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".

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 shift...here 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.

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.

Garth Daniels - Bohemian Polypharmacy

Parody of a  classic

 www.youtube.com/watch?v=Lp3pFjKoZl8

Garth Daniels - Amygdala - Fear Rage & Aggression

The Amygdala is almond shaped found in that region in the brain protected by the temporal bones immediately behind the ears. The Amygdala sits roughly on a horizontal plane midway between the ears and directly in line with the eyes.

The Amygdala interconnects with four major lobes of the cerebral hemisphere.  These interconnections serve to convey sensory information which the Amygdala processes as external inputs which may for example be a result of a negative or painful event.   These inputs encompass  pain, sound, touch and visual systems to which the Amygdala creates an associated response with these  negative stimuli and random events.    A particularly negative stimuli is fear which prompts the Amygdala to reinforce and trigger a learned response to such fear, much like that of Pavlov's Dog.

Is it the effects of drug toxicity (poisoning) coupled with negative environmental stimuli, sensory inputs, that the interconnections outputs within the Amygdala triggers various kinds of integrated activities as a defense mechanism ?   "... fear is one of the most common manifestations of amygdaloidal electrical stimulation and abnormal activations"(Rhawn Joseph, PhD.)

Is this a route cause which culminates in the involuntary actions of a patient taking these drugs being labeled violent?

Garth Daniels - and - "Syndrome Malin des Neuroleptique"

Despite an ALERT first recorded by Eastern Health in the medical files of Garth Daniels more than fifteen years ago, it appears that little attention was given to this treatment emergent condition first described by Delay and Deneker in 1960. "Syndrome Malin des Neuroleptic" that is Neuroleptic Malignant Syndrome...

The first reaction to it as described by the French clinicians Delay and Deneker is removal of the causative agent... The first recorded response is almost always the correct response... the literature confirms that the standard response has and always should be removal of the causative agent. Interestingly, that is precisely the response executed by Eastern Health when Garth was first treated there in 1996. What have been the consequences ?

The introduction of polypharmacy as has been documented in Garth Daniels volumes of medical records merely reinforces the notion that polypharmacy serves to "mask" underlying symptoms of this potentially fatal condition... So, why has it continued by other service providers?