Another fake psychiatrist

In a previous post I wrote about the case of two fake Australian psychiatrists. Now it emerges that a woman who falsely claimed to have a medical qualification from New Zealand practised as a psychiatrist for 22 years in the United Kingdom. It was one of the main stories on the BBC front page (“Zholia Alemi: Foreign doctor checks after fake psychiatrist case”) today and also appeared in many newspapers.

Alemi, who was convicted of fraud and sentenced to five years in jail last month (October 2018) for forging a patient’s will, has been revealed as a fake psychiatrist. She had worked for 22 years as an NHS psychiatrist without having any medical qualifications – having discontinued a medical course in New Zealand after one year. According to the BBC article:

“The GMC [General Medical Council] said Alemi was allowed to join the UK’s medical register under a section of the Medical Act which has not been in force since 2003.

The act meant medical school graduates from certain Commonwealth countries – like New Zealand – were allowed to join the register on the basis of the qualification they obtained at home.

They did not have to sit and pass the standard two-part medical test that foreign doctors normally have to pass before they can work in the UK – the Professional and Linguistic Assessment Board exam (PLAB).”

The GMC’s explanation however leaves a number of questions unanswered. Apparently Alemi produced a fake certificate from a New Zealand university and a fake reference from a hospital in Pakistan when she registered as a doctor in the United Kingdom. Why weren’t the forgeries spotted?

Alemi had an apparently successful career reaching the position of consultant. Did no-one – colleagues, patients, relatives – notice anything amiss in her practice over the years? Was she as competent at her job as qualified psychiatrists? If so, it raises questions about the necessity of a medical education for psychiatrists.

Before her arrest for fraud, Alemi had had two run-ins with the GMC: once for not reporting a conviction for careless driving and once for having sectioned a patient when she was not certified to do so. Had no-one thought to check her credentials at that stage? Presumably not, as such things are probably considered fairly minor and routine. But it is more surprising that, during the investigation and trial for forging a will, no-one seems to have looked into her background.

How was it that it was left to a local newspaper (Phil Coleman at the Cumbrian News and Star as the BBC article makes clear) to do the investigation?

The BBC article ends by passing on the GMC’s advice to people who have been treated by Alemi

“It urges anyone who was treated by her to contact the GP surgery, hospital or clinic where they received treatment.”

Not even a dedicated helpline.

PS. Alemi was a member of the medical panel of the Mental Health Tribunal for Scotland (“We provide a responsive and accessible, independent and impartial service to help make decisions on the compulsory care and treatment of people with mental disorders in Scotland”), where presumably no-one checked to see whether she was a qualified psychiatrist. In the Summer 2012 Members’ Newsletter Alemi wrote about spending her tribunal payments on a trip to Turkey, where she prescribed anti-depressants to people, including earthquake survivors, who were suffering from pain. She also wrote that in the past she had worked for the UN.

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Gabrielle

In my last post I wrote about a young woman who had undergone a leucotomy in 1962. In this post I will write about a young woman who underwent a leucotomy in 1950 with tragic results.

In October 1952 the incoming president of the psychiatric section of the Royal Society of Medicine chose as the theme for his address “death due treatment”, published in the Proceedings of the Royal Society of Medicine in January 1953. He listed the deaths in England and Wales that had been caused by different psychiatric treatments over the past five and a half years:

Leucotomy 180

Electroconvulsive therapy 67

Insulin treatment 44

Continuous narcosis 8

Malaria therapy 6

Many of those who died due to leucotomy were young: just over a quarter were aged 19-35, with 40 per cent aged 36-55 and a quarter aged 56-75. Over one half were women. After discussing the deaths, W.S. Maclay added: “I think that it is permissible to mention as a possible lethal complication of leucotomy three murders committed by leucotomized patients who are now in Broadmoor”. A brief description followed:

“The third is a woman of 38 years of superior intelligence. For many years she was subject to migraines and to phases of depression with obsessional thought and actions. She received a great deal of psychotherapy and other psychiatric treatment culminating in a leucotomy all without benefit. She then murdered her daughter and attempted suicide.”

Thanks to a report in the Times newspaper (3 June 1960) about a divorce case, we know that the woman of “superior intelligence” was Gabrielle De Wolfe, daughter of Australian psychiatrist and psychoanalyst Paul Greig Dane. Her husband, theatrical agent Earl Felix Sylvester De Wolfe, was suing for divorce on the grounds of his wife’s “incurable unsoundness of mind”. The couple had married in 1942, with Earl departing almost immediately for service in the RAF. He returned to civilian life in 1946 and Gabrielle gave birth to their child in December 1947. In April 1950 Gabrielle underwent a leucotomy. According to the report in the Times:

“The operation had been partially successful in that it alleviated her distress. On the other hand severe intracranial bleeding had supervened upon it, resulting in severe epilepsy, and personality changes had taken place.”

