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Page 1 of 2 FORT WORTH--Hospitals in Fort Worth and Dallas that use electroshock therapy to ease severe depression have given individual patients too many treatments, administered the therapy despite patient refusals and performed inadequate medical screenings, according to state records reviewed by the Star-Telegram.
The violations, which occurred in late 1995 and last year, were uncovered by a random audit of hospital records by the state Health Department and have been corrected, officials said. At one Dallas hospital, two elderly, terminally ill patients were treated with electroconvulsive therapy -- or ECT--even though they were medically unstable or would not benefit from the treatment, Health Department records show. Both died of medical complications within two weeks of their last ECT.
Other state data show a striking increase in the number of patients receiving ECT at age 65 -- when most Americans generally become eligible for Medicare. Hospital officials and proponents of ECT said they cannot explain the increase. They dismissed critics who say hospitals are snaring patients once they become eligible for Medicare reimbursements.
The state issued no sanctions in any of the cases involving violations. And, in many instances, the infractions were considered clerical errors or record-keeping problems that were fixed on the spot, said Eloise Harris-Teas, the Health Department's manager of hospital psychiatric services. In more serious cases, hospitals submitted plans to correct violations and prevent further infractions, Harris-Teas said.
Still, at the request of a nonprofit advocacy group that opposes ECT therapy, the state attorney general's office is examining the Health Department's findings to determine whether to pursue possible state violations. "We've received a lot of data, a lot of information, and we're looking at it," said Ward Tisdale, a spokesman for Attorney General Dan Morales. "That's really the stage we're at right now." The revelations come three years after Texas strengthened its regulations of the use of ECT and began requiring hospitals and psychiatric facilities to provide the state with detailed patient information, including age, race, number of treatments and types of side effects. The disclosures also come as the Legislature is considering a bill that would ban ECT and psychosurgery, prefrontal sonic sound treatment or any other convulsive or coma-inducing therapy. Other ECT data provided to the Texas Department of Mental Health and Mental Retardation show that for the three years that ended Aug. 31, 1996, the number of patients receiving the treatment multiplied anywhere from two to four times between ages 64 and 65, the qualifying age for Medicare.
"Don't let the hospitals tell you there's not a financial incentive to doing electric shock therapy, especially when Medicare pays and there's a hospital stay," said Jerry Boswell, executive director of the Austin office of the Citizens Commission on Human Rights. The commission asked the attorney general to investigate whether hospitals have performed the treatment unnecessarily on people who turn 65, and whether they have violated regulations concerning patients' rights, medical screenings and treatment methods. Co-founded by the California- based Church of Scientology, Boswell's organization generally opposes the use of modern psychiatry. The California-based group previously spearheaded investigations in Texas that uncovered a systematic abuse of patients' rights and referral kickbacks in psychiatric hospitals in Texas.
"It's just too coincidental that there's this spike in numbers at age 65," Boswell said. The deaths related to ECT were recorded at Doctor's Hospital in Dallas, where Health Department investigators reported "poor examination or medical attention" before or during treatment. A 73-year-old woman who got ECT was terminally ill with severe respiratory problems and throat cancer, which eventually caused her death. She also received psychoactive drugs despite her refusal, and consented to ECT after the hospital exerted "undue influence" on her, state records say. The Health Department audit found that she was too ill to benefit from ECT. A 72-year-old man who had refused therapy but whose wife consented on his behalf was in renal failure when he was admitted for psychiatric treatment. He developed blood clots in his urine after a double treatment of ECT and died of medical complications within two weeks of receiving the treatment.
The 72-year-old man and two other patients received two ECT treatments in one session without a second psychiatrist's opinion, as state law requires. One of those patients was a 31- year-old woman who forgot how to feed herself after her treatments, records said.
Doctors provided correction plans to the Health Department, which visited the hospital again in December and found no deficiencies.
"They were deficiencies related to documentation, and we addressed those concerns with the medical and professional staff," said Mary Sellers, a hospital spokeswoman. "I'm sure there was some training, some policies were put into place, or at least were re- emphasized." In the three years that ended Aug. 31, 1996, 5,141 people in Texas received ECT therapy. Used to lift severe depression temporarily, ECT sends a one- to four-second jolt of electricity through electrodes on a patient's scalp. The shock induces a short- lived convulsion that some scientists believe counteracts or interrupts the electrical processes that cause some types of mental illness. The procedure is solidly embraced by mainstream medicine, including the American Psychiatric Association and the National Institutes of Health, as a treatment for severely depressed patients who don't respond to drug therapy or psychotherapy.
In addition to Doctor's Hospital, other infractions found in Dallas facilities included:
St. Paul Medical Center, part of Harris Methodist Health System, gave ECT patients insufficient medical screenings. One woman was 84, dependent on a feeding tube and losing weight. She later suffered an adverse reaction to ECT, the report says.
In response, St. Paul rewrote admission criteria for its psychiatric unit "to specifically exclude anyone too ill to participate in the program," spokeswoman Paula Davis said. The hospital also received invalid informed consent from three patients, each more than 70 years old and each too confused, disoriented or feeble-minded to understand what they were signing, according to Health Department records.
Davis said the hospital had received verbal consent from the patients, but that the permission was not documented in records reviewed by the state. To correct the problem, St. Paul developed consent forms to be used specifically for ECT patients, she said. St. Paul also gave three patients small jolts of ECT to test their reaction to a certain type of muscle relaxant, but did not notify them properly that the procedure was experimental, records said. Davis said the hospital revised its consent forms to comply with state regulations. Parkland Memorial Hospital did not give one patient full information on the nature of ECT or its possible side effects and did not include information on the nature or seriousness of the patient's illness in his medical records.
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