[SpottedOwl]

Possible trigger for people with trust issues.

One of my good friends (lets call him Ed) had a manic episode last year. He had been seeing a psychiatrist for many years prior, and had an established relationship with this doctor (Dr. X). During the episode, several people called this doctor to complain about the manic behavior.

Now, over a year later, Dr. X just told Ed (in an effort to try to tell him how bad the mania was) that other people had called, and that he had spoken with them -- but the doctor refuses to disclose *who* called, or what exactly was said during these conversations. Additionally, the doctor gave one of these people some psychotropic medications which were given to Ed secretly, by putting it in his food.

Dr. X never told Ed that these people called, who they were, or that he had handed out a sample of meds. All of this has been discovered after the fact by Ed trying to piece together what had happened. When confronted with this information, Dr. X does not deny any of it, and in fact says that he did nothing wrong.

Now, this really bothers me, so I wanted to post and get some feedback.

Is it ethical or legal for a psychiatrist to talk about you with another person *without * disclosing who that person was?
Is it ethical or legal for a psychiatrist to hand out psych meds to a third party, without the client's knowledge?

IMHO, this is so very wrong, and possibly illegal. If my T had ever done these things to me, our work would be over. Obviously the trust in the relationship has been broken, but aside from that is this serious enough to file a formal complaint?

Any thoughts or feedback would be appreciated.

Thank you, and I apologize if this triggered anyone. I have a wonderful T, and I do trust him.

[Perna]

I have trouble believing a psychiatrist gave out meds to be put in a another person's food. I might could see it if it was Ed's wife and they were working together to help Ed, people with problems often need spouses or others to work to get meds taken at the right time, etc. But I don't see how a friend of Ed's would get into it. Also, if the doctor is not saying anything, I don't know how Ed knows what he thinks is correct.

I've know people who have been ill and they need help with their meds; what they imagine happened while they were ill and what actually happened. . . not necessarily even close!

I love and trust my husband to love and care for me "in sickness and in health" and if I'm not rational, all bets are off on what happened and I'm going to trust his report. If I don't trust my spouse to care for me, I shouldn't be married to him and I don't know anyone else well enough that's going to come in (unless I'm a minor and have parents or siblings helping) and try to help me when I'm ill. I'll take all the help I can get when I'm ill. I don't think people who love/care about me are trying to "poison" or hurt me?

[Simcha]

Holy smokes Owl--Wow bad stuff here methinks.
Seems your put in quite a position here huh?

First you must ascertain if this is all in "Ed's" head or if this really happened. Do you have proof beyond "Ed's" report?

I think you obviously know it's unethical, but I would have posted the same thing, as this would put me in the position of trying to decide what to do about it. I would need to solicit answers from objective outsiders on the issue just to feel better about myself and field my options.

The MAJOR illegal thing was that the Pdoc gave samples of medication to a friend of one of his patients so that the friend of his patient could covertly drug him with it. Not only is this dangerous, it is also committing assault. Drugs have to be prescribed by the doctor to the patient; not given to a third party for the purpose of

The secondary illegal things are surrounding the violation of privacy of the patient. The Pdoc had no right to share anything with his patient's friends. The correct thing would be if the patient was a danger to himself or others he should have committed him for psychiatric evaluation and stabilization.

He didn't do that for some reason, which has me confused. It's really standard procedure, and he failed to do that. Why? I don't know. As it stands, what he is doing now is illegal and he could possibly lose his license to practice medicine over it.

Does "Ed" know EVERYTHING now?

Honestly, I think the doctor needs to be reported, and the friend who slipped "Ed" the medication samples in his food should get their own head checked---

This is why blind obedience to authority figures is a really bad thing. The friends who secretly drugged "Ed" at the doctors request was "only following orders", and it didn't cross the friends mind that it would be unethical.

What are you thinking of doing about this Owl?
I'm really sorry you are in this situation. This would REALLY bother me.

[searchingmysoul]

I second EVERYTHING that Simcha wrote.

