GW: The Amazing Adventures of the Cavalier Stuart Sotsky, M.D.

Effective June 30, 1996 my out-patient psychiatric treatment by Dimitrios Georgopoulos, M.D. was terminated upon the completion of Dr. Georgopoulos' residency training program at the George Washington University Medical Center Department of Psychiatry. GW adopted changes requiring patients to be members of GW's insurance plan.  Dr. Georgopoulos had promised, but, in fact, did nothing to help me find alternative psychiatric treatment. I found GW's handling of my case to be suspect in view of my diagnosis -- paranoid schizophrenia, a debilitating psychotic disorder -- as well as the fact that information from several seemingly reliable sources indicated I could become violent, even homicidal.

Was GW's handling of the termination of treatment consistent with sound medical practice in view of all the facts of my case? Did GW's cavalier handling of my termination constitute an admission that the diagnosis "paranoid schizophrenia" was not made in good faith? Did GW's handling of my case indicate that it was privy to information about my nonviolent nature that was supplied by my former employer, the law firm of Akin, Gump, Strauss, Hauer & Feld? Is the following memo that I wrote in May 1996 consistent with the thought process of someone suffering from paranoid schizophrenia or, alternatively, consistent with my being a nonpsychotic lawyer trying to engage in a power play?

I did not meet with Dr. Sotsky about this memo; he never requested a meeting. In fact, I have never met Dr. Sotsky, who was the Psychiatry Department's head of out-patient care.

TO: Stuart M. Sotsky, M.D.

FROM: Gary Freedman
DATE: May 21, 1996 (hand delivered 5/22/96)
RE: Psychotherapy Termination - Risk Assessment Issues
__________________________________________

I am currently undergoing out-patient psychiatric treatment at the George Washington University Medical Center Department of Psychiatry. My current treating psychiatrist, Dimitrios Georgopoulos, M.D., chief psychiatry resident, has advised me that my psychiatric treatment will be terminated at the end of June 1996 due to policies recently adopted by the Medical Center relating to residency training.

This will confirm that Dr. Georgopoulos has assured me that he is engaged in efforts to locate appropriate alternative therapy for me.

http://dailstrug.blogspot.com/2009/11/gw-dropped-me-like-any-ordinary-patient.html

This memorandum is intended to apprise the Medical Center of risk assessment issues relevant to a consideration of the appropriate standard of care required of the Medical Center in its disposition of my case, with respect to both (1) possible future legal exposure of the Medical Center (and individual psychiatrists associated with the Medical Center ), and (2) compliance with the ethical standards of the medical and psychiatric professions.

You may wish to review this matter with he University’s legal counsel.

PERTINENT RISK ASSESSMENT ISSUES:

1. My current diagnosis is schizophrenia, paranoid type (295.20) (subtype unspecified). See Letter dated February 14, 1996 from Dr. Georgopoulos to Gary Freedman. The cognitive impairment characteristic of this disorder may significantly impair the ability of a patient diagnosed with the disorder to carry out reasonable and appropriate efforts to locate psychiatric treatment on his own. See e.g. Spitzer, R. L., et al. DSM-III-R Case Book at 30 (Washington ,DC: American Psychiatric Press, 1989).

2. I have been called in for questioning on two occasions by the U.S. Secret Service with respect to concerns that I may pose a risk of harm to President Clinton and Mrs. Hillary Rodham Clinton The most recent interrogation was on February 16, 1996.

3. I continue to have fantasies about the President of the United States. See e.g. Letter to Dr. Georgooupolos, dated January 22, 1996.

4. I continue to have fantasies about designing weapons of mass destruction. See Letter to Dr. Georgopoulos, dated May 6, 1996 (Appendix).

5. I have been unemployed since late October 1991.

6. My last employer, the law firm of Akin, Gump, Strauss, Hauer & Feld (Akin Gump), terminated my employment, effective October 29, 1991, upon determining, in consultation with psychiatrist, that I was mentally unstable and might commit an act of violence. The employer has expressly stated in writing that its termination decision was prompted by a concern for the safety of firm personnel: that to permit me to remain on the firm’s premises might expose the firm to possible future legal liability.

7. My direct supervisor at Akin Gump advised her staff at the time of my termination that I might be homicidal.

8. Shortly after my job termination senior supervisors at Akin Gump secured an office suite against a homicidal assault that they feared I might commit.

9. In August 1989 a co-worker at Akin Gump stated to me: “We’re all afraid of you. We’re all afraid you’re going to buy a gun, bring it in, and shoot everybody.”

9. The District of Columbia Corporation Counsel, the highest legal officer of the District, filed a document with the Superior Court of the District of Columbia on May 17, 1996, that states that the fears of senior supervisors and managers at Akin Gump concerning my potential for violence (including murder) were genuine and not pretextual in nature. See Brief of Respondent in Opposition to Petition for Review of No Probable Cause Determination by Department of Human Rights, filed May 17, 1996 (“Brief of Respondent”).
[paragraph 9 was misnumbered in the original document.]

