Garth Daniels - and - Monash University Teaching Hospitals

"...Whether true or not the fact that the patient is in litigation and being treated in the same hospital is a conflict of interest."  A recollection of the words of a Justice of the Supreme Court of Victoria, Australia. 2008
                                                                ----------------------
The acronym HREC is an interesting one for it stands for Human Rights and Ethics Committee.
Here is an extract from Ethics Committee Approval Collaborators.
"The Alfred- Karen Hirth et al; Austin Health-Dr. James Oliver ; Southern Health - Dr. Saji Damodaran; Thomas Embling- Dr. Ann Brennan; Eastern Health- Assoc.Prof.Paul Katz;Peninsula Health - Dr. Sean Jespersen; et al..."

"A case-control study to identify risk factors for myocarditis with clozapine.

....  In Australia, 264 cases of myocarditis with clozapine were reported to the Therapeutic Goods Administration (TGA) up to the end of 2008, and 26 reports have been received in New Zealand.  6% of the Australian cases were fatal... ... study involves identifying cases of myocarditis at the psychiatric units around Australia and New Zealand and matching each of these to four control patients who have also been treated with clozapine at the same psychiatric unit but without developing myocarditis.  We will then obtain as much relevant information as we can about these patients, including age, sex, race, smoking status, use of illicit drugs, concurrent disease, other medication and dose of clozapine each day.  Where we are able to contact the patient and they give their consent, we also plan to take a blood sample so that we can look for a genetic marker for myocarditis. We are hoping to include about 200 case patients and 800 controls.  The data will be analysed to look for factors that occur significantly more frequently among those with myocarditis than those without." Source: 2010 Monash University [ABN 12 377 614 012], M8 Alliance Group of Eight Australia. Maintained by Webmaster@med.monash.edu.au-Accessibility information. Garth Daniels has REFUSED CONSENT to Clozapine

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2015- Maroondah 

Sixty nine days strapped to a bed... a Monash University Teaching Hospital. This surely would not have ethics approval would it? Is this possibly in violation of the International Covenant on Civil and Political Rights? 

[actual photograph]

Is public service psychiatry in the State of Victoria Australia in a state of anarchy?  The new 
Mental Health Act 2014 (Vic) would appear to negate this assumption.  There is a Mental Health Tribunal which is automatically triggered when a patient is admitted and placed under a Temporary Treatment Order (TTO) and reviews that patients status.

It is assumed that this process is there to monitor and oversee the well-being of the patient, review the criteria for inpatient status and where a question of law arises under the Mental Health Act 2014 (Vic) adopt the following protocol:-

Section 196 Questions of law.

"A question of law ( including a question of mixed fact and law) arising in a proceeding before the [Mental Health]Tribunal must be decided by the presiding member".

OR

Section 197 Referral of question of law to Court

 "...(2) A referral may be made ...on application of a party to a proceeding before the Tribunal..."

WHAT IF, a presiding member decides to answer a question of mixed fact and law without recourse to the Trial Division of the Supreme Court?  WHAT IF the President decides that questions of law have never before been referred to the Supreme Court?

Does this imply that the Tribunal may act Judicially?  Can the President of the Tribunal rule on a question of law simply because "that" particular question is believed to not invite interpretation by the Trial Division of the Supreme Court?  Conversely...  

  ..".(3) If a question of law has been referred to the Trial 

          Division of the Supreme Court, the Tribunal must not-

          (a) make a determination to which the question

              of law is relevant while the referral is pending; or

          (c) proceed in a manner or make a determination

              that is inconsistent with the opinion of the the 

         Trial Division of the Supreme Court on the 

             question."

WHAT IF, such circumstances where the interpretation of a question of mixed fact and law is not referred?  What could be the likely implications for the patient where the request is denied?  Does this require a Writ of Certiorari or an Originating Motion?  Who pays? Who suffers?  These scenarios are worth exploring... for it is quite possible for this to occur.. or is it not?

The Mental Health Tribunal may explore these scenarios as such a situation under the current legislation is possible.

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2015 - Upton House Box Hill Hospital

       In a period out of restraints Garth Daniels was without  

  provocation attacked by patient with a knuckle duster 

(metal instrument) ... Garth Daniels right forearm was broken.

The immediate assumption was that Garth Daniels initiated the incident and as a result Garth Daniels was again strapped to the bed.

