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March 3, 2001
His New Battle
Patient takes fight against electric shock treatment to court
by Andrew Smith
Staff Writer
Paul Henri Thomas, a former Haitian human rights activist, is now an American citizen championing a different cause: the right of psychiatric patients to refuse forced electric shock therapy.
As in Haiti, he counts himself among the oppressed here. Thomas, 49, has been a patient at Pilgrim Psychiatric Center in Central Islip for the past 22 months, where he has received shock therapy between 30 and 50 times.
Pilgrim psychiatrists say he needs to be shocked because he has schizophrenic affective disorder, a form of psychosis that in Thomas' case shows itself through manic, delusional behavior.
Thomas says he's fine. He's not mentally ill, so he doesn't need shock treatment, he says. If anything, Thomas says, shock treatment makes his life worse.
"After the treatment, it is just as if I came back from nowhere," Thomas said during a court hearing Friday. "I am surprised I am myself... It is not a pleasant experience."
The hearing was held to determine whether Thomas is psychologically competent to refuse shock therapy. If state Supreme Court Justice W. Bromley Hall determines he is competent, the focus of the hearing will turn to whether shock treatment is appropriate for Thomas. If Hall decides Thomas is not competent, the hospital may proceed with therapy, despite Thomas' wishes.
Thomas and his plight have become an international cause. Anti-shock therapy Web sites urge viewers to rally behind him.
Friday's hearing took place in a cramped courtroom in Building 69 on the Pilgrim campus. About 30 activists, some from as far away as Syracuse, gathered outside. Although Thomas waived his privacy rights and Hall assured the public it could attend, state Office of Mental Health officials made the activists unwelcome.
Pilgrim police officers made them stand outside in the snow for hours until court was in session and then allowed only five to sit in the courtroom. Pilgrim police also threatened news photographers with arrest if they took pictures on campus. Police followed a group of activists to make sure they were photographed beyond Pilgrim's property line.
Dr. Robert Kalani, Pilgrim's associate medical director and the director of electroconvulsive therapy there, testified that Thomas came to Pilgrim in May 1999 when he became unmanageable at South Nassau Community Hospital in Oceanside.
Thomas' psychiatric problems date to 1977, when he had a breakdown while living in Haiti.
Kalani said shock treatment is appropriate for Thomas because years of taking psychotropic drugs have damaged his liver. Thomas still takes 3,000 milligrams of Depakote and 1,200 milligrams of lithium a day. Depakote and lithium are mood stabilizers.
During questioning by Assistant Attorney General Laurie Gatto, Kalani said Thomas is not competent to decline shock treatment. Evidence of that is Thomas' belief that he's not even mentally ill, Kalani said.
"He does not appreciate the consequences of refusing treatment," Kalani said.
Kalani also said Thomas' illness is apparent in how he communicates. He has "pressured speech" -- he speaks rapidly -- and needs to be frequently redirected or else his answers to questions quickly ramble off the topic. For example, Thomas responded to one question during an interview about how he was functioning by listing his educational background, Kalani said.
But Thomas' attorney, Kim Darrow of the state Mental Hygiene Legal Services, suggested that Thomas gave his education as an example of how well he was functioning.
But Thomas' own sister, Mary Ann Pierre-Louis of Elmont, testified that he cannot function in society. Before his transfer to Pilgrim, Pierre-Louis said, Thomas was out of control.
"He was playing with his feces," she said. "He said he was doing an experiment."
Later during the hearing, Thomas said he didn't recall that, adding that if he had been experimenting with feces he would have known enough to have worn latex gloves.
"My brother is sick," she said. "We know it. My brother is very ill."
Thomas' answers on the witness stand were frequently elliptical, often unrelated to the question and sometimes completely incoherent. At times Darrow struggled to follow his client's answers.
"What are we talking about now?" Darrow said in confusion at one point.
Thomas' speech was slurred and his hands trembled, a result of the psychotropic medicine he took when he was younger, according to his doctors.
But Dr. Ron Leifer, a Syracuse psychiatrist hired by Darrow, testified that he agreed Thomas had no major mental illness.
"If he's suffering from delusions, so am I," Leifer said. "His speech is not disorganized, if you have the patience to listen to him. He always comes back to the point."
Thomas' refusal of shock therapy is well reasoned, Leifer said.
"Shock treatment is very unpleasant, and because he believes he's not mentally ill, it doesn't make any sense," Leifer said.
