Ian Mulgrew and Petti Fong
Vancouver Sun
Monday, December 03, 2001

A psychiatrist at Riverview Hospital says he has been fired for blowing the whistle on "greedy" colleagues and trying to protect elderly patients.

Dr. Jaime Paredes, who alleged last year that some doctors at the institution were performing needless electro-shock therapy to plump their bank accounts, said he was told a week ago his contract was being terminated.

He said one colleague, an internist, also had her contract terminated because she supported him and a second had been demoted.

Paredes has intermittently worked at Riverview for about 15 of the past 20 years, the last four years in a full-time capacity. "Of course this is because I blew the whistle," he said in an interview Sunday. "We were given notice a week ago and our last day of work is Friday [Dec. 7]."

Alastair Gordon, Riverview's director of strategic communications, said Sunday that Paredes' contract was not renewed because of changes to program delivery at the hospital. "It's a matter of restructuring the way programs are being delivered," said Gordon. "The hospital has not fired him; he's been given notice his contract is not being renewed because we're in the middle of making changes." Gordon said he could not be specific about the hospital's program changes nor comment about whether other doctors are also failing to get their contracts renewed.

Gordon did say that Paredes' non-renewal had nothing to do with the doctor's decision to speak to the media about the use of electro-shock therapy. "There was a full review of ECT last year, and the program was recognized as a good one by the reviewers and it continues to be used where appropriate," Gordon said.

According to Paredes' termination letter, Riverview will continue to pay him $4,278.84 biweekly until Feb. 21, 2002. He resigned earlier this year as the president of Riverview's medical staff because of the electro-shock controversy. Paredes claimed last December that electro-convulsive shock therapy (ECT) treatments on depressed elderly patients had more than doubled in the past four years at Riverview and doctors' billing was behind the trend.

Beginning in 1996, psychiatrists were allowed to bill the Medical Services Plan $62 for each ECT treatment. Previously, compensation for ECT treatments was included in the doctors' contractual payments. The hospital denied Paredes' claims and insisted each treatment is prescribed by the patient's personal physician, who derives no financial benefit, and is administered by other physicians who rarely initiate the treatment. Then-minister of health Corky Evans ordered a review of the hospital's use of ECT, the safeguards in place to protect patients and the doctors' billing practices.

Although 30 hospitals in the province can use ECT, Riverview accounted for a large number of the more than 10,000 ECT treatments performed last year. Of the 2,363 treatments at Riverview in the 1999-2000 fiscal year, 1,553 were conducted on depressed or demented geriatric patients, and the remainder on adult psychiatric inpatients and outpatients. The previous year, 1,558 ECT treatments were done on 373 geriatric patients at Riverview. In 1996, 678 treatments were provided to 177 patients.

Still, the provincially appointed committee was unable to substantiate the charges made by Paredes. In March, after a three-month review of practices at Riverview, the panel of medical professionals chaired by Dr. Caroline Gosselin, head of geriatric psychiatry at Vancouver Hospital, concluded "there was a lack of pertinent statistics pertaining to ECT at Riverview." Without such a database, the panel said evaluating Riverview's ECT practices was "virtually impossible." The hospital saw the review panel's report as a vindication and said it would immediately make the changes recommended to its record-keeping system and its ECT procedures.

Paredes said he takes some satisfaction in knowing the number of electro-shock therapy sessions involving the elderly at the institution has fallen this year to a level similar to that in 1996. The radical therapy, in use since the 1930s to chiefly treat depression, consists of sending electric shock waves through the brains of anesthetized patients. The greater usage of ECT in recent years is ascribed by some professionals to the growing understanding that it is a safe and effective treatment for depression in geriatric patients.

However, a study published this spring in the Journal of the American Medical Association indicated it is so ineffective at ridding patients of their depression that nearly all those who receive it relapse within six months of stopping treatment. The "almost universal relapse rate" can be expected unless doctors also treat patients with anti-depressant medications during their ECT treatments and for several months, or even years after, advise the authors of the study of 290 patients.