Cynthia Brockman Testimony
Friends,
I have been granted permission to share with you one mother's plight to save her
son's life. Her son was sixteen years old when he was sentenced to prison. This
mother, Cynthia Brockman, is absolutely certain that her son became psychotic
from the combination of prescription drugs he was taking.
Since his incarceration, she has been engaged in a constant battle to make sure
he receives adequate medical care and follow up. Last Monday she presented the
following information to both the Texas House and Senate. You can hear an
audiotaped version of same, along with the testimony of an RN who assisted this
mother in her presentation. You can find the audio version at:
http://www.house.state.tx.us/house/commit/archive/c200.htmOnce at the
site, click on the 5/14/02 session under the "Interim" heading, 2:00 - 4:38 time
frame.
You will need "real player" to listen to the testimony given. Fast forward to
time 1:33:09 to hear a woman giving the panel a piece of her mind for their
failure to respond to questions she had forwarded to their attention. Then fast
forward to 1:46:09 to hear the beginning of Cynthia Brockman's testimony. Here
now is the written draft of her testimony:
Thank you, Honorable Senators, for the opportunity to address your Senate
Criminal Justice Committee on mental health care issues in the Texas Department
of Criminal Justice (TDCJ) and the University of Texas Medical Branch at
Galveston (UTMB). I would like to tell you about the UTMB/TDCJ mental health
care problems that my son, Christopher Brockman #1017204, and I have been
encountering over the past 12 months while, upon the advice of my son’s private
psychiatrist, Dr. Scheffer, we have attempted to obtain medically safe
psychiatric care and have tried to prevent UTMB/TDCJ’s medical negligence,
malpractice, and medical policy violations from fatally harming my son.
I would like to address with you today several UTMB/TDCJ problem areas that have
created a life-threatening medical situation for my son who is not only a
psychiatric patient, but also a teenager. These problem areas are primarily a
result of failed access to care and poor quality of care psychiatric treatment
that are below legal medical minimum standards and are also primarily a result
of UTMB/TDCJ systemic health care problems from the September 1, 1994 Texas
legislation which reorganized medical and mental health care creating a lack of
accountability for correcting UTMB/TDCJ medical problems.
Specifically, these problem areas include the following:
1) Medication mismanagement, which involves administration of wrong and/or
harmful psychotropic drug therapies, non-access to doctor prescribed
non-formulary medication at assigned unit, and failure to administer doctor
prescribed medication,
2) Retaliation for reported medical policy violations, which involves Dr.
Ducate’s, UTMB Director of Mental Health, denial of my direct medical monitoring
of my son’s health and medical progress and my direct access to my son’s medical
caregivers and their medical information about my son,
3) Non-access of a patient to have his private medical records, assessments,
diagnosis and treatment recommendations by his private physician’s in his UTMB/TDCJ
medical chart,
4) Medical policy violations, which includes failure of medical staff to respond
to medical crisis, failure to document patient’s chart with medically pertinent
events, failure to administer medications and forcing patients to take
medication against their will, and finally,
5) 8th Amendment violations of the mentally ill involving cruel and unusual
punishment and appalling prison conditions, which includes punishing mentally
ill in Ag Seg and keeping mentally ill in unhealthful living conditions that
contribute to injury or harm.
In order to understand our medical complaints, it is necessary to summarize
Chris’ medical background.
In 1999 and 2000, several doctors confirmed that Chris had been experiencing
very severe akathisia and psychosis caused by Zoloft (an antidepressant),
Risperidol (an antipsychotic) and Adderall (a stimulant) that lead to him
committing his 1999 offense.
Regrettably, the same medication problems that he experienced in 1999 that led
to his 1999 offense have recurred in TDCJ since some of these same harmful
antidepressant and antipsychotic medications were restarted again by UTMB in
August of 2001 against Chris’s will and against Chris’ private psychiatrist’s
strong warnings. These traditional antidepressant and antipsychotic medications
make Chris so dangerously ill that they cause a type of drug poisoning that
worsens his bipolar condition by causing medication-induced psychosis,
hallucinations and akathisia, i.e. “intolerable states of anguish” and
“uncontrollable suicidal-homicidal feelings”. These medication induced adverse
reactions are commonly known in the psychiatric community and have been
published in leading psychiatric medical journals as well as through the
National Institute of Health and the Physician’s Desk Reference. Generally, not
only has my son’s private psychiatrist confirmed the dangers of these drugs for
Chris, but also abundant scientific literature substantiates that both
antipsychotic and antidepressant medications cause akathisia, uncontrollable
aggression, impulsive behavior, mind-altering, thought-influenced cognition, and
withdrawal symptoms, especially in high-risk patients like Chris.
