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Public trustee's office investigates Riverview case
by Pamela Fayerman Vancouver Sun April 17, 2002
The Public Guardian and Trustee's office of B.C. is investigating the case of an elderly Riverview Hospital patient who has received more than 130 electric shock treatments over the past three years, sometimes as often as every few days.
Riverview psychiatrists have declared that the patient, 71-year-old Michael Dennis Matthews, is unable to give consent to the shock treatment because of his mental state. So, as with many geriatric patients, they are administering electroconvulsive therapy (ECT) to him on an involuntary basis.
During a recent interview outside Riverview, where he said he has been confined for the past four decades, Matthews told the Vancouver Sun he fears the shock treatments more than anything else.
"I'm braver now, but I don't like it. They hurt, I don't want it," said Matthews, who recalled he was admitted to Coquitlam's Riverview Hospital 39 years ago -- for what reason, he cannot remember or cannot disclose.
Billing records shown to The Sun (dating from 1998 to February of this year) show that Matthews received about 135 ECT treatments, and they have continued in the past few months, but with less frequency. This is well above the average number of ECT treatments of between six and 12. Doctors normally expect improvement within 15 treatments.
He has a terrible forehead gash, sustained, he said, after he fell over in a dizzy state following a recent shock treatment session.
Matthews said he was born in Cranbrook, although he remembers living for a time in Creston. Matthews does not appear to have any contact with relatives or people from his Kootenay past.
The public trustee's office, which has jurisdiction over Matthews' financial and legal affairs, was made aware of his ECT situation by Julie Butler, who appears to be Matthews' only visitor at Riverview. Matthews has an affectionate regard for Butler, and during the interview with The Vancouver Sun, he kissed her hand and hugged her when asked if he enjoys her visits.
Butler is director of the B.C. chapter of the Citizens Commission on Human Rights, a Church of Scientology affiliate.
The commission lobbies around the world against psychiatric "abuses and violations of human rights."
Butler, who wants doctors to halt Matthews' ECT sessions, said she became aware of Matthews when she read about him on a Web site and began visiting him several months ago.
On the Internet, an anonymous, former caregiver at Riverview participated in a forum, complaining about the relentless frequency of the shock treatments Matthews was receiving and the increasing adverse effects she perceived as stemming from them -- agitation and confusion among them.
Catherine Romanko, deputy public guardian and trustee, said although her office's authority does not extend to Matthews' personal or health-care matters, she feels that it is important to nevertheless "make inquiries into the situation because of circumstances which we have been made aware of.
"So if, for example, it appears that medical opinions are not in support of this treatment, or there are reasons to review it -- and I'm not sure what our inquiry will turn up -- then there are avenues of recourse we can consider on behalf of him," Romanko said, referring to independent medical opinions and even litigation if it came to that.
She acknowledged that the Public Trustee is stretching the boundaries of its jurisdiction somewhat by delving into matters that are not strictly confined to authority over his legal and financial affairs.
The trustee has a committee of estate protective role over the financial and legal affairs of many other patients at Riverview. "Clearly, we deal with them all the time," Romanko said, referring to some patients and administrators at the hospital.
Because of the close contact between the trustee and the hospital, there is an awareness of the scrutiny the hospital faced last year after the former provincial government appointed an external review panel to investigate ECT practices at Riverview.
The Vancouver Sun reported on the sharp increase in the number of ECT procedures, beginning in 1997, when doctors were allowed to bill MSP for each ECT treatment. Some questioned if the increase was tied to a financial incentive and in late 2000, the then-health minister, Corky Evans, said he wanted an external review of the hospital's ECT program to find out why treatments on elderly patients had more than doubled.
The report never offered a conclusion on the question because, as it stated, the lack of a detailed database "makes examination of the Riverview practice of ECT with respect to patient selection and outcome virtually impossible."
The external review report noted that the average number of ECT treatments is normally between six and 12, but more may be needed. Dr. Martha Donnelly, a Vancouver Hospital geriatric psychiatrist and member of a team that has just delivered a report to the minister of health on recommended guidelines for ECT delivery, said doctors hope that patients improve within 15 treatments.
Sometimes, they will continue ECT on a "maintenance" program which could mean once a week, bi-monthly, or monthly.
Asked if there was an upper limit of ECT treatments any patient should receive she said: "The point is that you want the patient to be well, and if they are doing well, then you continue on. After 15 treatments or six months, you should redo the whole informed consent and in an involuntary patient, ensure there is a second opinion," she said.
The most commonly cited reason for giving ECT is severe depression, but there is widespread controversy over whether it is the best treatment.
A Columbia University study published a year ago found that ECT is so ineffective at ridding patients of their depression that nearly all of those who receive it relapse within six months of stopping treatment. Many experts have therefore questioned whether it is a worthwhile treatment plan, given the risk posed by continually administering general anesthesia, especially to elderly patients who are known to be potentially vulnerable to worsening dementia and cognitive deficits with general anesthesia.
ECT proponents say it is worth the risk, especially for patients who have failed other treatments such as prescription drugs. The biochemical reasons for its success are not fully understood.
