33. Claims, errors, and compensation payments in medical malpractice litigation. Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL, Brennan TA.

RESULTS: For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred less frequently than did the converse form of inaccuracy--nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors (313,205 dollars vs. 521,560 dollars, P=0.004). Overall, claims not involving errors accounted for 13 to 16 percent of the system's total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs. CONCLUSIONS: Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant.

N Engl J Med. 1996 Dec 26;335(26): Relation between negligent adverse events and the outcomes of medical-malpractice litigation. Brennan TA, Sox CM, Burstin HR.

RESULTS: Of the 51 malpractice cases, 46 had been closed as of December 31, 1995. Among these cases, 10 of 24 that we originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were 6 of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and 5 of 9 cases in which adverse events due to negligence were found in our assessment (mean payment, $66,944). Seven of eight claims involving permanent disability were settled for the plaintiffs (mean payment, $201,250). In a multivariate analysis, disability (permanent vs. temporary or none) was the only significant predictor of payment (P=0.03). There was no association between the occurrence of an adverse event due to negligence (P = 0.32) or an adverse event of any type (P=0.79) and payment. CONCLUSIONS: Among the malpractice claims we studied, the severity of the patient's disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff.

Med Care. 2000 Mar;38(3):250-60. Negligent care and malpractice claiming behavior in Utah and Colorado. Studdert DM, Thomas EJ, Burstin HR, Zbar BI, Orav EJ, Brennan TA.

RESULTS: Eighteen patients from our study sample filed claims: 14 were made in the absence of discernible negligence and 10 were made in the absence of any adverse event. Of the patients who suffered negligent injury in our study sample, 97% did not sue. Compared with patients who did sue for negligence occurring in 1992, these nonclaimants were more likely to be Medicare recipients (odds ratio [OR], 3.5; 95% CI [CI], 1.3 to 9.6), Medicaid recipients (OR, 3.6; 95% CI, 1.4 to 9.0), > or =75 years of age (OR, 7.0; 95% CI, 1.7 to 29.6), and low income earners (OR, 1.9; 95% CI, 0.9 to 4.2) and to have suffered minor disability as a result of their injury (OR, 6.3; 95% CI, 2.7 to 14.9). CONCLUSIONS: The poor correlation between medical negligence and malpractice claims that was present in New York in 1984 is also present in Utah and Colorado in 1992. Paradoxically, the incidence of negligent adverse events exceeds the incidence of malpractice claims but when a physician is sued, there is a high probability that it will be for rendering nonnegligent care. The elderly and the poor are particularly likely to be among those who suffer negligence and do not sue, perhaps because their socioeconomic status inhibits opportunities to secure legal representation.

Wednesday, August 15, 2007

Suicide Assessment Garbage Guidelines

It has been weeks since I requested data showing that following suicide assessment guidelines reduces the risk of suicide, short term or long term. I have not yet received any studies, nor even anecdotal reports. I contacted several authors of article putting forth these garbage guidelines. No reply. I have patience.

If any defendant finds himself facing these guidelines in a complaint or in discovery, I would appreciate an email from the defense attorney.

Monday, August 13, 2007

Authentication of E-Mail in E-Discovery

Authenticate emails before admission into evidence. On the other, seek to exclude adverse email by arguing against their authenticity, or about their being hearsay, so says the review.

Friday, August 10, 2007

Suicide in Bipolar Patients Tied to Being Male and Anxious

This retrospective study found a rate of suicide among bipolar patients of 1 in a 1000 person-years, and a rate of suicide attempts of 5 in a 1000. In terms of legal foreseeability, those chances are in the lottery ticket correct number selection range. Suicide attempts rates increased with substance abuse, decreased with age. Suicide increased with male sex, and anxiety co-morbidity.

Wednesday, August 8, 2007

Las Vegas Has the Highest Suicide Rate; Seniors Lead the Way

This article reviews the excess number of suicides in Nevada, and especially in Clark County.

Sunday, July 29, 2007

Driving Out Peds Will Also Increase Chronicity

The sole prevention of suicide lies with the long term treatment of its associated disorders. Peds will likely see mild or moderate severity ranges of depression. By driving out peds, by denying access to care for the mildly severe patients, delays in treatment ensue.

The longer the patient stays sick, the longer the toxic effects of the illness impact the brain. Such patients are harder to treat, more treatment resistant, take longer to recover. Suicide is only one fatal outcome of depression. The other is increased risk for heart disease and for sudden death.

The irresponsible FDA black box warning, by causing delays in the treatment of mild patients may result in greater chronicity of depression, and its associated medical consequences, including sudden death rate. The increase in sudden death may turn out to exceed the increase in the suicide rate.

Saturday, July 28, 2007

FDA Black Box Warning and Increase in Teen Suicide

The FDA issued a black box warning about SSRI's causing suicidal ideas. Perhaps, they occurred in 2% of placebo patients and 4% of SSRI patients. The counts included trivial self-injuries such as slapping oneself. No suicide took place in any reviewed study.