Please note the letters form my son’s private psychiatrist, his attorney,
Senator Moncrief, Representative Goodman, scientific evidence from research and
clinical studies, my letters to Chris’ UTMB doctors and the TDCJ/UTMB’s records
relating to my son’s worsened bipolar condition from the harmful drugs that were
administered to him.
Chris originally sought help at Clemens unit back in May of 2001 for depression.
He had been on a mood-stabilizer alone for about a year with no improvement in
his depression, but had not been psychotic, suicidal or hallucinating. When he
was put on traditional antidepressants in August of 2001, he began having
adverse drug reactions that induced these serious psychotic symptoms. At that
time, antipsychotic drugs were introduced to counter the antidepressant adverse
effects. Unfortunately, he experienced serious psychotic adverse affects from
the antipsychotic drugs, too. He was moved from doctor to doctor and from unit
to unit and over time the doctors, instead of reviewing his previous medical
history, incorrectly assumed that his psychotic condition was his normal state
of mind when, in fact, it was an iatrogenic phenomenon or doctor caused
drug-induced condition.
When Chris’ medical case was transferred to Dr. Michaels at Skyview unit last
November 2001, she inherited medication problems that had been created
previously by five other doctors before her. I have documented most of these
medication related medical errors that have been harming my son for almost 9
months. His medical record also documents some of the drug therapy failures,
however, there have been failures by the medical staff to document all medically
pertinent information. Since last December 2001, I have been working with Dr.
Michaels, and my son to resolve his medication hypersensitivity and adverse drug
reaction problems. I had built a relationship with Dr. Michaels. At her request,
I had provided her with numerous clinical studies pertinent to my son’s medical
needs and I provided medical information from my son’s private psychiatrist as
well as from other sources. Dr. Michaels was the first doctor to permanently
discontinue Chris from a class of antidepressant drugs (SSRI's and tricyclics)
that he has historically had therapy failures on every drug tried from this
class. She has also been discontinuing him from antipsychotic drugs, like
Risperidone, since she has also documented therapy failures in every drug tried
from this class, too. As a result of the medical evidence she gained through my
correspondence with her and through Dr. Scheffer’s medical records for Chris,
she began to implement the recommended depression treatment from Dr. Scheffer,
by ordering Lamictal, a non-formulary anti-seizure medication for treatment
resistant bipolar patients. However, she has not yet started the remaining
portions of Dr. Scheffer’s recommended therapy of Omega-3-fatty-acids and
vitamin E. Chris reported to Dr. Michaels and to me that he began to improve
several days after beginning the Lamictal medication and he has continued to
improve on this new medication to this date, though he is still being tapered
off of the Risperidone and experiencing drug withdrawals symptoms from that
medication.
The first reason that I am here today is because dangerous and deadly
psychotropic prescription drugs are being carelessly, excessively and
detrimentally used on prisoners who are suffering and even dying as a result of
the poor medical and correctional practices employed by TDCJ/UTMB. Though my son
finally has a competent doctor who is more responsive to his medical needs than
any other UTMB doctor has been and who is trying to reverse the damage that was
done to him by all of his previous UTMB/TDCJ doctors, there continues to be the
threat of medical harm by UTMB/TDCJ to my son. Not only do I want to ensure that
my son is totally removed from all harmful medications and that he is
administered the complete medication regimen recommended by Dr. Scheffer, but I
also want assurance that some other UTMB doctor at another unit of assignment,
when my son is later moved, will not disregard my son’s progress on these
non-formulary drugs and stop a successful therapy regimen, as is customary
whenever a TDCJ/UTMB patient is moved to a new unit of assignment.
I do not have
assurance that he will not be restarted him on harmful medications again as has
been previously done. Dr. Michaels told me that she cannot guarantee that this
will not happen because there is no guarantee that the last doctor can keep a
patient on non-formulary medication when the patient is eventually moved to a
unit of assignment because the non-formulary medications do not transfer
automatically and other unit doctors sometimes cannot or will not always use the
non-formulary medications, no matter how successful it previously was for the
patient. Additionally, Chris’ Lamictal medication was interrupted in April 2002
because it was not reordered in a timely manner by the medical staff and this
caused him to have a suicidal withdrawal condition.