During cross-examination by Gatto, Leifer stood by his diagnosis and added that everyone suffers from some kind of personality disorder.
The hearing will continue next week.
Notes Say Shock Treatments Help Man
by Zachary R. Dowdy
Staff Writer
March 13, 2001
The scribblings of doctors and nurses tell a tale of Paul Henri Thomas, a man they say lapsed into delusions and harassed Pilgrim Psychiatric Center staff until he was given a jolt of electric shock therapy.
The contents of the "progress notes" read by Pilgrim's Dr. Robert Kalani at a hearing before State Supreme Court Justice W. Bromley Hall in Central Islip yesterday formed the bulk of the state's claim that Thomas is better off, and more manageable to staff, when he gets regular doses of electroconvulsive therapy.
The notes, dating from the time he was admitted to the facility in May 1999 through last month, consist of dozens of short reports of Thomas displaying "manic behavior," "pressured speech" and "agitation." Soon after shock treatment, though, the notes said, he was "much calmer," displayed "no acting out" and was "no longer manic." State Assistant Attorney General Laurie Gatto asked Kalani about Thomas' treatment and used Kalani's opinion and the progress notes to draw a direct link between Thomas' behavior and the shock treatment, which Thomas vigorously opposes.
Kalani said Thomas, 49, is afflicted with "bipolar mania with psychotic features," though Thomas' disorder had been diagnosed as "schizoaffective bipolar type with psychotic features," Gatto said.
The hearing will determine whether Thomas should be subject to the therapy against his will.
Thomas, whose psychiatric problems date to 1977 when he had a breakdown in Haiti, came to Pilgrim after he became unmanageable at Southside Community Hospital in Oceanside. His plight has become, for some, a symbolic fight for the preservation of a constitutional right to refuse treatment.
His doctors at Pilgrim, however, say he is sick, and unable to determine what is best for himself.
Pilgrim officials, backed by three court orders, won the right to administer the treatment, subjecting Thomas to up to 60 shocks over the past two years.
Thomas' attorney, Kim Darrow of the state's Mental Hygiene Legal Services, said his client has no mental illness and is healthy enough to be released.
He objected each time Kalani began to read through the progress notes that contained illegible signatures. And, in what may have been the most dramatic moment of the hearing, he said some of them were written to make the case that Thomas should continue to receive the treatment.
"These notes are made for the specific purpose of this litigation and should not be admitted as evidence," Darrow said. But his objection, like dozens of others, was overruled by Hall.
Darrow, who did not get a chance to cross-examine Kalani because the court day ended, also argued the notes make "conclusions" and statements that categorize Thomas' behavior without describing what specific acts he allegedly committed.
At a hearing earlier this month, Hall divided the case into two portions: to determine whether Thomas has the capacity to make health decisions for himself and to determine whether the controversial shock treatment is an appropriate method in his case.
The next hearing date could be set as early as today, and Hall said it will likely occur Thursday.
March 16, 2001
Mental Competence in Question Doctors: Man not fit to refuse shock treatment
In June 1999, Paul Henri Thomas thought clearly enough to sign a consent form, giving his doctors permission to place electrodes near his temples and send jolts of electricity through his brain as part of his treatment at Pilgrim Psychiatric Center.
He underwent the painful and controversial electro- shock procedure three times, on June 9, 11 and 14. But after that third treatment, he had refused to submit to it again.
That's when his doctors began saying Thomas, 49, no longer had the mental capacity to make decisions on his own, so they obtained a court order to force the electroshock therapy upon him.
The revelation of a kind of Catch-22-the strange circumstance that Thomas was fine when he consented to the procedure but mentally incompetent when he refused it-took center stage at a hearing yesterday to determine whether doctors may again shock Thomas against his will.
Thomas, who has been a patient at Pilgrim since May 1999, is challenging the state's application to continue giving him shock treatments-a controversial form of therapy to treat a variety of mental illnesses. Thomas contends he is not mentally ill.
At the third day of Thomas' hearing yesterday, his attorney questioned a witness for Pilgrim.
"In June he was competent to consent and received three treatments, and some time after that he became incompetent. Is that correct?" asked Kim Darrow, an attorney for the state Mental Hygiene Legal Service, which is representing Thomas.
"I'm unable to answer that," responded Dr. Robert Kalani, Pilgrim's associate medical director.
But State Supreme Court Justice W. Bromley Hall swiftly cut off Darrow's line of questioning, saying Thomas' capacity to make decisions about his health may have changed since he consented to the treatment.