As a result of such warnings, pediatricians and general practitioners decreased their prescribing of the SSRI's. Psychiatrists, with more knowledge and confidence, ignored this idiotic black box warning. As a result of the decrease in total prescriptions to adolescents, the suicide rate stopped dropping, and for the first time in decades, increased. There have been 100's of needless, excessive suicides in teens, as a result.

Now, if one my decisions kills 100's of people, I should resign from my job. No? I made that point to a friend on that FDA Advisory Committee.

He replied. The Committee faced 80 raucous, threatening witnesses with extreme views. These included left wing ideologue doctor wackos. They included grieving parents blaming SSRI's for their child's suicide. They included parents of Columbine victims blaming SSRI's for the massacre.

The Committee faced loud calls for the banning of SSRI's entirely. The black box warning represented a middle ground decision made in the face of horrendous bullying.

The irresponsible bullies and wackos who testified now have blood on their hands. Beyond the few children murdered at Columbine, these vicious, bullying, scapegoating, misleading Columbine parents now assassinated a number of children 100's of times greater than the Columbine mass murderers.

SSRI's boost serotonin. It inhibits dopamine. Dopamine inhibition causes restlessness and an irritated mood that are very uncomfortable. People punch walls, drive at 120 mph, and can't stop yelling in order to get relief. If one has not been warned of agitation as a side effect, and one is depressed and impulsive, one does not tolerate the discomfort.

One should warn patient that 1 in 30 patients gets agitated, most likely the first day, and that the drug should be stopped.

Is there such a really useful warning to that effect? No.

When left wing ideologue doctor wackos, and vicious, vengeful parent bullies prevail at a hearing, 100's of innocent teens die, and the really useful warning does not appear.

Tuesday, July 3, 2007

Timing of Treatment and Suicide Attempts

This study shows the rate of suicide attempts highest before the start of treatment, followed by the rate the first month of treatment, and declining thereafter. The type of treatment correlates with the absolute rate, likely because of a correlation with severity of depression. Thus treatment by family doctors with antidepressants had lower rates of attempts than treatment with psychotherapy.

The study also implies, the course of depression determines the rate of suicide attempts. At long periods of treatment and improvement progress, the attempt rate decreases. The study rebuts any assertion that anti-depressants cause suicide attempts.

A reasonable editorial adds perspective.

Monday, July 2, 2007

Sunday, July 1, 2007

The Plaintiff Legal Case

From:Robert K. Jenner and Bryant Welch, Suicide watch: liability for negligent psychiatric care, Trial, 37(5), 2001.

1) Mentally ill patients receive negligent care for their life threatening behavior. The foreseeable result is death. Should the court allow defenses of contributory negligence or assumption of the risk when patients die from the very behaviors for which they sought treatment? The courts have said, no. (Brandvain v. Ridgeview Inst., Inc., 372 S.E.2d 265. Ga. Ct. App. 1988, and McNamara v. Honeyman, 546 N.E.2d 139. Mass. 1989).

2) A New Jersey patient flung herself from a height in the hospital. The defense appealed the failure of the judge to give the jury an instruction on the contributory negligence defense. The appellate court found, contributory negligence, in any sense, was not a relevant issue. The duty to exercise reasonable care to prevent her from engaging in self-damaging conduct; because it would serve to excuse defendants’ own failure to exercise reasonable care, such conduct by the plaintiff could not be the basis of a contributory negligence defense." Cowan v. Doering, 522 A.2d 444, 450. N.J. Super. Ct. App. Div. 1987. "The acts which plaintiff’s mental illness allegedly caused him to commit were the very acts which defendants had a duty to prevent, and these same acts cannot, as a matter of law, constitute contributory negligence."

The concurring appellate courts of other states want to prevent, "strict nonliability" for mental health care professionals. They "recognized a "special relationship" between mental health patients and professionals who are deemed to have training and expertise that enables them to detect mental illness or the potential for suicide and who have the power or control necessary to prevent attempts at suicide,... so long as the suicide was reasonably foreseeable, and the defendants breached the applicable standard of care."

The plaintiff lawyer authors assert, "With the assistance of expert testimony, the plaintiff attorney should be able to explain that a mentally ill person can be expected to care for himself or herself only to the extent that the patient’s diminished capacity permits. As the suicidal patient’s capacity decreases, the medical provider’s responsibility increases."

Then, the lawyers state, "A competent psychiatrist will take an extensive history of the patient and make an assessment of all the risk factors in the context of the other current psychiatric symptoms before agreeing to a discharge. If the doctor makes a cursory assessment and, as is often the case today, simply discharges the patient because of pressure from a managed care company, that psychiatrist may be liable for malpractice. If the assessment is done properly, in the vast majority of cases, suicide can be prevented."

