Health care experts say most hospitals depend on Medicare for 35 percent to 50 percent of annual revenue. Termination would be devastating for a hospital, they say.

Regulators oversee 500 Texas hospitals. The Pavilion was one of 11 put on the short termination track since July, federal officials said.

Dr. Michael Jenkins, The Pavilion's medical director, said the hospital changed its admitting policy. Patients must now be "factually competent" - meaning they must know the time, place, who they are talking to and the nature of their medical problem - before they can sign themselves into the hospital.

The new policy leaves few treatment options, Dr. Jenkins said.

"These rules tell me to send the patient back to the nursing home," he said. "Medical literature tells me to treat the patient. So what do I do?"

Inspectors came back to The Pavilion early in May and found enough positive changes to take it off the termination track.

Some say therapy safe

The health care industry's formal name for shock treatment is electro-convulsive therapy, or ECT. Psychiatrists say they prescribe it only after psychoactive drugs fail to relieve debilitating depression or manic depression.

To the chagrin of shock treatment opponents, nationally recognized professional associations of psychiatrists and physicians all recognize ECT as safe and effective.

The therapy typically comes in a series of five to 10 treatments - a treatment every other day over a two- or three-week period. Sometimes, doctors give a single "maintenance treatment" on an outpatient basis.

Psychiatrists administer the procedure in a hospital's surgical suite. After anesthesia, electrodes are attached to the unconscious patient's head. At the other end of the wires is a briefcase-sized machine that provides the electric pulse. The electricity is applied for about a second, inducing a seizure that lasts 20-30 seconds.

Opponents say those seizures can result in brain damage, epilepsy and prolonged memory loss.

ECT advocates say the electricity-induced seizure changes the brain's chemistry for the better, eliminating suicidal tendencies and improving the patient's life.

Last month, the Texas Senate's committee on health and human services heard testimony on Mr. Patterson's bill requiring two physicians to review medical records before the elderly receive ECT.

Some patients said ECT is the only thing standing between them and suicide.

"It is better for me to have the treatments because the other choice I have is death," Virginia West, a manic depressive, told the committee.

Others said ECT impaired their ability to think, work or perform routine tasks such as getting dressed.

"It has devastated my life," said Jane Betzen, a former ECT patient. "It's inhumane. It needs to be stopped."

Numbers questioned

State regulators accused The Pavilion of giving shock treatment to too many patients. Pavilion administrators said the number - 201 patients in the most recent 12-month reporting period - looked big because the hospital serves a vast area of the Texas Panhandle, western Oklahoma, southern Colorado, eastern New Mexico and the southwest corner of Kansas.

Pavilion administrators say their company didn't even own the hospital when the 79-year-old woman died Dec. 30, 1995.

Records show Pennsylvania-based Universal Health Services Inc. bought the Pavilion and its parent, Northwest Texas Hospital, from the publicly owned Amarillo Hospital District about a year ago - some four months after the death.

The Pavilion and 45 other Texas hospitals reported giving shock treatments to 1,781 patients from Sept. 1, 1995, to Aug. 31, 1996, according to reports on file at Texas Department of Mental Health and Mental Retardation.

County, state and federal tax dollars paid for a vast majority of the treatments.

Copyright 1997, The Dallas Morning News.

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