What you describe is both illegal and unethical. It is illegal to give out anyone's info to a third party without a release from the client. And giving meds to a third party to be slipped into someone's food is reprehensible and deadly not just illegal.

A psychiatrist has the ability to involuntarily commit someone... A hard choice I am sure...But they have that ability...

I do think that it is within your ability to file a formal and anonymous complaint if you are so inclined.

What an awful situation...

SpottedOwl and a big hug to your friend!

[sunrise]

SpottedOwl, is Ed going to file a complaint? Is Ed still seeing Dr. X? I'm not trying to discourage you from filing a complaint, but if Ed joined in the complaint, it would carry more weight. What if you file a complaint, they talk to Ed, and he says everything is fine and he doesn't know what they are talking about? That's why I asked if Ed was still seeing Dr. X. If he is, I wonder why, and does it mean he is not disturbed by the doc's actions and that he would try to protect him?

[Capp]

Owl,
What a difficult position you are in right now!

Jme/Jmo
Do you know, or have a way of finding out, if Ed has given permission for anyone to talk with his physician? It's standard policy for a competent patient to sign a form giving the physician permission to talk to designated people. It's done for several reasons, and most of them are for the safety of the patient.

The meds and food issue is also tied to the written permission...if it was given and there was reason to believe Ed was endangering himself, it's possible it was done.
It's very disturbing to think a pdoc would do this, but these things need to be considered...
The refusal to share information with Ed leads me to believe there may be more going on than you are aware of. Please tread softly while you get a handle on this situation.

Another thing you may want to consider is talking with your T about it. One, it can help you sort through your feelings about it. Two, he can advise you on the legality and what options you have...actually what options Ed has.
Ultimately it is Ed that would have to make the complaint about the pdoc.

A few years ago my former pdoc had several complaints lodged against him for inappropriate practices. My own experience was him sharing with me that he was suicidal, crying because he couldn't make his mortgage payment, but his girlfriend was fantastic in bed.
It took me 12 seconds to walk out of there.
He entered treatment and is resuming being active but it is under supervision.
I shared this because strange things do happen with pdocs.
What Ed is saying may be spot on...most patients don't think anyone will believe them.

I applaud your concern for Ed and your willingness to try and help him.
Please let us know how everything goes, ok?

Cap

[SpottedOwl]

Originally Posted by Simcha

First you must ascertain if this is all in "Ed's" head or if this really happened. Do you have proof beyond "Ed's" report?

I do think that Ed's perception of things is off on some things. His memory of the episode is spotty, and he has a hard time accepting that other people's experiences were different than his own.

The medication being given to a friend and put in the food I heard about from a third party, so I consider it is likely true. The dr. brings up these calls in sessions (present day, when Ed is functioning normally) as a means of convincing Ed that he really was 'that bad' and that he really does have a problem. Obviously there was something going on with him, but to try to beat a person up like that in therapy seems wrong.

Originally Posted by sunrise

SpottedOwl, is Ed going to file a complaint? Is Ed still seeing Dr. X? ...If he is, I wonder why, and does it mean he is not disturbed by the doc's actions and that he would try to protect him?

Yes, he is still seeing the dr. Ed is disturbed by the actions, and has recently started talking about whether this was legal and if he could file a complaint. He goes back time after time and tries to convince the dr. that what he did was wrong. I honestly think the best thing would be to get him under the care of another dr. Once he has that support, then he can decide what to do. If he does decide to file, I will support the case, but the decision has to be his.

I guess what bothers me the most is that Ed calls me upset after his sessions, and I see a relationship that may be damaging instead of healing. I have openly shared my own experiences with therapy, and how important having trust is to the process.

Originally Posted by Capp

What Ed is saying may be spot on...most patients don't think anyone will believe them.

I think this goes to the core of what bothers me. I know Ed had a manic episode, and I think he knows it to. I talked to him often during that time, and it was a serious situation. That said, it was handled in a clumsy (at best) and damaging (at worst) way.

He deserves to have a doctor who treats him as a human being, not as a diagnosis. There is much more there, and obviously a complex story. I've talked some with my T about this in the past, but perhaps I should bring it up again since it is obviously weighing on me.