In March 1951 “she attempted to gas herself. She survived but killed her child.”

In May 1951 Gabrielle was tried for murder. She was found guilty but insane and admitted to Broadmoor Hospital. Her husband obtained his divorce and was soon remarried.

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A (A Patient)

An inquisition of lunacy, where a person’s soundness of mind was tried before a jury and a Master in Lunacy, sounds archaic – indeed they date from 1324. Wealthy families would petition for an inquisition to protect their estates (or, sometimes, for more nefarious reasons). But the inquisitions of lunacy survived into the second half of the twentieth century, finally becoming obsolete when the Mental Health Act 1959 came into force in 1960. According to the Times, 30 June 1955, there were 43 surviving inquisition cases, many of which “were merely to satisfy Ireland or some other country which does not recognize receivership.” And the numbers were still being added to.

case ([2016] EWCOP 3) came to court in 2016 which involved one of the last survivors of an inquisition of lunacy. A or A (A Patient), as she is called in court documents, came from a titled family and had been the subject of an inquisition in 1959 (the family have estates in Ireland).

A was born in January 1937. Her father, a baronet, was a major general who had served in both world wars; he was also a freemason and a justice of the peace. A was the youngest of five children, seven years younger than her nearest sibling. An older brother was killed in action in World War II, another brother died in infancy; A also had two older sisters.

Notices in the Times newspaper give a glimpse of A’s life as a teenager: in 1953 she was a bridesmaid at the wedding of one of her sisters; in 1955 her mother gave a dance for her at their London house. According to the court case she had first had electroconvulsive therapy (ECT) in 1954, having “complained of command hallucinations” at the age of 17. Her father petitioned for a inquisition of lunacy in 1959. She continued to receive courses of ECT and in 1962 underwent a leucotomy at the Priory Hospital in Roehampton.

The 2016 court case came about because A’s relatives could not agree on who should have charge of her affairs, and also because A’s GP had suggested that A, resident in a Yorkshire nursing home, might have the capacity to manage her own affairs, a suggestion that was put paid to when the court-appointed psychiatrist, Professor Robert Howard, visited her and declared her to lack capacity.

Later that year there was a further court case ([2016] EWCOP 38), relating to costs. During the case the judge quoted from a ruling he had made in 2015 in which he refers cryptically to the “social deprivations” A suffered prior to her institutionalisation.

“Her difficulties have not been assisted, to an extent they have been compounded, by what might be called the social realities of that short period of her life before she became institutionalised and more particularly by the institutionalisation to which she has been subjected for so many decades. But it is perfectly apparent, in my judgment, that, even if the adverse consequences of those social deprivations and institutionalisation were to be wholly removed and reversed, she would not thereby – even with the maximum of appropriate assistance – regain the capacity which manifestly she does not have at present. I repeat the incapacity is unhappily the consequence of schizophrenia that has been present for many decades and the irreversible consequences of the surgery.”

Sir James Munby cannot have been referring to weddings and dances as “social deprivations”. Perhaps he was talking about the treatment A received in a mental hospital or perhaps there was a dark secret concerning A’s life between her first ECT and the lunacy inquisition. A’s father wrote a memoir in the 1980s and I wondered if it might contain more information about what happened to his daughter. I was not, though, optimistic as her father was a military man and, sure enough, there was no mention of what happened to his youngest daughter. Even though it was a military memoir, there was some mention of family: of how his wife used to have lessons with Princess Mary at Buckingham Palace; of the tragic loss of their son in World War II; of the marriages of A’s sisters and the military decorations of their husbands and the names of their children. Of A, nothing, beyond her birth date. There was room in the memoir for a half-page description of a dinner at the Duke of Westminster’s Eaton and four pages on freemasonry so the omission was a question of taboo and not of space.

When,  incidentally, Professor Howard decided that A lacked capacity to manage her affairs he made much of her bizarre-sounding talk about royalty, quoting her as having said she had met Prince Charles. A’s father’s memoir contains anecdotes about royalty so, even if A’s talk was fanciful, such talk was at least in keeping with the family tradition. And, since her family lived at Anmer Hall on the Queen’s Sandringham estate for a time, she could, depending on the dates, quite possibly have met Prince Charles, although he is eleven years younger than her.

The court documents give no details of why A had a leucotomy or what particular type of operation she had. By 1962, when she underwent surgery, the practice was already on the wane. Introduced into Britain in the early 1940s, its use peaked at over one thousand operations at the end of the decade. By the early 1960s that figure had declined to about 500 a year as disillusionment with results of the operation set in, especially when it was used on people diagnosed as schizophrenic. The Priory, Roehampton, where A underwent surgery, is a private hospital, and in 1961 only seven operations were carried out in private mental hospitals in the United Kingdom.

