What does this psychiatrist do to earn $179,000 a year?

On August 5, 2009, New York psychiatrist Royle Miralles was suspended with pay from his $179,000 a year position as staff psychiatrist for Wayne County Behavioral Health Network after his superiors discovered (courtesy of a local television news investigation) that he had been disciplined by the state medical licensing board for numerous instances of negligence, incompetence and recordkeeping failures.  Miralles never reported the disciplinary action to his employer.

Miralles is noted as being the highest-paid employee in Wayne County.

What does a county psychiatrist do to make that kind of money?

Perhaps only Miralles and his patients know the answer to that question for sure.  What is known is what Miralles doesn’t do.  According to disciplinary documents acquired by Citizens Commission on Human Rights International (CCHR) from the New York Board for Professional Medical Conduct, Miralles did not do the following standard (and sometimes critical) tests or examinations and/or other medically-required tasks with regard to seven patients:

• Failed to obtain and/or document patients’ informed consent (patient’s cognizant understanding of the benefits and liabilities of the suggested method of treatment, applicable alternative treatments as well as no treatment) for the drugs he prescribed

• Failed to adequately monitor lithium levels (failure to do this can result in liver damage and/or failure)

• Failed to conduct adequate assessments and/or document adequate assessments for tardive dyskinesia (a serious potential side effect of antipsychotic drugs, resulting in abnormal involuntary movements of the face, tongue, limbs and trunk)

• Neglected to obtain neurologic consultations for patients risking tardive dyskinesia

• Failed to adequately monitor blood sugar levels, lipid profiles, weight and/or girth during treatment with atypical antipsychotic drugs (which carry known dangerous side effects of abnormal weight gain, blood sugar abnormalities and diabetes)

• Failed to monitor kidney function and coagulation status prior to and during treatment with a particular drug (the use of which requires such tests)

• Failed to maintain accurate medical records

This is just a partial list of Miralles’ failures to uphold the standard of care, for which his license was placed on probation for five years with terms and conditions.

$179,000 is a lot of county money to pay someone to neglect basic patient health and safety requirements.

So what do psychiatrists do to earn their pay?

A 2007 review by CCHR of U.S. Department of Justice inspections of public psychiatric facilities revealed that six out of seven of the institutions investigated engaged in some degree in the use of seclusion and/or restraint as a first line of treatment (which it is not) and/or the strikingly high use of pro re nata (Latin for “as needed”) medications as a “chemical restraint” for the convenience of the hospital staff.

What else do psychiatrists do to earn those big paychecks?  A 1997 study revealed that 10% of all psychiatrists admitted to sexually abusing their patients; 80% admitted to being repeat offenders.

If our counties and states really want to balance their budgets and have money available for constructive and community-desirable programs, they need to look at how they might be throwing their citizens’ money away on psychiatrists like Miralles, who take the money but neglect the patients, often to the point of sickness, disfigurement and death.

For more information about psychiatric crime, fraud and more, please contact Steve Wagner, Director of Litigation, CCHR International, 800-869-2247 or swagner@cchr.org

Antidepressants, shooting rampages, suicide and senseless violence

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Ever since the new class of antidepressants hit the market in the mid-80s, we have stood by and watched in horror, confusion and apathy as the number of school, workplace and domestic shootings, stabbings and dismemberments has increased to the point that it is almost commonplace.

DO NOT ACCEPT THIS AS BEING A NORMAL PART OF “MODERN SOCIETY.”

Too many of the perpetrators of these senseless and gruesome crimes were shown to have been taking or withdrawing from antidepressants or other psychiatric meds.

We have had firearms for hundreds of years and we weren’t using them to commit these incomprehensible acts:  Murderous rampages ending in suicide; dismemberment and slaughter of one’s own children.

THE POLICE, SHERIFFS AND CORONERS WHO INVESTIGATE THESE KILLINGS NEED TO LOOK INTO THE SHOOTER’S MEDICINE CABINET OR MEDICAL/PSYCHIATRIC HISTORY.  IF THEY SUICIDED, THE CORONER NEEDS TO DO A TOXICOLOGY SCREENING ESPECIALLY TARGETING PSYCHIATRIC DRUGS!!!

Here’s what the governments of the world have to say about antidepressants and suicide and violence:

2003

Drug: Seroxat (UK brand name for paroxetine, known in U.S. as Paxil)
Type of drug: SSRI antidepressant
Warning: Seroxat should not to be used on children under 18 years of age due to increase in self-harm and suicidality.
Age group: Children under 18
Agency: UK Department of Health’s Medicines and Health Products Regulation Agency (MHRA)

2004

Drug: Celexa, Effexor, Luvox, Paxil, Prozac, Remeron and Zoloft
Type of drug: SSRI or SNRI antidepressants
Warning: Under-18s to consult physicians if they are being treated with newer antidepressants to evaluate risks vs. benefits, due to recent safety concerns, including suicide-related events.
Age group: Under 18
Agency: Health Canada
Date: February 3, 2004