 [actual photographs]

Garth Daniels left little finger  was also broken... surgery took place several days later.  It was also later established that the other "patient" perpetrated the assault and was subsequently discharged from the ward. 

                                                    
 In attempts to reduce the feelings of inner restlessness and to attempt to scratch himself... a result of the allergic reaction of the Clexane/Fragmin ( causes Garth's to itch)... movement restricted so the scars on the forearm reflect pressure of the restraints on the skin.
 [actual photograph]

 Of course, the paradox is that the restlessness appears to be interpreted as an emergence of psychosis "exacerbating"  "aggressive" and "violent behaviour...".  Spitting at staff and screaming at them and verbal abuse...  How else do you prevent yourself from being further frustrated...?

No mention of Akathisia possibly attributed to intra-muscular injections of Zuclopenthixol (decanoate) or similar compounds of Acuphase (clopixol), is there?   

[ actual photographs]

Acuphase seems to be paradoxical in that it was administered to Garth presumably to promote sleep   and reduce anxiety but appeared after frequent administration to create an inner restlessness ...  (inability to sit still)in clinical terms defined as Akathisia.

Criteria for compulsory treatment. Chronic schizophrenia, treatment resistance ... [not resistant ]noun the refusal to accept or comply with something...  the criteria for Clozapine is to be TREATMENT RESISTANT. The label "treatment resistance is used particularly to refer to patients whose positive symptoms of schizophrenia ( including delusions and hallucinations have not responded to treatment.  Medical Journal of Australia).

Pantelis C, Barnes TR. Drug strategies and treatment resistant schizophrenia. Aust N.Z.J.Psychiatry 1996; 30:20-37 [Pub.Med] 

Kane J.M. Treatment restant schizophrenic patients. J.Clin.Psychiatry 1996;57 (suppl.9); 35-40 [Pub.Med]

So, therefore, Garth Daniels does not eet criteria for "treatment resistance"... Garth is not currently psychotic, deluded and hallucinating...

... in a meta analysis, clozapine rated above other second generation anti psychotics on two out of three measures of efficacy plus overall symptoms and was second only to AMISULPRIDE ... for quality of life ( Leucht et al 2009). 

N.B.  Garth Daniels is currently on 300mg Amisulpride ( mono-therapy ).

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Garth Daniels - " CODE BLACK "

What is CODE BLACK?   In its plain overt sense it is a silent code signifying serious personal threat ( Police Assistance Required) written up as policy in the event of serious incidents of aggression and violence.  BUT, is this really necessary in a hospital psychiatric ward?  The following is an extract from just such a policy;
Quote:

• " Serious incidents of aggression and violence beyond the control of the Code Grey team.( i.e. hospital patient security staff)

• Armed (with a weapon or using an object as a weapon) or unarmed person threatening serious injury to self or others.
• Person armed with a prohibited weapon/s, controlled weapons or dangerous articles who will not voluntary surrender their weapons...
• Hostage Situation
• Hostile Intruders
• Illegal occupancy."

 Unquote.

Serious incidents of aggression and violence... a patient suffering mind altering drug(MAD) prescriptions, the effects of which give rise to aggression and violence so often denied. But, that is not at question here what is important is which branch of the police force responds.

Being privy to three "Code Blacks"... this is what was witnessed.  Rapid Response Team at one, Dog Squad at another along with your highway patrolman, police on the local beat and leading constables and Sergeant...  How would you respond to such a call " CODE BLACK?"

Whose MAD here the policy makers or the MAD patient?  Equating a psychiatric patient as a possible "Hostage situation? Hostile Intruder? Armed with a weapon?Serious incidents of aggression?"  Do we really need a CODE BLACK for a Psychiatric Ward?   What if the code black was initiated for you; you who entered hospital to seek assistance with your delirium or psychosis?

Whats happened to humanity or is this just another facet of mans inhumanity to man for the sake of humanity? Australia is signatory to the Helsinki Declaration.. the International Covenant on Civil and Political Rights and then there is the Hippocratic...  FIRST DO NO HARM.
 

Garth Daniels - Duty of Disclosure

"...Human rights are essential in a democratic and inclusive society that respects the rule of law, human dignity, equality and freedom..."
                                  Parliament of Victoria Australia. initiated in Assembly 2 May 2006. A Bill.