"There are a lot of people walking around with capacity for whatever," Hall said in the Central Islip courtroom. "The fact that you have capacity today doesn't mean you will have capacity tomorrow," he added, prompting gasps from Thomas' supporters.
The proceeding marked the first time Darrow could cross-examine Kalani, who was testifying for Assistant Attorney General Laurie Gatto on Monday.
Gatto had made the case then that Thomas was perceived to be much more manageable during the periods when he was receiving shock treatments.
If Pilgrim officials are successful, they will be able to administer the treatment to Thomas, who is also on mood stabilizing drugs, despite his wishes.
The facility seeks authorization for 40 more shock treatments.
It would be the fourth time they have obtained court approval for the procedure on him. Thomas has already received at least 57 treatments over a two-year span without his consent.
Under questioning by Darrow, Kalani also admitted that on Feb. 1, he signed a form for a court order for additional treatments without first examining Thomas, an act that Darrow said was a violation of state rules regarding treatment of mental illness.
Darrow also said the affidavit submitted to the court for additional shock treatments was only a stock form with spaces for the date, patient's name, name of the doctor and the disorder. It had no specific details concerning the patient.
Darrow asked Kalani how he could sign off on such a form, but Kalani said he based his decision partly on a conversation he had with Thomas' physician.
Testimony ended with Darrow asking Kalani, given that Thomas has called the procedure "torture" and "evil," how has it improved his life.
"Do you think you have improved the quality of life for Mr. Thomas?"
"I think we have," Kalani answered.
The hearing will continue next week.
March 28, 2001
Man Says More Rights Violated
by Zachary R. Dowdy
Staff Writer
In recent weeks, Paul Henri Thomas has become Long Island's most visible and vocal opponent to electroshock treatment, a procedure he has undergone at Pilgrim Psychiatric Center nearly 60 times against his will since he was confined there in May 1999.
His fight against the treatment has spilled into public forums, including news media and the Internet, but most notably state Supreme Court in Central Islip, as he challenges the state's application to give him 40 more shocks.
He has called the procedure a form of "torture," claiming doctors at Pilgrim are violating his constitutional right to refuse the treatment.
Now, Thomas, 49, and his attorneys say Pilgrim officials are violating another basic right-freedom to speak his mind about electroshock treatment-by monitoring his conversations with people who visit him at Pilgrim in Central Islip. And, they say, the restrictions that have been imposed on Thomas are in retaliation for his efforts to publicize his plight.
"Under the guise of seeing whether he is competent to do such things as sign papers or have a conversation, they are providing obstacles for his free communication to the public about his views on what's happening to him," said Dennis Feld, deputy chief attorney for the state Mental Hygiene Legal Service, which is representing Thomas.
Jill Daniels, a spokeswoman for the state Office of Mental Health in Albany, declined to comment, citing ongoing litigation.
Feld, whose agency filed the lawsuit Friday in Federal Court, said Pilgrim officials have placed Thomas under so-called one-to-one observation. That designation means Thomas cannot sign papers or have a conversation with anyone outside of his family or attorneys without a Pilgrim staff member present.
Thomas, who Feld said receives visitors almost daily, seeks a declaration from the court that his rights were violated, an order barring the restrictions, in addition to attorney fees and monetary damages.
The one-to-one designation, Feld said, is normally applied to patients who have been "acting out," or who do not have the mental capacity to sign papers.
The lawsuit comes as State Supreme Court Justice W. Bromley Hall tries to decide whether Thomas has the capacity to refuse the treatment and whether shock treatment is appropriate therapy for him.
April 17, 2001
Judge Continues Electroshock
Saying that expert witnesses for Paul Henri Thomas were "simply not credible," a State Supreme Court justice yesterday gave Pilgrim Psychiatric Center the green light to resume the electroshock treatments Thomas had hoped to stop.
Justice W. Bromley Hall's seven-page decision comes more than two months after Pilgrim applied for a court order to administer 40 shock treatments to Thomas.
The judge approved the treatments and lifted a temporary injunction blocking three treatments Pilgrim had won the right to give by a previous court order.
Thomas, 49, who emigrated from Haiti in 1982, denies he has a mental illness, but doctors at Pilgrim testified he displays signs of several disorders including schizoaffective disorder and bipolar mania.
He has received nearly 60 electroconvulsive therapy treatments -- most of them against his will -- since he was committed to the institution in May 1999.
