Thursday, August 02, 2007

Slippery Slope

I know this isn’t uncommon, but unfortunately we often don’t pay attention until it happens in our backyard.

Omaha psychiatrist attacked at Lincoln Regional Center dies

Dr. Louis Martin spent the last 18 years examining the minds of the criminally insane.

Thursday, he died from the severe brain injuries that authorities say he suffered at the hands of one of those patients.

Dr. Y. Scott Moore, a fellow clinical director at the regional center, said Martin was tirelessly dedicated to his patients...

"He was very concerned for his patients," Moore said. "He leaned over backwards to make sure he had made an honest evaluation of a patient.

"He was extremely careful — and very empathetic with his patients. This was his life."

Ultimately, it was his death, too.

Eric F. Lewis, 35, had been charged with first-degree assault in the attack on Martin. Lewis, one of Martin's patients at the regional center, had made several vows that he would not be force-fed medication for paranoid schizophrenia.

After Martin testified at a hearing two weeks ago, a Douglas County district judge ordered that Lewis be forcibly medicated so he could regain his competency to stand trial on charges that he sexually assaulted two Omaha women.

Upon his return to the regional center, Lewis wrote an 11-page letter saying he wouldn't take his medicine.

The morning of July 22, a State Patrol investigator said, Lewis then piled his belongings at the front door — and ambushed Martin as he walked inside.

It was an attack that regional center officials say they couldn't have predicted or prevented — despite a history of threats and assaults by Lewis. That history included two assaults on patients at the regional center and a third assault in which he is alleged to have jumped and attacked a Douglas County inmate.

Society has the right to not fear an attack by a person with a history of schizophrenia, who has exhibited violent behavior in the past. But the person suffering from schizophrenia has the right not to be forced into a medicated state against his will. Where on this slippery slope do you draw the line? Or do you?


Amanda said...

If he's dangerous then yes, he can retain his right to remain jail.

Meredith said...

When someone exhibits violent behavior, whether or not they are mentally ill, they should be removed from society. No one should be drugged into compliance, but when the alternative is killing people (and only when, because I'm not in favor of pre-emptive jailing), that person should not be allowed to interact with society. Whether that means jail or a mental hospital or what, I don't know, but something has got to give.

Also, as a side note, besides personal liberties reasons, I believe no one can be forced to take meds because they ultimately won't work. One has to want to take them and to be in a positive state of mind before they even have a chance of making a real impact, and even then, as we all know, meds don't work for many people.

Just Me said...

My chart has a clear notation that if a time comes that I am hospitatlized and refusing meds I want to be forced to take them, preferably via injections. My reasoning is this: I know right now that I need meds. When I am sick my ability to understand that is quickly affected. My paranoia also increases greatly.

I have specific people who treat me or are support people who are the ones who would hospitalize me. Hopefully I'd agree next time it's suggested, but so far I have freaked out and refused and made it past being put in against my will by the skin of my teeth (aka my professional background giving me the right words to argue in the only way that prevented it). I am pathologically afraid of the hospital though, so I know that if I am there I'm going to be very ill and very likely quite paranoid.

I also see an attending physician at a teaching hospital. If I am admitted she will have peripheral involvement in my case, but I'd be mainly treated by a resident. My list of 40 meds and general history is complicated and hard to believe if you are not my doctor, who has seen it occur. Much of it is not in the computer system because I came to the big hospital with her from her private practice. Plus nobody could sort through it all to know the things my doctor knows, like my strong bias against Zyprexa. Years ago she promised me it's a last resort. It's probably about here though, when I am ill next.

My fear is that I will be in a hospital and angry about it. Knowing now it is sometimes good doesn't mean anything during a mixed episode. I will be prescribed Zyprexa or something else I don't want to take, and will not remember that I've agreed to take it given certain circumstances, or have the insight to see those circumstances exist. That keeps me ill.

This decision has a lot to do with knowing myself and how I have reacted to things in the past during major episodes. My doctor agrees.

This is also why I'm writing a mental health living will type of document.

But this is MY decision for ME, not sure what I think about it being decided for someone. (Saying that while knowing that when i worked in psych I held someone down (along with 3 or 4 other staff) to get meds because she was trying to pull her own tongue out of her mouth. It was horrible to see, horrible to do to someone, and yet the pulling the tongue out thing was even worse.)

Sorry for writing a book.

Jon said...

I'm not taking sides on this, and I have no answers myself, but I'm going to play devil's advocate with the responses here. Please don't take offense, I want to illustrate how there is absolutely no good or easy answer on this.

Amanda - I understand and don't disagree with you, but dangerous by who's determination? By some accounts, I'm sure I'm considered dangerous. Also he was in a regional mental health facility, a form of "jail". But I really doubt the general prison system is ready for him - do we want to toss mentally unhealthy people in regular prisons?

Meredith - just like Amanda above, I understand your position. But it's a subjective determination. Unlike crimes like robbery or murder which are pretty well defined, this determination is very subjective.

Just Me - excellent. Outlined in a WRAP (wellness recovery action plan) or similar legal document is ideally the way to go. But what if you can't get the patient to agree to this? Can we take their rights and force medication?

Amanda said...

Unfortunately, quite often, the best indicator for future behavior is past behavior.

The man in question had a violent past which could have justified certain protective measures.

Personally I don't think that criminally insane folks shouldn't be placed in together with patients who haven't done anything. Throwing them in together with the regular criminals is a bad idea too. In my opinion there should be an extra place for that.

Just Me said...

I do think forced medication is needed sometimes. If as a medicated person who is not harming anyone else I make a clear decision over time (ie, minnimally affected by illness) to try unmedicated life, I believe I have that right. Hopefully I quit in a way that gives me support to get back on meds if needed, but if I am well when I decide it is my decision.

When I am not well I make scary and bad decisions. If these decisions are bad enough to land me in a psychiatric center or equivilant, then I need to be returned to a level where I can think clearly. If I qualify to be there then it is because I'm not safe enough to decide for myself; this may change with meds. If I'm given meds, stand trial and am not guilty then it becomes my choice again, albeit a heavy one.

I have seen too many patients benefit from various ways of "forcing" (tricking) meds into them. One man went from one of the most affected patients in the facility when I arrived to a sweet man dressed in a tie after he was started on depot injections. I currently have a patient who refuses all meds, psych meds included. I got her a pain patch and the difference has been amazing.

When I discovered this issue a few months ago I talked to my doctor about it. She told me that in this state it takes a huge fight to medicate against current wishes, which is why she supports me specifying my wishes now. Apparently very few doctors here will even try unless it is a clear cut case.

I think it sounds so horrible that no judge would want his name associated with it?

Tough stuff.

Jon said...

A great discussion, and I don't disagree with anything. Thanks all for your thoughtful comments.