Pavilion pulls plug on shock therapy

5/18/97

By SHAE DODSON
Globe-News Medical Writer

Northwest Texas Healthcare System officials have decided to discontinue electroconvulsive therapy - sometimes called electroshock therapy - at the Pavilion, an Amarillo psychiatric hospital.

The Pavilion recently was cited by the Texas Department of Health for numerous patient violations, some of which were related to its electroconvulsive therapy, or ECT, program.

The Health Care Financing Ad-ministration gave the Pavilion until May 8 to correct the deficiencies or risk losing its Medicare privileges.

Mike Callahan, Northwest's chief executive officer, said HCFA was notified May 1 that the Pavilion no longer will offer ECT. Pavilion psychiatrists will now develop other therapies to care for their patients, he said.

"The reason we're doing this is because of growing political pressure and state scrutiny for that service," Callahan said. "In general, I believe the therapy is beneficial, but there is just a point where you have to make a decision, and we've decided to discontinue that service altogether."

ECT involves stimulating the brain with a controlled series of electrical pulses to treat certain illnesses, primarily severe clinical depression, according to the American Psychiatric Association.

Under a bill passed May 9 in the Texas Senate, two physicians would have to certify that ECT is necessary for a patient 65 or older before that individual could begin a series of the treatments.

Sen. Jerry Patterson, R-Pasadena, the bill's sponsor, said there have been instances of abuse in the use of ECT for treating the elderly.

The bill is expected to be taken up in the House this week.

Health department surveyors visited the Pavilion in February, March, April and again this month. During the March visit, surveyors found that patients were admitted as voluntary inpatients to the facility even though they weren't competent to sign in as voluntary patients, according to a report on that visit.

The report also said Pavilion patients were asked and allowed to sign informed consents for ECT even though they were not competent to do so.

"There were citations issued for those," said Richard Failla, Pavilion administrator. "We had some misunderstanding in terms of the whole issue of factual competency. TDH made recommendations to us to change our admission procedures, and we've done so. We have fully complied with the changes they recommended."

Failla denied some of the health department's findings. In other instances, he said TDH surveyors overlooked items during their visits, such as patients' medical histories that Failla said were actually on file.

Jerry Boswell, executive director of Citizens' Commission for Human Rights, applauded the Pavilion's decision to cease ECT. His organization, created by the Church of Scientology, has lobbied the Legislature to abolish ECT.

"They cannot defend this treatment," Boswell said. "You'll hear them say how it's life-saving and how it prevents suicide, but the actual medical studies do not support that.

"People are so debilitated by this treatment that they get to the point where they can't even complain."

A March 12 internal memo authored by Northwest Chief of Psychiatry Dr. Michael Jenkins states that during the health department's March survey, "several opportunities for improvement were identified."

The memo reminds Pavilion employees to verify and document that patients are appropriate candidates for the Pavilion. It also says patients must understand their illness, the need for treatment and that they are being admitted to the Pavilion.

Jenkins also advises that post-ECT confusion has to clear up before another ECT treatment can be administered.

He outlines which diagnoses are acceptable for ECT to be considered a treatment option, and that for other diagnoses, employees should obtain a second opinion from a physician.

"We've been hammered so much on this ECT," Jenkins said. "From my perspective, and good, sound literature, I think people are going to be hurt by not having it (ECT) available. You really use it anyway as pretty much one of your last treatments, but, you know, it salvages those folks. I mean, it gives them life.

"I think we're going to have increased morbidity and maybe even more mortality as a result of not having the ability to do ECTs. I think the chance (for more suicides) is there because you're talking about those patients who are least responsive to anything.

"I don't agree that it should go away, but from (Northwest's) perspective, can they tolerate every two weeks the Church of Scientology filing a complaint so they're (TDH surveyors) here every two weeks to review everything we have?" Jenkins asked. "I don't know any hospital that can survive that. It's disruptive of patient care, and it's horrendously time-consuming."

Boswell said CCHR filed two complaints against the Pavilion. One was filed after CCHR found discrepancies in the number of ECTs the Pavilion reported to TDH compared with figures reported to the Texas Department of Mental Health and Mental Retardation. A second complaint was filed by CCHR after a Pavilion ECT patient died, Boswell said.

Health department records indicate the patient died of natural causes, not because of ECT.

Boswell said other complaints against the Pavilion were either filed by patients or by psychiatrists.

The Pavilion administered 991 ECT treatments in 1996, "an exceptional statistic," according to the department of health. State documents also indicate that 46 percent of all patients who receive ECT in Texas are 65 or older - an age at which they become eligible for Medicare.

"The Pavilion is the shock capital of Texas," Boswell said. "There's no question about it. They do more shock than any other hospital in the state, which is really interesting because 17 hospitals statewide over the last two years have shut down their shock programs."

In a Globe-News column published in January, Failla confirmed that the Pavilion uses ECT more than any other facility in the state.

St. Mary Hospital in Lubbock does fewer than 100 a year, said Community Relations Director Eddie Owens.

ECT also is available in Albuquerque, N.M., Elkhart, Kan., and Oklahoma City, Failla said.

Blake Kline, president of the inpatient psychiatric Quest Hospital in Amarillo, said Quest has never provided ECT and will not do so now that the Pavilion has closed its program.

Sandy Skelton, executive director of the Texas Panhandle Mental Health Authority, said TPMHA serves about 3,000 seriously mentally ill people each year. About 1,800 of them are on psychotropic medications - drugs that affect psychic function, behavior or experience - but the agency does not use ECT to treat its clients, Skelton said.

Failla said Pavilion psychiatrists are notifying their ECT patients of the decision to halt the treatment. He said he also will mail information about the decision to all Pavilion ECT patients.

"The physicians are offering their patients a choice to look at other medication regimens, or if they want ECT, they (the physicians) will refer them to other ECT providers," Failla said. "We're still in favor of the procedure. We think it's an excellent procedure. What's important is they (ECT supporters) need to make it clear to the Legislature that this is a practice they want and approach it that way."