Hall's decision, which evaluates the weight of testimony from Thomas, his sister and expert witnesses, came as no surprise, according to the state attorney general's office which represented Pilgrim.
"The intensity of the objection by Mental Hygiene Legal Service [which represented Thomas] is the only thing that was surprising," said Assistant Attorney General Laurie Gatto.
Denis McElligott of the state attorney general's office said Thomas' case shows that electroshock treatments are forced upon a patient only after a thorough legal debate.
"We're hoping that the best thing that comes from this entire situation is the public's understanding that when this is done it is only done pursuant to a court order after a judge has heard all of the testimony," McElligott said.
But Dennis Feld, deputy chief attorney for the state Mental Hygiene Legal Service in Mineola, said Hall discredited Thomas' witnesses, tipping the scales against him. "The decision doesn't come as a surprise with the court discounting our experts' testimony," Feld said. "It leaves very little to be argued and to be guessed as to which way the court would go."
Kim Darrow, an attorney who argued the case for Thomas, was unavailable for comment yesterday.
Feld said his agency would appeal the decision once the attorney general's office drafts an order to administer the treatments.
Hall's decision came after many weeks of testimony from experts who fall on both sides of the controversial electroshock treatment issue.
The hearing was designed to answer two questions: Did Thomas possess the mental capacity to make medical decisions on his own and was this form of treatment, ‚it is uncomfortable if not painful for some patients, has caused memory loss and is often followed by relapses -- the best treatment for Thomas?
Pilgrim doctors Robert Kalani, associate medical director, and Andre Azemar, Thomas' psychiatrist, both testified that Thomas badly needed the treatment, partly because drugs that would help him will further damage his liver.
They said he suffers from delusional thinking and is prone to behavior they consider bizarre.
"He has been found sitting on the floor comparing himself with Mahatma Gandhi," Hall wrote. "He was wearing three pairs of pants which he believed provided therapy for him. At the same time he was found, in the ward, wearing layers of shirts which were inside-out, together with jackets, gloves and sunglasses."
Hall dismissed the testimony of Ron Leifer, an Ithaca psychiatrist, and John McDonough, a psychologist, who appeared on behalf of Thomas. Hall said that Leifer was "evasive," and that his testimony was influenced by his opposition to electroshock and involuntary medical treatment altogether. The judge declared McDonough's testimony as "not helpful," saying it was based largely on a widely used intelligence test that measures cognitive ability and that he did not administer tests that measure psychosis or discuss Thomas' alleged illness or electroshock treatment.
The most damning testimony against Thomas, though, may have come from James D. Lynch, an independent psychiatrist who said Thomas has an acute form of bipolar disorder and manic behavior and needs more than the 40 shock treatments to help him function.
Briefs
April 25, 2001
Zachary R. Dowdy; Chau Lam
BRENTWOOD / Pilgrim Patient Wins a Stay Paul Henri Thomas, 49, the Pilgrim Psychiatric Center patient who is challenging the state facility's decision to give him electroshock treatments, will not have to undergo the procedure, at least for now, pending a decision from an appellate court.
On Monday, attorneys for Thomas secured from the Appellate Division a temporary stay of an order signed by State Supreme Court Justice W. Bromley Hall. Hall's order approved Pilgrim's request to administer 40 electroshock treatments.
The stay will remain in effect at least until Monday, the deadline by which Pilgrim officials must file papers with the Appellate Division, said Kim Darrow, an attorney for the state Mental Hygiene Legal Service, which represents Thomas.
After that, a four-judge panel will review the arguments from both sides and decide whether to grant another stay while the court reviews Thomas' appeal.
The stay, granted by Justice David S. Ritter, asks Pilgrim to make a case as to why shock treatments should not be prohibited while the court reviews Hall's order, which was signed April 20.
That order came after a weeks-long hearing in which Thomas challenged an application by Pilgrim in February to administer the 40 shock treatments. Hall ruled that the expert witnesses who testified for Thomas were not credible, saying in conclusion that the treatments are in Thomas' "best interest." Thomas, who Pilgrim doctors say displays signs of mental illnesses ranging from schizoaffective disorder to bipolar mania, has been in the Brentwood facility since May 1999.
He has received about 60 shocks in all, almost all of them against his will. Thomas signed papers consenting to the treatments in June 1999.
He underwent three procedures and then refused them. That's when doctors at Pilgrim sought court approval for the procedure, arguing that Thomas did not have the mental capacity to make medical decisions for himself. -Zachary R.