Thank you all for your great replies. I feel like there is so much more to say, but I'm tired, and that will have to do for now. Just writing some here, and sharing this with you guys has helped.

[imapatient]

This scenario is so outrageous and unbelievable that I can't bring myself to believe it.

I'm not saying you’re lying or that your friend is—though it’s an open question in my mind given how strange it is (I’m not accusing, I’m flabbergasted), but either so he's out of touch reality--then and/or now--so he doesn’t know what went on, or this is a textbook vignette for mental health pros to learn about 3-5 different major ethical (and perhaps depending on locale legal) violations in one case. I think in Law School they call those sorts of things "spotters"--spot the violations and the seriousness of each. Is it serious enough to report? In 5 different ways it is.

The only thing would explain what the pdoc did would be if there were some real mental breakdown with Ed that others needed to take responsibility for him. Were it that Ed was so far gone, his pdoc should've committed him. I can't believe the medication given to a 3rd party friend, except in an extraordinary circumstance with someone so out of touch--but given to a friend?

I had my brother once go try to talk to my T because he was really spooked at how strongly su I was. They would neither confirm nor deny that I was a patient. My T wasn't there, but another T sat and listened to my brother share his fears for a few minutes. He then asked that I not be told that he came to them; they told him that if someone who was a patient there had someone come like that that they'd be obligated to tell the patient. So they told me.

So people can call and share their fears under the umbrella of a T or pdoc not revealing ANYTHING AT ALL, even that you're the patient. What an ethical T or pdoc should do is if the information alarms them is to act without those others knowing anything about it. Like commitment. If Ed were so bad off that any of what you relayed is true, he wouldn't be competent to take care of himself. It sounds like more than just a manic episode, it sounds like a psychotic break with reality.

Even revealing what meds someone takes is a violation in a major way, because it can likely be identified with diagnoses.

If something extreme did happen along the lines of what Ed says, I can see where a T or pdoc would want to--or be required to--inform the patient for mental health purposes--bring back to reality--and ethical responsibility to be open. It's not beating up at all--it's full disclosure about the pdoc's and Ed's behavior and part of the attempt to treat Ed.

A T or pdoc needs authorization from a patient to share any info with others that identifies the patient--even with another pro. They can consult without ID'ing the patient. As with my brother situation, I can't imagine that there isn't a requirement to disclose any parties who were spoken to in any regard. Talking in the first place is a massive violation. Exceptions are made as far as I know only for when there is a reasonable threat of the patient harming self or others; the crisis exception. You haven't described a critical point like that.

What about these "friends" "others who were given meds?" Where are they now? What do they say now? Ed might be impaired in his faculties and the pdoc was impaired somehow, but they shouldn't be.

All I hear about the pdoc is that he's violated not just the most basic confidentiality issues, but extremely so with the meds thing.

If all of this is plausible enough to your T that it really happened--not that your T agrees with it or supports it, s/he should be reporting the pdoc or acting somehow--like contacting the pdoc. When a pro hears about serious ethical violations by another pro, they're supposed to act somehow, someway. It can be done without revealing you.

I can't imagine staying with that guy.

The best thing that you can do to help Ed is make sure he starts seeing a good T yesterday. A lay person can't handle figuring out what happened, the best way to go about reporting or not, and esp. won't be able to get the pdoc to open up about what the deal was/is. And Ed needs the help mentally. It sounds like he's a really stressed out wreck with all of these things going on, needs to realize he was abused by pdoc, and have someone keep him in touch with reality.

It's like the plot of a B movie trying to parody mental illness and getting it so wrong and a parody of what pdocs do.

It is unbelievable.

[ECHOES]

I don't think any of us know the complete details.
Anyone can call a physician and talk to them about a patient. The physician can receive information and concerns from others but isn't permitted to discuss the patient's treatment.

I wonder who the people are who called. Are they legal caregivers and/or medical personnel? That might make a difference.

