Prescribing Death

People who suffer from allergies, medical disorders, and disease usually know best what medications and/or food they can and cannot tolerate.  For example, I suffer from a type of inflammatory arthritis called gout. There are many foods and drinks that my body cannot tolerate. I realize, as do medical specialists, that foods high in purines, such as shellfish, will likely increase the risk that I will suffer a painful gout attack. Therefore, I avoid or reduce my consumption of specific foods and beverages in order to stay healthy.

I'm of sound mind, but if I wasn't, I'd have to rely on my loved ones to ensure foods high in purines are eliminated from my diet. Good health and medical care is often a family affair for all of us, whether we suffer from gout or medication allergies. Most doctors would agree that concerned family members play a vital role in patient care, particularly when the patient is a minor or might need assistance in decision making.

Thomas "Oliver" McGowan (18)

The Poisoning of Oliver McGowan

Eighteen-year-old Thomas Oliver McGowan, known as Oliver, died on November 11, 2016. He lived with cerebral palsy, epilepsy and autism, which began after contracting meningitis twice during childhood. On Saturday, October 22, Oliver was suffering from simple partial seizures and taken by ambulance to Southmead Hospital in Bristol, UK.

Upon arrival, Oliver was intubated, a process of inserting an endotracheal tube through the mouth and into the airway. This was apparently done to place Oliver on a ventilator to assist with his breathing. Oliver was sedated with Lorazepam, a drug indicated to treat seizure disorders. He was then taken for a CT scan which did not show any changes to his brain.

As doctors at Southmead Hospital eased the Lorazepam, Oliver's seizures returned. Instead of reinstating the Lorazepam, the doctors made a decision that ultimately killed Oliver. They prescribed him the antipsychotic, Olanzapine, a drug indicated to treat schizophrenia and bipolar disorder. It is better known in the US by its brand name Zyprexa. Oliver developed Neuroleptic Malignant Syndrome (NMS), an adverse effect of the drug, his temperature rose to 43C and his brain swelled to the point that it was coming out of the base of his skull.

Dr. Monica Mohan

Dr. Monica Mohan's Arrogant Destruction

The consultant neuropsychologist who made the decision to administer Olanzapine is Dr. Monica Mohan. It appears she made a calculation of risks and benefits but ignored more than 500 citations assessing the impact of antipsychotic drugs on challenging behavior. Of these 500 citations, only 3 were methodologically sound randomized controlled trials, and even these were unable to show whether antipsychotic drugs were beneficial in controlling challenging behavior. (1)

Neuropsychology and publications aside, doctors and staff at Southmead Hospital were repeatedly told by both Oliver and his parents, Paula and Tom,  not to give him antipsychotic medications because he was allergic to them.

Oliver's avoidable prescription-drug death and last week's inquest has been covered by the British media. The week-long inquiry showed how doctors, after learning of Oliver's adverse drug reaction to the drug that was administered, performed a CT scan on his brain which showed Oliver’s brain had swelled to the point doctors said there was no “meaningful recovery”.

During the inquiry, consultant neuropsychologist, Dr. Mohan, told the inquest she would do it again because she believed it was in “his (Oliver's ) best interest”.

I kept an eye on the proceedings and, like the majority of the public, I was gobsmacked at last Friday's verdict delivered by Assistant Coroner Dr. Peter Harrowing.

Harrowing, a former Director of Pharmacy Services to the University Hospitals Bristol NHS Foundation Trust, concluded Olanzapine had been properly prescribed and that NMS could not be predicted as it was a “very rare adverse effect”. Further, Harrowing said he agreed with Dr. Mohan. He said the doctors were right to prescribe the drug that precipitated Oliver’s death. Dr. Harrowing also ruled against a Prevention of Future Death.

I reached out to the McGowan family who told me, "The coroner argued that it wasn’t an allergy but a sensitivity or intolerance. Of note, Oliver had previously suffered oculogyric crisis (a dystonic reaction to certain drugs) in Bristol Children’s Hospital with his seizures increasing from one per fortnight to 30 a day.  Sean Collins, safeguarding lead at Southmead Hospital, had consulted with ICU staff about using a non-pharmaceutical approach for when sedation was refused but was not consulted by Mohan."

