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 1, 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 1, 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.