Unfortunately, this medical policy violation of allowing critical and
non-formulary medication orders to lapse is not an uncommon medical situation,
therefore, I am concerned that this medical problem will continue to recur
unless your committee corrects it.
The second reason that I am here is to seek redress for the retaliation by UTMB
against me. My reporting of the drug order lapse as a medical policy violation
by Eddie Chastain is the reason for Dr. Ducate’s prejudicial retaliation against
me and unprecedented obstruction of my right to directly monitor my son’s health
and medical progress by preventing Dr. Michaels from being able to discuss my
son’s medical condition with me by threatening to fire her on the pretext of
“time constraints on the doctor" if she does talk to me. As I previously stated,
I had an ongoing relationship to help Chris' doctor exchange valid, pertinent
medical information to assist with and to monitor my son's progress, which is
still needed.
My records reflect that I have contacted Dr. Michaels 6 times by
phone since December 2001 and I have written 4 letters directly to her within
the time frame of the last 5 months. My time with Dr. Michaels has not been
excessive and had not previously been a “time constraint” problem until my
complaint against Eddie Chastain was responded to by damage control reactions.
Dr. Ducate’s decision is wrong, has no basis in existing policy, and is
particularly prejudicial against me since it is not being implemented across the
board at this TDCJ unit or at other units. There has been no proof of any other
families of inmate patients who have been treated in the same manner. This
policy denies me direct and immediate access to my son’s doctor and prevents me
from continuing to work in the patient’s best interest with his doctor. Dr.
Ducate’s recommended secondary source of indirect and limited access to medical
information through Huntsville will delay, filter, and modify his medical
information before I receive it. Also, this arrangement will not give my son or
me full recourse on medically urgent problems that arise that are not being
adequately addressed by UTMB/TDCJ medical staff and that have continued to this
day to occur. Going through a secondary source rather than a primary source for
medical information on my son at this juncture will definitely not improve the
current situation and may even allow it to worsen, given the previous crisis
that my son has been placed in by bad medicine administered by UTMB/TDCJ since
August 1, 2001.
My son's health and safety depend on this form of direct
advocacy for him to access to care and to obtain the quality of care which I
have been enabling for my son by my direct contact with his doctor. There is
still potential for more medical mistakes and harm to happen to this teenage
boy. Direct patient advocacy is still necessary because he has still not been
completely removed from all of the harmful medications that were wrongly
administered to him, which are continuing to cause him medical problems.
Moreover, he still has not been given the other half of the medication regimen
that Dr. Scheffer had recommended to include with the Lamictal medication which
will be necessary to repair the damage that was done to him. There is still a
threat that decisions made and agreed to previously by his doctor, him and me
for improved treatment and safety of the patient may be again changed to his
detriment. And finally, my son has repeatedly asked for my direct help with some
very serious medical problems that he has had. Dr. Ducate’s arbitrary UTMB
policy decision against me is inadequate because it fails to serve the patient’s
best interest given the fact that he is still only a teenager who is intimidated
into taking medications that his private psychiatrist advised him to refuse on
the basis of prior dangerous and deadly adverse reactions. It is also inadequate
given the fact that his UTMB medication history has been so problematic and was
caused by UTMB medical personnel. These circumstances predicate the ensuing need
for me provide direct check and balance on UTMB for the safety of the patient.
UTMB has a very poor track record for patient medical care to date, especially
with my son’s care. I fundamentally and adamantly disagree with Dr. Ducate’s
suggested alternative to obtaining medical information on my son through an
outside source. For nine months under the advice of my son’s private
psychiatrist, I have been trying to stop UTMB’s wrongful administration of
harmful medications to my son, though I have been met with UTMB/TDCJ resistance
and numerous system barriers to resolving these problems. His private
psychiatrist, Dr. Scheffer, had previously assessed that antidepressants,
especially SSRI’s, were harmful to Chris documenting this fact in the patient’s
private medical records. Dr. Scheffer advised Chris to explain to the UTMB
doctors that under medical advice he was refusing antidepressant medication
based upon previous adverse reactions. Dr. Scheffer also sent letters and Chris’
private medical records to the doctors, which were refused and ignored by the
first few UTMB doctors who prescribed the wrong medications and chemically
injured Chris. This intimidated teenager was unable to refuse the coercion by
the UTMB doctors to take their prescriptions because they were so relentless and
they also incorrectly told him that the same medication to which he had
previously experienced adverse reactions would not happen again.