Drug: Celexa, Effexor, Lexapro, Luvox, Paxil, Prozac, Remeron, Serzone, Wellbutrin and Zoloft
Type of drug: SSRI and SNRI antidepressants
Warning: Worsening depression and suicidality in patients
Age group: Adult and pediatric
Agency: FDA
Date: March 22, 2004

Drug: paroxetine (Paxil)
Type of drug: SSRI antidepressant
Warning: Increased risk of suicidal behavior and hostility.
Age group: Should not be used in children or young adults.
Agency: European Agency for the Evaluation of Medicinal Products
Date: April 22, 2004

Drug: sertraline (Zoloft)
Type of drug: SSRI antidepressant
Warning: Stronger warning for SSRIs regarding the potential for behavioral and emotional changes, including risk of self-harm.
Age group: Patients of all ages
Agency: Pfizer Pharmaceuticals in cooperation with Health Canada
Date: May 26, 2004

Drug: SSRI antidepressants
Type of drug: SSRI antidepressants
Warning: “…may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or
harm to others.”
Age group: Patients of all ages
Agency: Health Canada
Date: June 3, 2004

Drug: citalopram (Cipramil, Celapram)
escitalopram (Lexapro)
fluoxetine (Prozac)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
venlafaxine (Effexor)
amitriptyline (Amitrip)
clomipramine (Anafranil)
desipramine
doxepin
dothiepin
Imipramine (Tofranil)
maprotiline (Ludiomil)
mianserin
noritriptyline
trimipramine
mirtazapine (Remeron)
tranylcypromine (Parnate)
Type of drug: All antidepressants, including SSRIs, tricyclics and MAOIs.
Warning: “…possible increased suicide risk and the need to closely monitor patients with depression…” and “…when treating children and adolescents with depression the risk of suicidal thoughts and behavior with SSRIs generally outweigh the possible benefits from the medication.”
Age group: Patients of all ages
Agency: Medicines Adverse Reactions Committee of the New Zealand Ministry of Health
Date: October 21, 2004

Drug: SSRI antidepressants
Type of drug: SSRI antidepressants
Warning: “…careful monitoring for the emergence of suicidal ideation and behavior which may particularly develop early in therapy”
Age group: Children and adolescents
Agency: Australia Therapeutic Goods Administration
Date: December 2004

Drug: Anafranil (clomipramine HCl)
Aventyl (nortriptyline HCl)
Celexa (citalopram HBr)
Cymbalta (duloxetine HCl)
Desyrel (trazodone HCl)
Effexor (venlafaxine HCl)
Elavil (amitriptyline HCl)
Lexapro (escitalopram oxalate)
Limbitrol (chlordiazepoxide/amitriptyline)
Ludiomil (Maprotiline HCl)
Luvox (fluvoxamine maleate)
Marplan (isocarboxazid)
Nardil (phenelzine sulfate)
Norpramin (desipramine HCl)
Pamelor (nortriptyline HCl)
Parnate (tranylcypromine sulfate)
Paxil (paroxetine HCl)
Pexeva (paroxetine mesylate)
Prozac (fluoxetine HCl)
Remeron (mirtazapine)
Sarafem (fluoxetine HCl)
Serzone (nefazodone HCl)
Sinequan (doxepin HCl)
Surmontil (trimipramine)
Symbyax (olanzapine/fluoxetine)
Tofranil (imipramine HCl)
Tofranil-PM (impiramine pamoate)
Triavil (Perphenaine/Amitriptyline)
Vivactil (protriptyline HCl)
Wellbutrin (bupropion HCl)
Zoloft (sertraline HCl)
Zyban (bupropion HCl)
Type of drug: All antidepressants, including SSRIs, SNRIs, tricyclics and MAOIs
Warning: FDA directed manufacturers of all antidepressant drugs to revise the labeling for their products to include a boxed warning and expanded warning statements that alert health care providers to an increased risk of suicidality (suicidal thinking and behavior).
Age group: Children and adolescents
Agency: FDA
Date: October 15, 2004

2005

Drug: SSRI and SNRI antidepressants
Type of drug: SSRI and SNRI antidepressants
Warning: Suicide-related behavior (suicide attempt and suicidal thoughts), and hostility (predominantly aggression, oppositional behavior and anger) were more frequently observed in clinical trials among children and adolescents treated with these antidepressants compared to those treated with placebo.
Age group: Children and adolescents
Agency: European Medicines Agency’s Committee for Medicinal Product for Human Use (European Union)
Date: April 25, 2005

Drug: Cymbalta
Type of drug: SSNRI (selectiver serotonin and norepinephrine re-uptake inhibitor) andtidepressant
Warning: All patients being treated with any type of antidepressants should be observed closely for clinical worsening and suicidality especially during the first few months of therapy and when the dose is modified. A higher than expected rate of suicide attempts was observed in controlled studies of Cymbalta for stress urinary incontinence in adult women.
Age group: Patients of all ages
Agency: FDA
Date: June 30, 2005