It was revealed in a further court case ([2018] EWCOP 16) that A died in March 2018.

Posted in 1950s, 1960s, DBS and psychosurgery, ECT and young people, ECT in the UK, Legal cases | 1 Comment

Charles Kellner visits London

In my last post I wrote about American psychiatrist Charles Kellner, only to find that he will be visiting London later this month to talk at two ECT training days at the Royal College of Psychiatrists. In the United Kingdom ECT is given predominantly to women. They make up about two-thirds of ECT patients. A similar situation exists in the United States. So you might think that female psychiatrists would be especially interested in this form of treatment. But the opposite seems to be the case, with female psychiatrists less likely to prescribe ECT or write books and articles about it. So perhaps it should not come as a surprise to find that very few of the speakers at the Royal College ECT training days are women.

On Thursday 29 November there is a training day for the ECT Team (“Nurses, site managers, anaesthetists, ODPs, psychiatrists and trainees”). There are fourteen speakers, of whom just two are women, and one of those is presenting a session on repetitive transcranial magnetive stimulation, not ECT, leaving only one woman who is talking about ECT and she shares the presentation of a workshop (on ECT practical simulation training) with two men.

On the following day there is a similar training day for ECT prescribers. Of the nine speakers two are women. While the seven men are doctors and professors, the two women are both administrators (one, a former nurse, for the Scottish ECT Audit Network and one for the Royal College ECT Accreditation Service) and present a workshop on “Update on ECT outcomes”.

Incidentally a 2017 Royal College of Psychiatrists’ survey found that 57 per cent of consultant psychiatrists were male, while 52 per cent of specialty doctors in psychiatry were female. And a quick glance at other Royal College training days saw more female names. For example, half of the speakers at the Autistic Spectrum Disorders training day are women. So the gender imbalance seems to be a particular problem with ECT.

 

Posted in ECT in the UK, Gender ECT | 3 Comments

Charles Kellner and the women

Charles Kellner is an authority on electroconvulsive therapy. On a recent article his affiliations were listed as chief of electroconvulsive therapy (ECT) at New York Community Hospital, Brooklyn, and adjunct professor of psychiatry at Icahn School of Medicine at Mount Sinai, New York (although his name does not appear on the Icahn website).

He has written books and articles about ECT and was for a time editor in chief of the Journal of ECT. But I have noticed something slightly odd about some of his more recent contributions to the ECT literature – sometimes he includes as co-authors of letters or short articles the names of very junior women, and I have been wondering what the dynamics of these collaborations are.

Until recently Kellner’s affiliation was professor of psychiatry and director of the ECT service at the Icahn School of Medicine at Mount Sinai, so perhaps anything coming out of the ECT department had to include his name on it. But in that case his name would appear lower down the list, and I am talking about examples where in some cases he is the lead author and simply appears to have added women’s names to his own. And the content of the letters or articles seems to be what Kellner has always said about ECT, so it is difficult to identify any true contribution from the co-authors.

For example, a May 2016 article on the STAT website is credited to Kate G. Farber and Charles H. Kellner. The lead author, Farber, is described as a volunteer at the Icahn School of Medicine at Mount Sinai but just what she does as a volunteer is not stated. A search on Pubmed reveals seven articles written with Kellner and nothing elseAs for the STAT article, ‘Don’t call electroconvulsive therapy “shock therapy”’, it is pure Kellner (safe and effective, stigmatised by media, Scientology, etc.) so it is hard to imagine how Kate G. Farber could be the lead author.

In a more recent (August 2018) article for Psychiatric Times (“The role of ECT in the suicide epidemic”) Kellner is the lead author this time and his co-author is Shaili B. Patel, described as an undergraduate at Emory University. I am puzzled as to how the co-authorship negotiations might take place. Presumably, since he has written books on the subject, he is capable of writing a short article about ECT without any help. Does he perhaps think that having the names of young women on his articles makes them look better? Ironically, the article itself points out that ECT is still very much a male thing

“There is a gender gap among ECT practitioners, with only 19% being female, despite the fact that psychiatry residency classes for the past decade have been more than 50% female. Only 14% of ECT procedures performed in the US are done by women psychiatrists.”

The last sentence of the article may give a hint of why this is so.

“ECT—marginalized for decades—is regaining its rightful place in the treatment armamentarium of contemporary psychiatric medicine”

Do women want an ‘armamentarium’ as much as men do?

Kellner seems to be surrounded by a group of young female co-authors who have never, with one or two exceptions, written anything that doesn’t have his name of on it. For example when Kellner wrote an article for Current Treatment Options in Psychiatry in 2016 he was joined by Erin Li, Kate Farber, Emma Geduldig and Gabriella Ahle. Li and Ahle were students, Farber a volunteer. Geduldig was a BA so possibly a student too.