My grandmother was very combative and had psychosis of some kind. She was never diagnosed because it was always called something else in the family and mental health treatment would never have been persued, unfortunately. When she was in her mid 90's she moved into assisted living. She had no physical medical conditions, she was just elderly and needed daily living help. While she was there her doctor did diagnose her with something (no one ever finds out anything in this family! so I don't know all the details. sigh.) and a medication was given to her by the staff in her coffee each morning. She would have fought taking it otherwise as she was on no medications and she was paranoid. So she received medication that way, it made her feel so much better and calmer and peaceful. Daily living was no longer a frightening torment. She was able to interact with others then, something she really valued and enjoyed. She was finally able to be taken care of and able to receive the loving care offered.

So, I give you that example as one scenario where administering medication in an unconventional way was beneficial. I know it is not the same scenario as your friend has, but maybe there are some similarities.

[MissCharlotte]

Spotted,

Whew, what a difficult situation, on so many levels. First and foremost you have the concern about Ed (now) and whether he is getting appropriate care. Then you have your own reaction to the whole scenario and exploration of that reaction with T. Clearly, it touched some sensitive spots in you. Finally, you have the decision as to whether or not you should report the doctor.

When an adult is sick with mental illness, it is a difficult situation at best. As adults, they have to make their own decisions. But if they are not making sound decisions and they are suffering it becomes so painful to sit by and idly watch. I would like to think that is what happened with Ed--that people cared about him.

Now, the whole thing about meds in the food is awful. I don't think it's legal, ethical, or conscionable.

I have an adult son who has suffered from psychosis in the past. I would NEVER sneak medication on him like that. I might nag him to death to take it, but that's another story. However, I would call his psychiatrist if I were worried about his behavior. I have called his T as well. He may not like it, but if I think he is in danger I do anyway. When I do, it is open and above board and she tells him I called.

There is a lot here for you to sort through.

((((Spotted & Ed))))

[madisgram]

(((OWL))) i'm in a quandry too. i don't know if in fact what your friend is telling you is true. if he is delusional it could cause him to believe something that has not happened, but it will seem real to him.
having said that, if it is true, then the pdoc is in violation of his ethics and would lose his license if this was reported.
i wish i could give you advice or suggestions but i'm not sure if this all really took place. sorry i couldn't be of more help to you. i hope that things work out and you certainly are a good friend to post about this. perhaps others may have better insight and suggestions.

[Simcha]

If indeed what Ed said was true about the doctor giving some sort of medication to a "friend" of Ed's to put in Ed's food, that is assault and is illegal.
Here's the thing Owl---

The doctor committed a crime, the "friend" committed a crime, and the doctor also violated privacy and ethics.

I don't think this is real. It is so unconscionable and unfathomable, it must not be true. You have zero evidence other than hearsay----hearsay is something you heard from another person.

Hearsay is so untrustworthy that it isn't even allowed in a court of law.

If it was indeed real, then I would say that YOU have a duty to report it. When good people stand by and do nothing... well we know what happens. They become complicit in covering up the crimes.

The 3rd party----did they allegedly tell your friend Ed this and then Ed told you? Or was it that the third party told you directly because Ed told him this? Or what?

I think you need to get to the bottom of this and lay it to rest one way or another. I don't trust anything Ed says at this point, because he is far to deep in his psychotic mania from the sounds of it.

[Simcha]

Originally Posted by ECHOES

I don't think any of us know the complete details.
Anyone can call a physician and talk to them about a patient. The physician can receive information and concerns from others but isn't permitted to discuss the patient's treatment.

I wonder who the people are who called. Are they legal caregivers and/or medical personnel? That might make a difference.

My grandmother was very combative and had psychosis of some kind. She was never diagnosed because it was always called something else in the family and mental health treatment would never have been persued, unfortunately. When she was in her mid 90's she moved into assisted living. She had no physical medical conditions, she was just elderly and needed daily living help. While she was there her doctor did diagnose her with something (no one ever finds out anything in this family! so I don't know all the details. sigh.) and a medication was given to her by the staff in her coffee each morning. She would have fought taking it otherwise as she was on no medications and she was paranoid. So she received medication that way, it made her feel so much better and calmer and peaceful. Daily living was no longer a frightening torment. She was able to interact with others then, something she really valued and enjoyed. She was finally able to be taken care of and able to receive the loving care offered.