Medical Services Plan billings of doctors who have treated Matthews, which were obtained by Butler, show that six different psychiatrists have delivered the ECT to him since Dec. 28, 1998.
Psychiatrists bill the public plan about $64 for each treatment, and the anesthesiologist who puts the patient to sleep during the treatment for a short time, bills a similar, additional fee.
Dr. Jaime Paredes, a psychiatrist who was fired by Riverview after he went public with his concerns about the sharp increases in ECT on Riverview geriatric patients, said Tuesday that he couldn't comment on the Matthews case since he is not familiar with it.
"But in general, it sounds like an excessive number of treatments and it sounds like the hospital or the doctors need to provide a very good explanation."
Asked if there are many patients, like Matthews, who seem to receive ECT indefinitely, Paredes, who worked at Riverview for 15 years, said practice guidelines and protocols vary.
"It can depend on whose writing them, and it is not unheard of to see them written by people who own the companies which make or distribute the ECT machinery.
"I personally prescribe ECT to patients only as a last resort, often in an emergency situation where someone is a violent risk to himself or others, or someone who is dying in front of me because they are refusing to eat," said Paredes, who has had some difficulty finding permanent hospital-based employment since he is stigmatized as the Riverview whistleblower.
Paredes is now working on a temporary contract with the ministry for children and family services, offering his psychiatric expertise to teenagers in the Fraser health region.
Riverview Hospital would not comment on Matthews' case. On the day Matthews was interviewed outside the building where geriatric patients live, two different security guards were dispatched to send a reporter and photographer away.
Riverview communications manager Alastair Gordon said doctors, legal counsel and senior medical and administrative personnel at the hospital "are agreed that any comment about this patient, or about electro-convulsive therapy as it might relate to this patient, would be both a breach of patient confidentiality, and contrary to the best interests of Mr. Matthews.
"As you are aware, there has been widespread dissemination of information about this patient and his treatment without valid or legal consent," he said, referring to the consent form Matthews signed, giving Butler authorization to expose his medical records to government agencies and journalists.
Matthews also signed a document allowing Butler to get access to doctors' billing records for medical care delivered to him.
Gordon said the hospital's position is that Matthews is not mentally competent to give such consent so the form he signed is invalid.
Figures provided by the provincial ministry of health show that ECT procedures have decreased provincewide in the past few years since Paredes first expressed his concern over the volumes. In 1999, there were 10,028; in 2000, there were 9,331 and in 2001, 8,540. The province paid doctors fees totalling $569,866 for ECT in 2001/2002.
HOW THE PROCEDURE WORKS:
Electroconvulsive shock therapy (ECT) involves the passage of an electrical current through the brain to induce a central nervous system seizure.
Patients are given a general anesthetic and muscle relaxants to ensure they don't break or dislocate bones from the severe muscle contractions.
Following injection of the muscle relaxant, a bite block is placed in the patient's mouth to protect teeth and tongue.
An ECT seizure usually lasts between 30 and 90 seconds.
ECT-induced memory loss usually improves within eight weeks of treatment. Agitation and confusion right after the procedure is not uncommon. Side effects can also include nausea, vomiting and headaches.
Patients who don't respond to medication or who can't tolerate the side effects of their medication are candidates for ECT.
The first use of convulsive therapy dates back to 1934, when camphor injections induced seizures and a benefit was observed in some psychotic patients.
In 1940, ECT using electric currents was introduced and curare was used as a muscle relaxant.
As one of the most invasive procedures used by psychiatrists, it is often controversial.
The mechanism of benefit is not understood but theories abound, and most people believe ECT has a biochemical effect on the brain.
Some studies have shown that about 50 per cent of patients with severe depression benefit from ECT.
Although ECT is usually reserved for patients who don't respond to drugs, sometimes it is indicated for suicidal patients who can't wait weeks for antidepressant medication to take effect.
Letter published in Vancouver Sun, from Don Weitz:
Public hearings needed to ban barbaric procedure
Vancouver Sun
Friday, April 19, 2002
Pamela Fayerman's article regarding Riverview shock-therapy victim Michael Matthews does not begin to describe this barbaric, brain-damaging, memory-destroying procedure. The article doesn't mention permanent memory loss and brain damage, common and serious effects of electroshock that have been scientifically documented for many years.
Like myself, Michael Matthews is 71, but he's been through more hell than most of us can imagine. After close to 130 forced electroshocks, it's a miracle he is still alive. When or if Matthews is released from the Riverview shock mill, I hope to hell he and his family sue all five or six doctors who forcibly shocked him (without informed consent) and the hospital for millions.
As an insulin-shock survivor and antipsychiatry activist, I've talked with and listened to more than 200 shock victims in Canada and the U.S. during the last 15-plus years. Virtually every person has painfully acknowledged permanent memory loss as well as problems in learning and concentration.
Public hearings on shock therapy should be held until this barbaric psychiatric procedure is banned.
Don Weitz
Co-founder, People Against Coercive Treatment