Smoke-and-mirrors

I'm never shocked anymore by Inquest verdicts. I've long been a fan of the website AntiDepAware, moreover its author Brian. AntiDepAware includes links to reports of inquests held in England and Wales since 2003. It's a great window into the world of coroners and how they don't really work for nor represent the dead. Coroners are often just doctors protecting doctors and the majority repeatedly fail to protect the living by being honest about what happened to the dead. Oliver's case is, tragically, no exception to the medical industry's business-as-usual model. Loved ones who question the medical industry in order to help protect others from suffering avoidable harms are often shocked to see the medical industry's chief concern is to protect their colleagues and business systems.

It's difficult enough to lose a beautiful child who had his whole life ahead of him. But to then endure more smoke-and-mirrors deception from a pharmacist-cum-assistant coroner is beyond the pale. Further, Oliver's parents had to pay for the ordeal following Oliver's death whereas Southmead Hospital was supported throughout the inquest by public funding. (Yes, folks, this is where your hard-earned tax money goes.)

When I think about the avoidable death of the talented and handsome young man named Oliver McGowan, I can't help but also think about thousands of other "Olivers" and "Olivias" out there whose prescribed deaths aren't covered by the news. While they remain faceless to the public, they are not faceless to family and friends.

Nothing will bring Oliver back to life. The inquest that could have reduced future avoidable deaths by improving crisis communication and medical safety instead seem to have increased the likelihood that doctors will practice medicine however they choose, parents be damned.

Arrogance among doctors is a deadly flaw. A 2002 journal article by Allan S. Berger (2) states, "...the most critical variable in the development of arrogance is a physician's knowledge and thereby his or her power over the patient. This can delude some physicians into imagining that they are all-powerful." He continues, "...we should not exaggerate our own importance. We are but an instrument of healing and not its source."

I couldn't agree more.

Bob Fiddaman

(1) Are antipsychotic drugs the right treatment for challenging behaviour in learning disability?: The place of a randomised trial

(2) Arrogance among physicians ~ Berger AS

Samantha Parnell - Caught in the Mental Health Trap

Samantha Parnell -  8 different psychiatric drugs

When Samantha Parnell was just 15 she, like many teenage children, experimented with recreational drugs, her choice being skunk, a selection of selectively bred cannabis strains.

Her parents, Sharon and Steve, became aware when she started behaving out of character, in fact her mother thought that her daughter had a brain tumour such was the drastic change she had seen in her. Alarmed by this Sharon took her daughter to a local hospital whereupon Samantha finally admitted that she was smoking cannabis.

Confused and showing signs of agitation a doctor injected Samantha and told her that it would help calm her, the hospital then prescribed her Risperdal, an antipsychotic used to treat schizophrenia. The hospital told her parents that Risperdal was a standard drug they used to treat teenagers who had taken street drugs. Samantha's parents were also informed that the "medicine" was well tolerated.

As weeks turned into months Samantha found it difficult to tolerate the Risperdal, in fact, recalls her mother, "the Risperdal made things worse." When Samantha told the health care professionals about her intolerance they simply upped the dose. She was told by medical staff that they needed to keep adjusting the dose until "they got it right" as everyone needed "different amounts."

In 2007, seeing no marked improvement, Samantha was prescribed Zyprexa. Concerned, her mother told the prescribing doctor that she was not happy that her daughter was being prescribed drugs and asked if there were any alternatives.The doctor told her there were no alternatives and that this was the standard treatment.

Things went downhill for Samantha and her behaviour became worse, so bad was her behaviour that she was sent into an acute young persons unit where she was given more psychiatric drugs.Her parents noticed that Samantha became lethargic and showed little or no emotion and also learned that she was self-harming, she also lost track of time and didn't know what day it was, recalls her mother.