Yet, other
published, reputable experts in this field have documented and advised the
medical community about harm caused to patients when they are not removed from
psychotropic medications to which a patient is having adverse reactions. These
other doctors in good standing have advised to immediately discontinue these
types of medications in a patient when it causes dangerous adverse reactions.
They have published this warning in accepted medical publications. These
warnings apply to patient treatment under the same or similar circumstances
according to the common set of medical standards establishing a reasonable legal
duty of care which requires psychotropic high risk medical treatment be
immediately discontinued when certain adverse drug reactions occur to prevent
doctor caused harm to patients, i.e. iatrogenic phenomenon. Several UTMB doctors
would not stop administering harmful medications to Chris, despite all of this
proof and despite that the UTMB doctors who themselves repeatedly documented
failures of their own antidepressant and antipsychotic therapies which continued
to cause increasingly dangerous and harmful adverse reactions in Chris so bad
that he almost died. Once, he lost 20 pounds in less than three weeks due to
these inappropriate medication changes. From most of the other medication change
occurrences, Chris would become suicidal from the medication or so over-sedated
that he was practically comatose.
The third reason that I am here is because of the current policies which deny
inmate patients from medical support by their outside, private physicians. I was
sent a TDCJ letter which explains that the UTMB doctor is allowed to determine
whether or not a private physician’s assessment is included in patient’s
records, despite the fact that the private physician has been authorized by the
patient and by a TDCJ through a doctor visit authorization form. The TDCJ/UTMB
rationale for allowing UTMB medical doctors to determine if a free world private
doctor's evaluations can be included in a TDCJ/UTMB patient’s medical chart is
because they want to prevent “garbage” from the private doctor, though this will
also prevent any legitimate private doctor's assessments that are in
disagreement with the patient's UTMB unit doctor, especially when the unit
doctor has a wrong patient diagnosis or has caused injury to the patient.
The fourth reason that I am here is because TDCJ officials have repeatedly told
me that the system is broken and that there is no real accountability for UTMB
and I have also experienced first hand that the system is broken when it comes
to correcting medical problems relative to access to and/or quality of health
care that inmates receive. Avenues for recourse involving health care problems
are inadequate to correct sometime serious medical problem situations. TDCJ has
no real power over UTMB because TDCJ can only make suggestions or
recommendations to UTMB regarding access to care or quality of care issues
concerning patients. I have further learned that the reason for this is that on
SEPTEMBER 1, 1994 the Texas Legislature deposed TDCJ from responsibility for
health care for employing all medical staff by establishing in its place the
Correctional Managed Health Care Committee to contract with UTMB. Because TDCJ
now contracts with a committee who contracts with UTMB, TDCJ’s role has changed
from managing and controlling UTMB to merely monitoring inmate’s access to and
quality of mental and medical health care without the authority to hold UTMB
accountable for any medical mistakes or wrongdoing.
The direct response of the UTMB executives that I have received when I have tried to get medical problems
corrected for my son is generally a rubber stamped form letter that not only
takes no responsibility for any medical problem, but also does not even
acknowledge that there is a medical problem. Within TDCJ, there is virtually no
real mechanism that holds UTMB accountable for medical negligence, malpractice
or medical policy noncompliance, which results from violations of the federal
court ordered RUIZ mandates. Even with a strong advocate as myself, the system
is so poorly designed and so problematic that it sets itself up for a lawsuit
for one to get any real resolution of a dispute. This can affirmed not only by
my son’s personal experience with life-threatening medical problems that were
caused by TDCJ/UTMB staff for almost a year, but also by the number of medically
related grievances still being received by TDCJ/UTMB to date and by the
substantial number of out of court cases being settled for medical injury
liability.
In my opinion, an overhaul of the existing organizational bureaucracy
and an outside third party along with external third party auditor is essential
to correcting existing systemic health care problems and to providing true
access to health care and to treatment ordered by medical professionals, and to
providing quality of care equivalent to the minimum legal standards that
establish physician competence requirements and public safety measures. Also,
thorough reporting of patient problems, adequate patient monitoring and
compliance to published safety guidelines for certain adverse drug reactions to
ensure safe medication dosing have not been strictly adhered to by medical staff
and that is another reason that I am requesting a change in the current UTMB/TDCJ
medical system. Inmate patients continue to receive harmful medications, which
are not recognized nor tested for dangerous adverse drug reaction side effects.
