Sunday, August 24, 2014

Garth Daniels - and the - Florence Nightingales

                                               A time and place for quiet contemplation.
                                                                  Garth in the garden
Eastern Health’s Maroondah and Box Hill Hospital; Dandenong Hospital; the Austin Hospital; the Alfred Hospital; Frankston Hospital; Thomas Embling Forensic Hospital(sic); the  Melbourne Clinic and St. Vincent’s Hospital in the CBD of Melbourne.... Australia.

Dandenong Magistrates Court, Frankston Magistrates Court, Ringwood Magistrates Court, Collingwood Diversion Magistrates Court, the Melbourne Magistrates Court... What was this all about we may well ask?

It has been seventeen years since that first admission of Garth Daniels being labelled mentally ill to which was added the word "violent".  What followed saw Garrth Daniels being shafted to and fro between these hospitals.  Not lost inbetween were charges and summons served upon Garth Daniels for alleged assault against staff while being treated under an Involuntary Order (ITO).  In 2014 we find Garth Daniels having gone full circle and once again admitted to Eastern Health.  

Out of the east a paradigm shift… a psychiatrist director of the acute ward, the director of nursing and the psychiatry ward nurse unit manager… Transparent and open discussion… a collaborative approach by the treating team in communicating with the patient and… they listened to the family with a real sense of purpose and understanding.

What ensued was a level of encouragement unsurpassed…  a determination by those nurses some who volunteered to be involved in Garth Daniels treatment and care, under trying circumstances which may be described as frightening.  Caring in a controlled environment for a patient whose reputation preceded him and who had been to date described as violent...."not to be approached when unwell". 

What changed may be best described as extraordinary… it was more than a paradigm we find the consultant diverging from the standard response of increasing dosages to C-Max, but rather a return to basics.  Open discussion with the patient and concerns of the family being placed first and foremost…   This despite a high level of abuse and acute agitation and aggression being directed at them by the patient in his delirious state.  And, an alleged history of violence enough to frighten away even the more seasoned and experienced nurses in psychiatry…  Yet, they persevered with an uncanny determination to get Garth Daniels well to return him to his pre-morbid state and sense of well-being.

While there is an association between high dose of anti-psychotic drugs and extra-pyramidal side effects (EPSE) and Adverse Drug Reactions (ADRs’).  Similarly, there exists a cause and effect relationship between elevated creatinine kinase (CK) a muscle enzyme of the skeletal system, psychosis and extreme agitation/aggression.  Except of course no one who treated Garth Daniels before would accept such an association.  It was perhaps easier to “blame” the dis-ease and the concomitant label of being mentally ill.  The latter being associated with Garth Daniels violence and notated that he be approached when unwell with "extreme caution…" 

Of course it was not easy to get clinicians to consider the effects of polypharmacy; high dose anti psychotics or the impact of potent anti-psychotic drugs upon the 5HT2A cytochromes more than its effect on the D2 dopamine and its concomitant effect in elevating CK levels… until NOW. All credit to the treating team headed by Clinical Director, psychiatrist Dr. Jennifer Babb and her treating team who dared to stop and listen…

What has been the effect… a return to mono-therapy, a return of CK to normal levels, abatement of aggressive and violent outbursts; compassion and understanding by nurses, who through dedication to their calling… and encouragement from each other and their peers nurtured Garth Daniels the alleged violent  patient back to a state of well-being.  

The template has been established and one that must not be ignored as contributing significantly to Garth Daniels returning to his pre-morbid state.  To those nurses who nurtured Garth Daniels under very trying and extreme levels of perceived and actual aggression and cognitive dysfunction… their efforts have produced a remarkable result.  And, while medication may have played its part... its the meticulous attention to detail ... the use of sensory measure all initiated by the clinical director/consultant... coupled with a level of nursing care that at this time is to be commended. 

The standard of nursing is beyond reproach and those nurses from Eastern Health who may well stumble upon this blog… let it be known that their efforts will be long remembered and have not gone unnoticed.  

A reflection of the leadership not only of the Consultant Psychiatrist, but also of MS.Rebecca Johnson, Director of Nursing and MS. Debra Siddell, Nursing Unit Manager... Foremost to those nurses who persevered with Garth Daniels in a manner that could only be described as being in the Spirit of Florence Nightingale.

Friday, April 18, 2014

Garth Daniels - Shock At the Crossroads

"Whether a patient gets shock treatment depends less on the patient's mental condition than on the doctor's mental and moral condition." Peter R.Breggin, MD. The Anti-Depressant Fact Book, Perseus Publishing, Cambridge, Mass, 2001. P.167

In early 2013 Garth Daniels voluntary signed into a Melbourne clinic to participate in a group therapy program. This was not to be... within less than twenty four hours Garth found himself hand-cuffed by police and bundled off to St. Vincent's Psychiatric Ward in the public sector.

Garth Daniels recollection of events was that he had "flashbacks", approached nurses and asked them if their conscience was not affected by their prior treatment of him. In reply Garth Daniels recalls hearing the duress alarm....

Within a short space of time Garth Daniels says he was surrounded by police who demanded he kneel on the floor, place his hands behind his back...Garth Daniels states he was then bundled into a police van and transported to St.Vincent's Hospital Psychiatric ward.

At St.Vincents adjustments were made to his pharmaceutical drug prescriptions and within two weeks he was discharged. ... it was soon realized that the alteration of the drug prescriptions required further review and adjustment... and, that this required monitoring which could best be achieved in a hospital setting. A negotiated and agreed treatment protocol was embarked upon with the treating clinician at Dandenong Hospital, Southern Health.

Since that initial negotiation and an improved outcome for Garth Daniels... a rotation of clinicians led to Garth being treated by Dr.Neeraj Sareen.... who railroaded over this understanding and forced a management plan upon Garth Daniels which resulted in known adverse drug reaction...  Subsequently, culminating in Garth Daniels being accused of intentionally being violent towards staff and causing injury.

Despite a prior advanced directive in the form of Refusal of Treatment Certificates 'which included a definitive DO NOT CONSENT TO ECT (shock treatment)...reinforced verbally by Garth Daniels. It appears the Medical Program Director, A/Prof. David Barton, his Clinical Director Dr. Fernandez and their consultant/registrar Dr. Neeraj Sareen have placed shock treatment at the crossroads... they authorized that Garth Daniels be given numerous shock treatments... Electro-Convulsive Therapy to curb his violence????.

Garth Daniels appeared before the Mental Health Review Board, who in their wisdom again found that Garth Daniels did not meet the criteria for continued involuntary treatment and discharged Garth Daniels from Dandenong Hospital... in August 2013.

...shortly after Garth Daniels discharge from Dandenong Hospital in August 2013... a policeman delivered Garth Daniels a Summons and Charge for assault to appear in the Dandenong Magistrates Court on 30 January 2014.