Drug: All antidepressants
Type of drug: Antidepressants
Warning: Possible increased risk for suicidal behavior
Age group: Adults
Agency: FDA
Date: June 30, 2005

Drug: SSRI antidepressants
Type of drug: SSRI antidepressants
Warning: Requirement of antidepressant makers to update product information to warn of emergence of suicidality.
Age group: Children and adults
Agency: Australia Therapeutic Goods Administration
Date: August 29, 2005

Drug: Strattera (atomoxetine)
Type of drug: Stimulant prescribed for treatment of “ADHD”
Warning: Eli Lilly and Company directed to revise the drug’s labeling to include a “black box” warning and additional warning statements about an increased risk of suicidal thinking.
Age group: Children and adolescents
Agency: FDA
Date: September 29, 2005

Drug: Effexor XR
Type of drug: SSNRI (selective serotonin and norepinephrine reuptake inhibitor)
Warning: Safety labeling change to show that the drug carries numerous potential side effects including “homicidal ideation.” (See pages 9 and 10 of document).
Age group: All ages
Agency: FDA
Date: November 2005

2006

Drug: Paxil and Paxil CR (paroxetine)
Type of drug: SSRI antidepressant
Warning: “…higher frequency of suicidal behavior in young adults (age 18-24) treated with paroxetine compared with placebo” and “…in the analysis of adults with MDD [major depressive disorder], the frequency of suicidal behavior was higher in patients treated with paroxetine compared with placebo.”
Age group: Children and adults
Agency: GlaxoSmithKline
Date: May 2006

Drug: Strattera (atomoxetine)
Type of drug: Stimulant prescribed for “ADHD”
Warning: Suspension of state registration (effectively, a ban), “Due to exposure of serious side effects, including the ability to cause suicide inclinations…”
Age group: All ages
Agency: Ministry of Health and Social Development of the Russian Federation
Date: April 25, 2006

2007

Drug: Anafranil (clomipramine HCl)
Aventyl (nortriptyline HCl)
Celexa (citalopram HBr)
Cymbalta (duloxetine HCl)
Desyrel (trazodone HCl)
Effexor (venlafaxine HCl)
Elavil (amitriptyline HCl)
Lexapro (escitalopram oxalate)
Limbitrol (chlordiazepoxide/amitriptyline)
Ludiomil (Maprotiline HCl)
Luvox (fluvoxamine maleate)
Marplan (isocarboxazid)
Nardil (phenelzine sulfate)
Norpramin (desipramine HCl)
Pamelor (nortriptyline HCl)
Parnate (tranylcypromine sulfate)
Paxil (paroxetine HCl)
Pexeva (paroxetine mesylate)
Prozac (fluoxetine HCl)
Remeron (mirtazapine)
Sarafem (fluoxetine HCl)
Serzone (nefazodone HCl)
Sinequan (doxepin HCl)
Surmontil (trimipramine)
Symbyax (olanzapine/fluoxetine)
Tofranil (imipramine HCl)
Tofranil-PM (impiramine pamoate)
Triavil (Perphenaine/Amitriptyline)
Vivactil (protriptyline HCl)
Wellbutrin (bupropion HCl)
Zoloft (sertraline HCl)
Zyban (bupropion HCl)
Type of drug: All antidepressants, including SSRIs, tricyclics and MAOIs
Warning: Proposed new warnings about suicidal thinking, behavior in young adults who take antidepressants
Age group: 18 to 24
Agency: FDA
Date: May 2, 2007

Drug: Effexor XR (venlafaxine)
Type of drug: SSNRI antidepressant
Warning: Federal request for the drug’s manufacture to cease dissemination of misleading information about the drug, based on An ad for the drug that was placed in a medical journal which was “misleading because it overstates the efficacy of Effexor XR, makes unsubstantiated superiority claims, in addition to other unsubstantiated claims, and minimizes the risks associated with the use of Effexor XR,” in violation of the Federal Food, Drug and Cosmetic Act.
Age group: All
Agency: U.S. Department of Health and Human Services’ Division of Drug Marketing, Advertising and Communication
Date: December 10, 2007

2008

Drug: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol
Felbamate (marketed as Felbatol)
Gabapentin (marketed as Neurontin)
Lamotrigine (marketed as Lamictal)
Levetiracetam (marketed as Keppra)
Oxcarbazepine (marketed as Trileptal)
Pregabalin (marketed as Lyrica)
Tiagabine (marketed as Gabitril)
Topiramate (marketed as Topamax)
Valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
Zonisamide (marketed as Zonegran)
Type of drug: Anti-epileptic, also prescribed for some psychiatric disorders
Warning: Patients receiving antiepileptic drugs had approximately twice
the risk of suicidal behavior or ideation compared to patient patients receiving placebo.
Age group: All ages
Agency: FDA
Date: January 31, 2008