So, I give you that example as one scenario where administering medication in an unconventional way was beneficial. I know it is not the same scenario as your friend has, but maybe there are some similarities.

Beneficial--- probably. Illegal--definitely.

I worked in inpatient psychiatry here in the States, and this is definitely bad juju...

Sorry you had to watch your grandmother deteriorate. It's always hard when you can't talk sense into someone we love.

[chaotic13]

Hmmmm. This situation surely is troubling isn't it. As a privacy/control freak I would have MAJOR, MAJOR problems with find out that my doctor spoke with another person without my knowledge/consent. Then to actually conspire with another person to medicate me without my knowledge would REALLY freak me out.

HOWEVER...I also (at least to my knowledge) am not suffering from a major psychotic condition. I feel that in my case, a competent health care professional should be able to deal with me directly and rationally and get me to take medication if necessary.

Ed...may not have been in this state at the time his physician and others were making these decisions for him. And maybe even now...he is having trouble comprehending where her really was mentally at that time.

I think this is where your therapeutic relationship and the integrity of the health care professionals working with you come in to play. Although I have only been with my new GP for a little over a year, in that time he as been excellent in treating me with respect, makes me feel like he is genuinely concerned with both my mental and physical well-being, has clearly indicated that he is willing to work collaboratively with me on mapping out my health care options and treatment approaches, and seems to know where I want his care boundaries to be. For example, I've confided in him that I am seeing a psychologist. During my visits he asks me if things are going OK and lets me know that he is willing to help me with that care. But he has never asked intrusive questions about my issues, required me to disclose anything, and has never asked for a report or permission to contact my T. My GP also treats my H, but short of asking in general how he is doing...my H's care and my care are totally separate. I don't think he would communcate with my H without my permission. If he did I would hit the roof...mainly because at this point I have some real trust issue with my H and my medical records do not give permission for medical disclosure. Based on my dealing with my GP to this point, I trust that he will respect my right to know everything about my care and that he will provide me with the best care possible.

Now, having said that... who should my physician communicate with in the event that I am not conscious or competent enough to make my own care decisions??? In that situation... I think my H would legally be appointed my guardian. I have a brother but... he wouldn't know what to do or what I would likely want done.My physician would have to partner with someone. This is scary even to think about. I hope I am never in a situation where I have to find out what would happen.

If I found myself dealing with the aftermath of a situation where I was demeaned incompetent by my doctor to make my own medical decisions, I hope I would be able to look at his actions and see that his intent was to provide me the best quality care. I would hope that if I did not approve of his handling of the situation (which would be the case if what happened to Ed happened to me), that I could see my GP's good intent and work through it from there. I would make my physician aware of my discomfort with how things were handled and would discuss exactly how I want to be treated in the event that this situation happened again. If my physician and I could not come to an agreement on an acceptable treatment plan for this type of situation....I would find a new GP.

I don't necessarily think this physician did anything wrong. Maybe the care rendered could have been done in a different manner, maybe it wasn't what the patient would have chosen for themselves. Maybe in hindsight, spiking his food was not appropriate. But then again... if Ed wasn't being cooperative and could not be communicated with on a rational basis.... what else should the the physician have done??? Hospitalized him, chain him to a bed and connected the IV? Which would be a less invasive/traumatic approach?

It sounds like the physician made a series of treatment decision that were intended to help the patient. It seems like the physician is also recognizing that the patient is competent enough now to make decisions for himself and therefore is informing the patient of the care that was render. He is not trying to hide his actions or keep the patient in the dark. He is not continuing to treat the patient as if he has no say in his medical care. This seems appropriate to me. If Ed is not comfortable with not knowing who the physician collaborated with... then he should specifically designate someone to make medical decisions on his behalf from this point on. In choosing that person I would want to know that they would be honesty with me (afterwards) about when and how they were called into service.