In a letter to Psychological Medicine in 2017 about electrode placement Kellner has, for a change, teamed up with two young doctors and one of them is a man. But again it is hard to imagine what contribution they made to the content of the letter.

Nowadays you see articles with dozens of co-authors and sometimes individual authors may  have made little or no contribution to the article but have their name on it because it came out of their department, or articles may be ghost-written. But there still seems something puzzling about Kellner’s co-authorships.

 

Posted in ECT in the media, ECT worldwide, Gender ECT | 3 Comments

News about ECT lawsuits

There has been recent (October 2018) news of two lawsuits involving electroconvulsive therapy. In the United States, ECT machine manufacturer Somatics LLC have made an out of court settlement to two plaintiffs from California. Represented by DK Law, the plaintiffs argued that the machine manufacturer had ‘failed to comply with the FDA’s [Food and Drug Administration] requirements applicable to medical device manufacturers’ and are therefore ‘liable for all unwarned brain injury caused by their devices’.

In Victoria, Australia, the Supreme Court ruled that the human rights of two people who had been given ECT without their consent had been breached. The two were represented by Victorian Legal Aid. Their lawyer Hamish McLachlan was quoted as saying:

“What the Supreme Court has decided is that the decisions that were made by VCAT [Victoria Civil and Administrative Tribunal] were incorrect and not in accordance with the law and, in so doing, that’s imposed a higher bar to mental health services,” Mr McLachlan said.

Australia has a high use of ECT, and a high rate of its use without consent.

PS This post was corrected on 14 November 2018 to clarify that the Californian lawsuit involved two plaintiffs and one defendant, ECT machine manufacturer Somatics LLC. (A previous version incorrectly stated that there were four plaintiffs and two defendants, Somatics LLC and Mecta.)

Posted in ECT machines, ECT without consent, ECT worldwide, Legal cases | 1 Comment

ECT and young men

In the United Kingdom, as in other Western countries, women and older people are overrepresented in electroconvulsive therapy (ECT) statistics. The most recent figures from the Royal College of Psychiatrists show that about two-thirds of ECT patients are women and the mean age of ECT patients is about 61. But ECT is not exclusively a treatment of women and older people. Young men are given ECT too, although in relatively small numbers. For example, in Scotland in 2016 men under the age of 30 accounted for fewer than one in fifty ECT patients. So it was interesting to see a young man talking about his recent experience of ECT.

Brian Lenihan, who is 24, used to play football for Cork City, the Republic of Ireland Under-21 team, and Hull City in England. However his career was set back by a series of knee injuries, as well as surgery for a hernia, and post-viral syndrome.

In December 2018, after taking an overdose, he was admitted to the Priory Hospital in Altrincham where he spent 3 months. During that time he was given a course of 12 ECTs. An interview appeared in the Irish Examiner, 3 October 2018:

“The reason why most people do ECT is because they’re medication-resistant and, at the time, the people looking after me felt I wasn’t progressing in the way I should have been so they sent me for ECT,” he explains.

“And it was quite scary. Basically, you fast from 12 o’clock at night, you do a mental assessment and then you go the hospital in a taxi with a carer or a nurse.

“You get your blood pressure taken and then you go in, lie on the table, the anaesthetist puts you to sleep and then they put in muscle relaxants in your body so that when you’re convulsing you don’t crack your teeth or your bones. And then they shock your brain and induce a seizure.”

“That’s supposed to be, kind of, like a reset button because I think scientists say it releases chemicals in your brain. So I had that twice a week and I had 12 sessions of it. And it’s not as barbaric as people believe it is from the movies, where it’s dramatised. It’s so advanced now.

“I did suffer memory loss (the most common side effect) from it so I don’t remember certain people from the hospital and I don’t remember certain periods of time.

“If my parents bring up certain people, I don’t know who they are. So that is a bit strange but it’s a small price to pay for the benefit.”

Up to a point, this is what you might read in a patient information leaflet. But Brian’s experience of memory loss would appear to be a little more extensive than information leaflets usually allow. In another interview  (with the Professional Footballers’ Association) he said he could only remember about 3 days of his 3 month stay in hospital and speculated about the reason for the memory loss:

“I do remember being on the table and waiting for the anaesthetist to put in the anaesthetic; I have vague memories of that,” he says. “It was just a really strange time and I don’t know whether my mind has blocked that out because it was painful, or whether it was the fact that I suffered some memory loss from the ECT. I’m not really sure. But either way, I don’t mind, because I don’t really want to think back to that time.”

Brian has decided to retire from professional football. He has his eye on a different job and he and his partner are expecting a baby so things are looking up.

Posted in ECT and memory loss, ECT in the media, ECT in the UK, Gender ECT | 1 Comment