Lawmakers want to halt unnecessary treatments

AMARILLO - The death of a chronically ill 79-year-old woman in a mental hospital has focused new attention on the emotional debate over electroshock therapy as a treatment for depression.

The woman, whose identity is protected by confidentiality laws, died 24 hours after a shock treatment Dec. 30, 1995. Medical records described her as confused and disoriented when she signed into The Pavilion on Dec. 27.

The Pavilion is an 85-bed, private psychiatric hospital in Amarillo, the heart of the Texas Panhandle. The woman was kept in the hospital's locked geriatric ward.

State legislators are pointing to her death and others like it across the state as they consider new laws to prevent hospitals and psychiatrists from giving unnecessary shock treatments to elderly people covered by Medicare.

"It {shock therapy} could be a moneymaker for those who use it unscrupulously," said Sen. Jerry Patterson, R-Pasadena, who is sponsoring legislation to put more regulations on shock therapy for the elderly.

Pavilion administrators deny that shock therapy is a high-profit procedure. They say medical reviews found no evidence that shock treatment contributed to the the woman's death.

Still, critics have designated Amarillo and The Pavilion as "the shock capital of Texas."

State records say psychiatrists gave the treatment to 201 Pavilion patients during the year ending Aug. 31, 1996 - more than any other Texas hospital. Memorial Southwest Hospital in Houston ranked second with 126 shock patients.

Under fire from Texas and federal regulators, the hospital announced that it stopped providing shock therapy May 1.

"It is a corporate business decision," said Richard Failla, The Pavilion's top administrator. "There has been a lot of {anti-shock therapy} propaganda over the last 18 months. And harassment of hospitals that do it."

State records kept during a three-year period ending Sept. 1, 1996, show that 17 Texas mental patients died within 14 days of receiving a shock treatment. The records, which include the Amarillo woman, do not allege cause-and-effect between the treatments and death.

Mr. Patterson's bill would require two doctors to certify that shock treatment is medically necessary for patients 65 or older. It also requires the doctors to inform patients or their legal guardian whether shock treatment might worsen other medical conditions.

The proposed law passed the Senate last month and was reported out of a House committee with no amendments. It awaits consideration by the full House. The Legislature adjourns June 2.

Patient gave consent

Texas Department of Health inspectors examined a random series of patient records at The Pavilion in February and March. The 79-year-old woman was among them.

Inspectors said she had undergone knee replacement surgery, suffered a post-surgical heart attack and "an exacerbation of congestive heart failure." She also had a urinary tract infection.

The woman was put in a nursing home. Records said her medical problems had stabilized and that depression had become "her major health problem."

The nursing home transferred her to The Pavilion on Dec. 27, 1995. Medical records said she was suffering from unstable blood sugar related to diabetes, incontinence, bedsores on her buttocks and swollen hands and feet.

"She was able to ambulate only 3-4 steps only with maximum assistance, choking easily on food or fluid, needing total assistance with personal care." She was also disoriented and confused, according to inspection reports.

"This patient, although not competent to give informed consent, was allowed to sign herself into the psychiatric unit and to sign for {shock therapy}," inspectors wrote.

Inspectors said The Pavilion violated a 3-year-old state law by allowing the woman and several other mentally incompetent patients to sign themselves into the hospital and then sign papers consenting to shock therapy.

The woman took her first shock treatment Dec. 29 - two days after arriving at The Pavilion. Nurses found her "unresponsive" at 7:15 a.m. the next day. She died several hours later.

The federal Health Care Financing Administration, which monitors the Medicare program, considered the case serious enough to put the hospital on "the short track" toward terminating Medicare reimbursements for patient care.

Andrew R. Perez, a federal official who monitors hospital quality, sent The Pavilion a warning letter April 11. He said the hospital constituted "a serious and immediate jeopardy to patient health and safety." He gave The Pavilion 10 days to submit a corrective plan of action or face loss of its Medicare privileges by May 8.

"The case itself is terrible, obviously," Mr. Perez said. "It's very serious anytime we take an action like this."