D.C. Dept. Mental Health -- Inadequate Treatment -- 2005

May 25, 2005
3801 Connecticut Avenue, NW
Apartment 136
Washington, DC 20008
Telephone: 202 362-7064

Henry Barbot, M.D.
1125 Spring Road, NW
Washington, DC 20020-1421

Dear Dr. Barbot:

You have recommended that I arrange a routine physical exam. I decline to do so at this time, as a form of protest against serious inadequacies in my mental health treatment, which are outlined in this letter. My aim is to draw attention to the mental health problems that I face, which are not being addressed appropriately by this facility.

1. I have been a patient of the DC Department of Mental Health System since July 1996, nearly nine years. My quality of life and my mental state are as poor now as they have ever been since my entry into the system. I suffer from chronic feelings of futility, apathy and a sense of meaninglessness. My psychological distress is ever-present, and moderate to severe in intensity.

I spend a lot of time lying on my couch in my apartment, just staring into space.

2. I suffer from chronic insomnia, moderate to severe in intensity. The condition is not being addressed by available medications at appropriate doses. I obtain significant relief of symptoms with Ativan at a dose of 2 mg/day (at bedtime). Several months ago I requested an Ativan prescription, but you declined to prescribe the medication and instead prescribed Klonopin at 0.5 mg/day (at bedtime). I find it incomprehensible that you would believe that 0.5 mg of Klonopin would remedy moderate to severe chronic insomnia.

3. I am totally isolated. I have no family, friends, or acquaintances. I go for weeks at a time without interacting with anyone. I experience my relationship with Dr. Bash as aversive. I believe that Dr. Bash and I are absolutely incompatible as patient and therapist. I believe that Dr. Bash has nothing to offer me as a therapist. I have chosen to see Dr. Bash monthly instead of weekly, which increases my lack of human interaction. My social isolation constitutes a major psychosocial stressor that adversely impacts my mental state.

4. I have not worked since October 29, 1991, nearly fourteen years ago. I am interested in obtaining part-time employment. By letter dated November 17, 2004 (six months ago), my case manager Dr. Bash was specifically directed in writing by the Workforce Development Bureau of the DC Department of Employment Services (Daryl Hardy, 698-5146) to prepare a written report summarizing my mental state that would permit the agency to assist me in a job search. Dr. Bash refuses to prepare such a report, thereby impairing my ability to find employment. I advised Dr. Bash that I was interested, alternatively, in the District's Supportive Employment Program, administered by Gail Newman (576-5783) at Spring Road. Dr. Bash has attempted to dissuade me from getting involved with the Supportive Employment Program; her rationale is that my job skills are too advanced for the program, which is geared to low-functioning patients.

RECOMMENDATIONS:

1. I request that my depression be assessed and that aggressive measures be instituted to treat the illness. Perhaps medications other than Effexor, singly or in combination, might be effective. Also, the limitations of medication in remedying my depression need to be considered. As noted above my social isolation constitutes a major psychosocial stressor that adversely impacts my mental state. Medication cannot compensate for exogenous sources of mental distress.

2. I request that aggressive measures be instituted to treat my insomnia. I read one research study that found that Paxil (Paroxetine) is useful in the treatment of insomnia. Treatment in the form of 0.5 mg/day of Klonopin is a pitiful joke. Note that Klonopin can be prescribed in amounts up to 20 mg/day. I request that I be switched back to Ativan at 2 mg/day. I note that a previous treating psychiatrist (Louis C. Alikakos, MD, now deceased) recommended that I take Ativan at 6 mg/day.

3. I request that my relationship with Dr. Bash be terminated as quickly as possible and that some other therapist be assigned. I note that on March 17, 2004 Dr. Betsy Jane Cooper assured me that my relationship with Dr. Bash would be terminated effective immediately. Dr. Cooper never followed up on her promise. Perhaps Dr. Smothers, as a professional courtesy, would be willing to take me on as a Medicare psychotherapy patient in his private practice.

4. I request that personnel at the Spring Road Clinic provide appropriate assistance in helping me find part-time employment. Such assistance might include the preparation of written reports as requested by the DC Department of Employment Services.

I don't want to sound alarmist, but frankly I can't see living another thirty years like this.

Sincerely,

Gary Freedman

cc: Ms. Donaldson