Congress Looks to Revamp Mental Health System

Soon, Congress will hear testimony concerning the Helping Families in Mental Health Crisis Act. Republican representative, Tim Murphy, from Pennsylvania, sponsored the bill, and, though many agree that the mental health care system requires revamping, some provisions in the bill have sparked controversy. Among the more controversial provisions is one that supports the increased use of involuntary outpatient treatment—via court-ordered therapy for “certain mentally ill people with a history of legal or other problems.” Detractors of this provision claim that it will erode trust in doctor-patient relationships, and that it presents a civil rights issue. However, 45 states have compelled treatment programs already, one of which is New York.

New York’s compelled treatment program, Kendra’s Law, was passed in 1999. Since the implementation of Kendra’s Law, studies show that the percentage of patients returning to the hospital or getting arrested has greatly decreased. The statistic is significant, as “about 350,000 Americans with a diagnosis of severe mental illness…are in state jails and prisons” and the availability of psychiatric beds meets only 10 percent of that need. 

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Potentially Dangerous Precedent Possible in Mississippi

Anti-fetal homicide laws were enacted originally to protect mothers of unborn children against violent acts. Yet, in reality, “they’ve led to disproportionate prosecution against African American women who suffer miscarriages.” An ongoing case in Mississippi could set a dangerous precedent with regard to the criminalization of pregnant women for their purportedly reckless acts.  Rennie Gibbs was charged with the murder of her unborn child after it was stillborn when she was 16 years old. Gibbs is being prosecuted for “depraved heart murder” because the autopsy showed that Gibbs had used cocaine during her pregnancy—but the cause of death was originally attributed to the umbilical cord being wrapped around the infant’s neck. That cause of death was never ruled out.

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Bitter Battle Rages over Continuing Life Support for Brooklyn Woman

A bitter court battle is raging over whether an elderly Brooklyn woman should continue to be kept alive. Sylvia Sodden, 78, is still on life support, even though her original health care proxy agreed to its removal. In 2011, Sodden appointed her godson, Joe Arrigo, as her health care proxy. Arrigo is Catholic, and states that Sodden converted from Orthodox Judaism to Catholicism when she was 20 years old. He states also that Sodden did not want to be on life support, and that “she didn’t want to end up like this.” He consulted with two priests prior to making the decision to remove life support.

 However, on March 18, 2014 a Brooklyn Supreme Court Judge determined that Esther Feigenbaum, Sodden’s sister, would replace Arrigo as Sodden’s health care proxy. Feigenbaum claims that Sodden never converted, and that shutting down life support is “anathema to Orthodox Jewish belief.” The Court indicated that part of its decision to divest Arrigo of his role as health care proxy rested on the fact that Arrigo was absent from Court on the day of the proceedings. Arrigo maintains that he did not know he was supposed to appear.

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Doctor Argues for Measured Paternalism

Dr. Sandeep Jauhar, a cardiologist, offers anecdotal evidence in support of his argument that even though autonomy is, and should be, medicine’s guiding principle, paternalism has its place. The principle of autonomy in medicine encompasses a patient’s right to direct care his or her care, and requires the doctor to fully inform the patient regarding medical treatment. Dr. Jauhar reflects on his early belief that autonomy was “an absolute good, an ethical imperative that trumped all others.” After some years practicing medicine, his belief has changed.

Dr. Jauhar has come to believe that “no ethic in medicine is absolute.” Though the consequences of a breach of trust between a physician and a patient are severe, the consequences of full disclosure can be adversarial to the doctor’s duty to select the best course of treatment for his or her patients. However, Dr. Jauhar states that if a doctor believes that a paternalistic approach is necessary to a patient’s care, a soft approach is most appropriate. He describes hard paternalism as “coercive,” while soft paternalism “involves negotiation.”

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Assisted Suicide Case Dismissed: Pennsylvania v. Mancini

A nurse named Barbara Mancini was accused of homicide in 2013. Allegedly, she handed her father a bottle of morphine with the intent to assist in his suicide. Her father, Joseph Yourshaw, 93 years old, suffered from end stage renal disease and was in home hospice.  However, the case has been dismissed. Judge Jacqueline Russell stated in her decision that the Pennsylvania Attorney General did not prove that Ms. Mancini gave Mr. Yourshaw the morphine with the intent to assist in his suicide, and that Ms. Mancini could have intended solely to alleviate his suffering. Some believe that though assisted suicide is legal in five states only, this decision “is the latest in a series of recent developments signaling the reluctance of courts” and legislatures to criminalize medical treatment that “may hasten death.”