                                                                       Garth
                                                              September 2014

...
 These are the fundamental principles which would be expected in any democratic and inclusive society... except somehow in the discipline of psychiatry within this State of Victoria, Australia, Mental Health ... it appears there are psychiatrists who consider themselves exempt with respect to some if not all of these Human Rights.

The International Covenant on Civil and Political Rights - Article 7 states that "No one shall be subjected to torture to cruel, inhuman or degrading treatment or punishment.  In particular, no one shall be subjected without his FREE CONSENT to medical or scientific experimentation".

The new Mental Health Act 2014 of the State of Victoria makes provision for a patient to prepare an Advanced Directive and to assign a Nominated Person to exercise his rights under the legislative provisions should that person become incompetent.  These fundamental principles were ignored despite the psychiatrists treating Garth being made aware of it.

Perhaps the attention of those psychiatrists should be drawn to the Crimes Act of this State of Victoria... in particular that :-

"A person who -without lawful excuse, administers to or causes to be taken by another person any substance which is capable, and which the first mentioned person (is made aware) knows is capable, in the circumstances, of interfering substantially (a potentially fatal allergic reaction) with the bodily functions of the other person; and...

knows that the other person has not consented to the administration or taking of the substance or is reckless as to whether or not the other person has so consented - is guilty of an indictable offence. Penalty 5 years imprisonment."

After being discharged from hospital late last year and actively participating in the community some minor adjustment due to clinical reasons were necessary to Garth's prescriptions; and, he voluntary re-admitted considering that any adjustments to his prescriptions (on the advice of his psychiatrist in the private sector) would be better facilitated in hospital.

Garth and his parents both considering that his prior admission to Eastern Health had been so very successful and  attendant care of the nurses exemplary - assumed this to be a viable proposition. What was to follow prompted these references to Human Rights, the Mental Health Act and the Crimes Act.

Garth's voluntary admission to seek adjustments to his drug prescriptions in a controlled environment while met with some trepidation, was without major incident... Garth willingly accepting to be strapped to a bed rather than be held in isolation/seclusion in a room which is locked from the outside and, in the past caused Garth to being claustrophobic. Besides which allegations of Garth being violent appears to be systemic despite evidence to the contrary with no cognizance of the iatrogenic effect of polypharmacy.

However, nine weeks strapped to a bed and being injected with a drug that gives rise to akathisia (inner restlessness - inability to sit or stand still)... and to a patient who is prone to treatment emergent Neuroleptic Malignant Syndrome (NMS) can be fatal and may be only described as absolute torture. Particularly, when the patient is unable to move freely and is compliant with oral medication... Voluntary admitting to hospital and then finding himself strapped to a bed...indefinitely. 
  

Now at Eastern Health  it appears that all the legislative safe guards of Parliament which ensures the rights of patient in particular, the patient's right to consent and that the patients wishes be taken into account in relation to Garth, have been railroaded yet again... despite the new Mental Health Act 2014.

A return to polypharmacy (combination of prescription drugs) and intra-muscular injections... a potentially fatal injection which is in direct conflict with the oral prescriptions and mono therapy initiated and implemented by a consultant from Eastern Health; whose successful treatment is  negated by colleagues within the same mental health service.

It is four months since that admission and only recently Garth has been released from being strapped to a bed.  Garth had deteriorated and showed little improvement since the reintroduction of an intra-muscular injection as part of Garth's treatment, with a concomitant exacerbation of side effects ... akathisia, cog-wheeling, tardive symptoms, Parkinson like tremor and a state of delirium.

The current treating psychiatrist Dr. Andrew Cheong considers that Garth has showed substantial improvement since commencement of the intra-muscular injection.(see footnote*)

Foot note:

Garth on 12 February was given another depot intra-muscular injection despite his refusal and that of his nominated person to consent. Garth is prone to treatment emergent Neuroleptic Malignancy (NMS).   Today,(15 February 2015) Garth is back in four point restraint strapped to a bed. 

Are psychiatrist not aware that when the injection reaches the body water table it causes adverse drug reactions?  This patient has the right to claim having his own PhD in regard to how the drugs affects him adversely... after all he has been treated by some 250 psychiatrists within the State of Victoria Mental Health System. What has been the outcome?

* 2 March 2015 Dr. Andrew Cheong ceased prescribing Zuclopenthixol (Decanoate) aka Clopixol Depot Injection...But, Clopixol Acuphase (a short acting injection) continues to be administered as a "prn".