In a phone conversation with Sharon, she told me:

It was just a downward spiral, by this time she was a shadow of her former self. She asked Steve and me several times please help me too die. Can you imagine that, she even said I’ll write you a letter so you and daddy don’t get into trouble.

Samantha was becoming more violent and her mother noticed that it became worse just a couple of weeks prior too her menstrual cycle. Sharon relayed this to Samantha's doctor as she felt it may be of importance. Her doctor, apparently, never investigated this finding.

During 2007 Samantha was in and out of hospital units and was also sectioned under the mental health act where she was prescribed Clozaril, an atypical antipsychotic, her parents had to sign a consent form and were told that their daughter's blood would be checked regularly as it could interfere with her white blood cells.

Sharon:

I didn’t like the sound of it at all but it was said this was the last she could try as this is the drug they use for treatment resistant people. 

At this point Samantha was taking three drugs, Zyprexa, Abilify and Lamictal, a fourth, Clozaril, was added to the mix and each time medical staff tried to 'up' the dose Samantha's heart reacted which ultimately saw Samantha admitted to a cardiac unit where she was told the Clozaril had to be stopped with immediate effect. Her mom recalls:

Whilst introducing Clozaril they reduced her from Zyprexa. Each time they tried to raise Clozaril her heart reacted so the cardiac doctor said it must be stopped immediately. They then proceeded to put her back on Zyprexa and also adding Abilify and lamotrogine.

Samantha's Clozaril was substituted with Diazepam, a benzodiazepine used for the short-term relief of symptoms related to 'anxiety disorders'.

Sharon:

Hindsight is a wonderful thing, if we knew then, what we know now, I would have said no. Sam’s life at this moment in time is a mess; I never want to hear of another child being abused by so called doctors again with these so called medicines. Sam has been so violent and she has hurt people and damaged lots of things too but their drugs have done that to her.

On 20th May 2011 Sharon took Samantha to a private hospital too see a consultant obstetrician and gynaecologist. She explained all of her daughter's mood swings and violent outbursts. After discussion, he prescribed Oestrogen patches for Samantha to wear two weeks on and two weeks off and said, "if you get a 10% difference after the two cycles then I will put her on the lowest dose to start just too see and then maybe go up to the next dose if it works for her."

The patches seemed to calm Samantha down somewhat, although she was still experiencing rage. The patches,recalls her mother, "stopped her more violent outbursts, she stopped attacking people and smashing up the place."

Unfortunately, Samantha, had previously attacked a bus driver who had refused her on a bus, Samantha had tried to board the bus with a train travel card and lashed out when she was refused to board.

Yesterday, Samantha, now 19, was sent to a medium secure unit. Her mother wrote a letter to the court explaining what she believes to be the reasons why her daughter acts the way she does. It bore no weight with the magistrate.

The final words goes to Sharon:

I know from the research that I have done on these so called medicines that two of the drugs Sam was on, clearly says can interfere with women’s hormones and they never told us that in the beginning. The same as they only chose too tell of what they call minor side effects. Anyone who has been on these drugs and anyone who has looked after anyone on these drugs know they are actual side effects.

Sharon Parnell has been creating awareness about the use of psychiatric drugs in children and wishes for parents across the UK to research any psychiatric drug prescribed to their children. Her website, Revelations UK has been running since 2010.

To date Samantha Parnell has been prescribed the following psychiatric drugs;

Diazepam
Phenergan
Olanzapine
Lamotrigine
Risperidone
Clonazepam
Aripiprazole
Clozaril

She is currently spending time at a secure unit, a young woman trapped in the mental health system, hooked on psychiatric medication that has escalated her problems and eradicated nothing.

Her mother sought the help of professionals, that help resulted in misery starting in 2006 and, it appears, continuing throughout 2011. Samantha Parnell has been punished enough, it's time for those responsible to remove their heads from the sand, it's time to stop the chemical cosh whipping of this young woman.

She is one of many thousands of children, teenagers, adults and elderly caught in the mental health trap.

Bob Fiddaman.




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