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UPDATE: Man Forced to Undergo 3 Enemas and Colonoscopy by Police

David Eckert, from Hidalgo County, New Mexico, was subjected to numerous, highly invasive procedures, because police suspected him of hiding drugs in his rectum. Mr. Eckert had been convicted of methamphetamine possession in 2008, and the police suspected his continued involvement with drugs. However, the officers who searched both Mr. Eckert’s person and his vehicle, after pulling him over for a traffic violation, found neither drugs, nor weapons. One officer indicated that Mr. Eckert held himself in an “erect” position, and “kept his legs together,” which led the officers to assume that Mr. Eckert held drugs within him.

 After a local hospital refused forcibly to search Mr. Eckert, he was transported to the Gila Regional Medical Center (GRMC), 50 miles away. At GRMC, Mr. Eckert was subjected to two rectal exams, three enemas, forced bowel movements in front of officers and nurses, x-rays, and a colonoscopy performed under anesthesia. However, each search was fruitless. Mr. Eckert received a bill from the hospital for $6,000. Mr. Eckert filed suit against the hospital, and the parties settled for $1.6 million.

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VT Bill Streamlines Involuntary Commitment Process, But May Not Protect Privacy

The bill to streamline the involuntary commitment process for mental health patients in Vermont is not finished yet. However, some are concerned that the bill does not sufficiently protect the rights of patients committed involuntarily under the new, streamlined process. The head of Vermont Legal Aid’s Mental Health Law Project, Jack McCullough, requested that the Vermont Senate Judiciary Committee add language to the bill that would preclude a patient’s name from being added to the federal registry’s list of individuals who should not own firearms, at least until a preliminary finding of mental illness was adjudicated fully. Lawmakers indicated that they would not add the requested language in this bill, and would rather deal with that issue in separate legislation.

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Vermont Lawmakers Consider Rights of Patients Committed Involuntarily

Recently, Vermont Senate committees conducted hearings regarding the involuntary administration of psychiatric medication for some psychiatric patients who pose a danger of harm to health care providers. Proposed legislation would “streamline the process” of involuntary commitment and would allow the state simultaneously to request authority to require a patient to take psychotropic medications against his or her will.

On January 22, during the hearings, Dr. Gordon Frankie, Chief of Psychiatry at the Rutland Regional Medical Center, offered anecdotal evidence regarding a patient who assaulted two of the Center’s staff members—leaving one member brain damaged. Dr. Frankie indicated that the staff awaited a court order before it could medicate the patient. The lawyer who directs Vermont’s Legal Aid’s Mental Health Law Project, Jack McCullough, claims that the commitment process operates appropriately and requires no intervention.

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Shortage of Execution Drugs Creates 8th Amendment Dilemma

Pentobarbital was used, primarily, for the purpose of lethal injection in America. However, the principal manufacturer of pentobarbital, Hospira, Inc., halted its production of pentobarbital in 2011. As a result, states that allow the death penalty are experiencing a shortage of lethal injection chemicals. The shortage has caused states, such as Ohio, to modify their lethal injection protocols, which has led to new quandaries that implicate the 8th Amendment of the U.S. Constitution.

Counsel for the convicted murderer, Dennis McGuire of Ohio, argued recently on Mr. McGuire’s behalf in the U.S. District Court for the Southern District of Ohio.  McGuire’s counsel claimed that the new, untried drug substituted for pentobarbital could leave Mr. McGuire conscious and suffering from “air hunger,” thereby posing “a substantial risk of severe pain” which would violate the 8th Amendment’s prohibition against cruel and unusual punishment. However, the Court ruled that the defense did not offer sufficient evidence to support a finding that the new drug poses a substantial risk of severe pain, and did not delay the execution proceedings.

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Minorities Underrepresented in Federal Regulations on Human Subject Research

“Redressing Past Wrongs: Changing the Common Rule to Increase Minority Voices in Research” (forthcoming, American Journal of Public Health) states that the underrepresentation of minorities in human subject research is particularly alarming because many diseases are more prevalent in minority populations, irrespective of age, gender or income. The article suggests that minority underrepresentation reflects minorities’ mistrust of the government, due, in part, to cases of abuse of minorities in human subject research; and, minorities’ comparative lack of access to health care, leading to fewer opportunities for minorities to participate in research.

The article was co-written by Bill Rencher, the health access program director of the nonprofit, Georgia Watch, and Leslie Wolf, Professor of Law at Georgia State University, and it appears in a special issue on the Ethics of Human Subjects Research in Minority Populations. The authors suggest that federal regulations be changed to protect minority populations as they protect prisoners, children and pregnant women.

Read more here.