They propose excluding jurors who believe in personal responsibility for one's intentional acts, or that suicide is a sin.

From Law and the Mental Health System, 4th Ed., by R. Reisner, C. Slobogin, A. Rai, West, St. Paul, MN. pp. 729-731.

The prediction of violence has an 80% false positive rate. The lawyer argues that predictive studies also result in intervention, preventing the violent act. The overwhelming majority of patients attempting suicide were glad someone stopped them. The suicide attempt is an attempt to improve one's life. The degree of compentency is irrelevant. The burden of proof is "clear and convincing" (about 2 of 3 times likely). There is no right to commit suicide, and the liberty to do so does not fall under the protection of the Due Process Clause. Nor is any right to receive assistance in doing so (Washington v Glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 2269, 2271, 138 L.Ed. 2d 772 (1997)).

Wednesday, June 27, 2007

Preparation with the Defense Expert

This is a brief review. I add that the defense expert should be consulted early, not late in the case. Experts should help prepare early interrogatories. They should list the question they want answered in early depositions. They should read plaintiff expert publications, and point to contradictions with case expert reports and other testimony.

Appellate Decision on Abusive Depositions

One should walk out, get a ruling from the judge. According to the author of the article, that may embolden abusiveness.

Monday, June 25, 2007

Attorney Flops Around on VTech Shootings

Daniel W. Shuman, attorney, flops around in his editorial. "...there is good reason to conclude, in this case, that the threshold for emergency intervention failed to do what it ought to do." "One suspects that public policy in Virginia will demand less risk tolerance after this incident." "A word of caution: There will be no simple, single fix for what went wrong in Blacksburg at Virginia Tech on April 16, 2007."

Get the lawyers out of the running of psychiatry. Reverse, by Federal statute, the abomination of the Supreme Court decision that qualified the murderer for care after he murdered 32 people and himself so that Shuman's lawyer friends can have more jobs.

The sole effective remedy that prevents suicide is long term treatment, and compliance with such.

Friday, June 22, 2007

Clueless Forensic Psychiatrists

Hand-wringing American College of Forensic Psychiatry has trouble with the self-evident conclusion of the Virginia Tech shootings. The moderator, a lawyer, wants more data, because 32 murders and a suicide are not enough data for Dr. Steven Pinkert.

Here is a clue, Dr. Pinkert. This paranoid schizophrenic could not be forced into treatment until he committed his murders and suicide. Now, he qualifies for treatment.

If you loved this massacre, thank the rent-seeking lawyers on the Supreme Court. They took over the governance of psychiatry to generate jobs for three lawyers every time a dangerous mental patient refused care. There were no abuses to remedy. There was lawyer unemployment to remedy. In order to commit a person, one must now show imminent dangerousness. One must have a lengthy hearing. During the hearing, the prosecutor will prosecute. The defense lawyer will defend. And, a magistrate, yet another unemployed lawyer, will decide the clinical need of this dangerous mental patient, without the slightest knowledge of psychiatry. So three lawyers can pursue the rent, hundreds of victims get murdered. Thousands of mentally ill people commit preventable suicide, each year.

The pro-lawyer rent seeking members of this organization still wonder about the meaning of this massacre. The public sees the obvious. They demand changes in this Supreme Court horrible, lawyer full employment, rent seeking abomination.

No Duty of Therapist to Warn of Suicide

So held a Florida appellate court.

Still Waiting

It's been weeks. I requested the data showing that following garbage guidelines of suicide assessment reduced the risk of suicide. No one has provided data yet, not Drs. Harvey Dondershine, Richard Frierson, Jon Grant, Shawn Shea, not the JCAHO, not lawyer Skip Simpson. I have patience.

Wednesday, June 20, 2007


To end lawsuits for suicide because they contradict the modern, multi-factorial understanding of the causes of suicide, and indirectly hurt many unseen patients. The sole claim for suicide with merit involves assisting the suicide in violation of law.

This site is for defendants and defense lawyers in suicide malpractice suits, to improve defense expert testimony, perhaps to reduce losses in adverse settlements or verdicts.

These settlements and judgments devastate the practice of psychiatry. They cause the needless incarceration of thousands of suicidal patients without proof of benefit. The resulting defensive treatments consume a large fraction of the budget for wasteful treatment and starve proven preventive measures. These lawsuits are also morally wrong. They extort money from the party least influential in the many factors causing the suicide of the victim, the clinician trying to help. If they continue, the most suicidal and neediest patients will be avoided.

Explaining modern, multi-factorial understanding of the causes of suicide in plain language may result in more common sense judgments from jurors. The defendant may also prosecute, with licensing boards and in court, attorneys promulgating "junk science." The frivolous, malpractice lawsuit, because of profound, indirect impact on medical costs and life threatening errors, is another serious ethical lapse.

In systems closed to attorneys (e.g. the military), the rate of suicide may be cut by a large fraction reliably, quickly, at almost no additional expense.