[chaotic13]

I just have one comment regarding the physician giving the medication to a "friend" as being illegal. I think that would depends on Ed's situation. In my case I think I would trust one of my friends to make better medical decisions on my behalf than my H at this time. My one friend is much closer to me and has a strong medical background. She would not just blindly accept what the physician recommended.

Also... you hear about situations where gay couples have problems. The patient's partner or "friend" may be a better advocate and may know what the individual truly would want...better than the family. Consider how many people here would find themselves back in the lion's den, if their physician by default turned their medical decisions back to an abusive family member.

If anything this situation make you consider who you list as an emergency contact on your medical record paperwork/insurance. This discussion is prompting me to reconsider the stuff I quickly jotted down during my first office visit.

[hangingon]

Spotted

I am doing clinicals at a psych facility right now, and the law is that nurses, doctors, nor psychiatrists can push meds on a pateint, (a patient cannot be forced to take meds) whether this patient is voluntary or involuntary admitted.

There are two exceptions to that rule:
One- The only way meds can be pushed on a patient is with a judicial order from the courts.
Two- if the patient is hurting himself or someone else, a one time ordered dose may be pushed on a patient, but it can only be a one time dose, and it can only be a short term medication.

If this was being done to ED without a court order, then it's absolutely unethical, It goes for a patient's wife or husband as well, no one can force a patient to take meds without his/her consent or a judicial order.

Hope that helps. As others had stated, one would really have to check into these allegations and be certain before filing a complaint.

[SpottedOwl]

Originally Posted by chaotic13

If anything this situation make you consider who you list as an emergency contact on your medical record paperwork/insurance. This discussion is prompting me to reconsider the stuff I quickly jotted down during my first office visit.

Most definitely, and a very good point. A reminder to myself to make sure my own papers are in order.

Simcha, thank you for your very logical and practical replies. It helps me to separate my own emotions from the reality of the situation.

I talked with Ed again last night, and the issue of the complaint came up. I told him that whatever his decision I would support him. I emphasized that his best bet would be to find another dr. first, so that he could get an objective professional involved.

I decided that it is not my job to decide what is true or not, but rather to just be a supportive friend. I think the way I can be most supportive is to help him find a really good doctor so that he has a professional helping him figure this all out. If he does decide to file a complaint, I will talk to whomever and share my concerns.

Many hugs to all of you for listening, responding, and helping me work through this!

[ECHOES]

My grandmother suffered for years and years. Only when she was in the care of others, including her doctor who prescribed the medication and my mother who was her legal guardian, did she get any relief. I was glad she didn't have to suffer from the torment that was with her most of her life. I strongly believe this relief and peace contributed to her living happily at last and she lived to 102.

[sunrise]

Originally Posted by chaotic13

Now, having said that... who should my physician communicate with in the event that I am not conscious or competent enough to make my own care decisions??? In that situation... I think my H would legally be appointed my guardian....

Consider how many people here would find themselves back in the lion's den, if their physician by default turned their medical decisions back to an abusive family member.

These are really good points. For medical decisions, I have appointed a "healthcare power of attorney." It is my sister. If I did not have this legal document appointing her, then by default, it is my husband. Since I don't want my H making potential life and death decisions for me about my health, I needed a third party. I trust my sister, so she is who I chose, after discussing it with her and getting her consent. Everyone should have a healthcare power of attorney unless they are comfortable with the default (a spouse or parent or closest family member).

[Capp]

Sunrise,
I also encourage people to designate a decision-maker they trust to follow their wishes.
Medical decisions for sure, but also psychiatric decisions.
It can be a big surprise to people that one is even needed, but it's in a person's best interest to have one. There are no clear cut instructions like there are with medical issues, but an advocate is still needed...

[imapatient]

Originally Posted by SpottedOwl

I emphasized that his best bet would be to find another dr. first, so that he could get an objective professional involved.

I decided that it is not my job to decide what is true or not, but rather to just be a supportive friend. I think the way I can be most supportive is to help him find a really good doctor so that he has a professional helping him figure this all out. If he does decide to file a complaint, I will talk to whomever and share my concerns.

Sounds like a good plan.