The fifth reason that I am here is because mentally ill inmate patients,
including my son, continue to be punished in Ag Seg. My son was locked up in Ag
Seg with nothing but a 3 foot sheet for several days. These practices contribute
to mental and emotional unstable conditions for a psychiatric patient. Also,
there are still living conditions in TDCJ prisons that are appalling. At the
Clemens unit in April and May of 2001, it took two months to fix a broken sink
for my son that the medical staff had already treated him twice for contaminated
water from the sink's plumbing and had documented in his medical chart that
contaminated drinking water from the sink was making both him and his cellmate
sick with fever. Additionally, Chris has experienced problems was lithium
toxicity several times since he has been on this drug due to the
unairconditioned and unventilated condition of some of the TDCJ facilities and
due to the lack of immediate response to emergency situations by TDCJ and UTMB
staff.
At Skyview, Chris had lithium toxicity symptoms. He had a sore and
swelling throat which is a hyperthyroidism condition that he previously had at
Clemens unit and had to be discontinued from lithium. He was throwing up every
day regularly for about two weeks from overheating from his lithium in
March-April 2002. However, when he reported his lithium toxicity symptoms to
medical staff nurses and Correctional Officers and even when he vomited in front
of them, all he was being told to do was to drink water and lie down. The
medical incident was not being properly documented to his medical chart nor was
his doctor notified, though this condition can be fatal.
Consequently, on 3/24/2, he had a psychotic episode that was most likely
triggered because he had lost so much fluid from sweating causing a lithium
toxicity reaction and because he kept vomiting his medications probably
decreasing the dosage level thereby possibly causing a drug induced psychosis or
discontinuation mania syndrome. Since I was restricted from being able to
contact any medical personnel directly after my son's attempts to correct his
medical problems had failed, I contacted the assistant warden to request a fan
be given to my son for medical reasons because Chris fan had broken and had been
prohibited from purchasing a new fan at that time. These medical problems could
have and should have been prevented, but could not be avoided because the
medical system to do so is inefficient, ineffective and broken.
Thank you for listening to my concerns today. I hope that you will take
appropriate action to correct the UTMB/TDCJ systemic problems, which have
prevented reliable, adequate access to mental health care and which have caused
poor, unsafe quality of mental health care for my son. Specifically, the actions
that I am requesting relative to my son’s mental health care problems in TDCJ/UTMB
are as follows:
1) Repeal the September 1, 1994 TDCJ/UTMB reorganization legislation which does
not protect the health and welfare of the inmate patients and establish a third
party medical advocacy separate from TDCJ or UTMB as a check and balance for
patients with diminished mental and physical capacities who have experienced
medically harmful situations and who have on-going unresolved medical problems.
2) Amend the non-formulary policy to provide a guarantee that a patient will
continue to receive doctor prescribed critical drug therapy at any unit of
assignment, which means that a successful non-formulary therapy, like Lamictal,
will not be interrupted and/or discontinued when the patient is moved, and amend
the non-formulary policy to include over-the-counter prescribed vitamin and
mineral supplements, like essential fatty acids, that are part of a medication
treatment plan or allow the supplements to be added to the commissary, i.e.
ensure that the Dr. Scheffer’s remaining recommended prescription regimen of
Omega-3-fatty-acids and vitamin E will be given to Chris.
3) Revise the current policy for private doctors to provide their inmate
patients with their private physician’s records, assessment, diagnosis and
treatment recommendations of his patient will go into the patient’s permanent
TDCJ/UTMB medical chart. Also, provide some recourse, other than the current
recourse, to challenge UTMB doctors and to seek and receive treatment from a
private or third party medical group when UTMB doctors’ treatment fail to meet
health needs of a patient or has caused injury to a patient. Due to
vulnerability and diminished capacities of mentally ill patients, they need an
outside third party to advocate for at least the minimum medical standards
established by law for their health care needs. Inmate patients need the ability
to be able to improve medical care by having access to a private physician to
provide some level of assessment, diagnosis and care when current medical care
is not only unhelpful, but is also harmful.
4) Reverse the illegal, retaliatory, prejudicial decision of Dr. Ducate, which
prevents my son’s doctor and counselor from discussing his health and medical
progress with me. Thank you for addressing and taking actions to correct these
mental health care problems in TDCJ/UTMB.