10. The District of Columbia Corporation Counsel now maintains that I am even more disturbed and potentially violent than Akin Gump could have possibly feared at the time of my job dismissal. See Brief of Respondent at pp. 2-8, filed May 17, 1996.

11. I have requested of Dr. Georgopoulos on numerous occasions, both orally and in writing, that he offer a simple statement to Akin Gump management that I do not pose a risk of violence. Dr. Georgopoulos has consistently and steadfastly refused to offer such a statement that I do not pose a risk of violence, including disposition to commit murder or other heinous crime.

12. I am totally isolated socially and rely on my twice-weekly psychotherapy sessions at GW as my only contact with the outside world. I have no friends. My only sibling is a sister who lives in New Jersey whom I have not seen since September 1992 and whom I have not spoken with since early February 1996.

13. I subjectively experience my situation as desperate. I feel entrapped and hopeless. I have the growing feeling that I have nothing to lose.

14. I appear to fit the psychological profile of the severely disturbed loner, capable of acts of extreme and heinous violence. (John Hinckley, Jr., found not guilty by reason of insanity in the attempted assassination of former President Ronald Reagan, has been diagnosed as suffering from paranoid schizophrenia).

15. A memorandum written by Suzanne M. Pitts, M.D., my former treating psychiatrist at GW, to Stuart Sotsky, M.D. (Director of GW Psychiatry Department Out-Patient Care) in April 1994 makes a strong case for continuing my psychotherapy. Presumably, the memorandum highlights areas of severe psychopathology in my personality, and was a factor in the Medical Center’s decision to continue my treatment beyond the completion of Dr. Pitts’ residency in late June 1994.

16. On August 19, 1993 I met with Jerry M Wiener, M.D., GW psychiatry department chairman, in his office. Dr. Wiener stated to me that I was a psychological cripple--that my paranoia had crippled my life. On the evening of August 19, 1993 I spoke by telephone with my sister, and communicated Dr. Wiener’s statements to her. I provided a tape recording of that telephone conversation to Dr. Georgopoulos and to the Office of U.S. Attorney (Eric H. Holder, Jr.).

17. I underwent psychological testing at GW in May 1994. William Fabian, Ph.D. assigned the following diagnosis: Delusional (Paranoid) Disorder. The test report states that I may not have a good psychological coping mechanism; that further psychotic decompensation is possible; and that I may have lied on the tests in order to conceal the nature and severity of my illness.

18. I underwent additional psychological testing at GW on March 11, 1996, administered by Ramin Mojtabai, M.D. The test report states that the results, though negative, are consistent with the existence of a delusional disorder. (Results of Wisconsin Scales of Psychosis Proneness: 6 nonperseverative errors).

19. I have been determined to be unemployable by the U.S. Social Security Administration, and currently receive disability benefits paid by that agency. The assessing psychiatrist for the U.S. Social Security Administration, Paul G. Yessler, M.D., who performed a psychiatric assessment of me in June 1993 in connection with my disability claim, is a clinical professor of psychiatry ay the George Washington University Medical Center. I do not know what communications, if any, Dr. Yessler may have had with staff psychiatrists at GW concerning my case, or whether any information provided to Dr. Yessler by GW staff psychiatrists (including psychiatry residents) may have influenced statements made by Dr. Yessler in his medical report to the U.S. Social Security Administration.

Issues Pertinent to Medical Management:

20. On no occasion during my psychiatric treatment at GW have I ever refused to take medication in a situation in which a psychiatrist wrote out a prescription, and advised me to take the medication as prescribed.

21. In February 1993 Suzanne M. Pitts, M.D. prescribed lithium for the treatment of a supposed bi-polar disorder. I duly took the medication as prescribed. As assay performed in late February 1993, the results of which are maintained in my medical records, should indicate a lithium serum level consistent with my having diligently taken the medication as prescribed. I discontinued the lithium; it was later confirmed that I did not suffer from bi-polar disorder, and that Dr. Pitts had misprescribed the medication (Paranoid schizophrenia is a rule-out for bi-polar disorder. See Spitzer, R. L., et al. DSM-III-R Case Book at 30 (Washington, DC: American Psychiatric Press, 1989)).

22. In August 1993 Dr. Pitts recommended that I take the anti-psychotic Haldol. I repeatedly stated that I was eager to take the medication if she could establish a causal link between the target symptoms of the medication and significant interpersonal difficulties I have experienced, namely, (1) a causal link between the target symptoms of Haldol and the fact that I was fired from my job despite an outstanding work performance; (2) a causal link between, on the one hand, the target symptoms of Haldol and, on the other, the fact that I was totally socially isolated at Akin Gump but simultaneously initiated frequent social contacts with several persons from a previous place of employment; (3) a causal link between the target symptoms of Haldol and the act of Akin Hump managers in fabricating evidence of mental disturbance, etc. Dr. Pitts consistently refused or was unable to establish such a causal link.

It is noted, incidentally, that the DSM-IV recognizes the principle (with respect to one mental disorder, dysthymia) that symptoms alone in the absence of impaired work or social functioning are not sufficient to establish a diagnosis, or, by implication, indicate the need for medical management. It is true that I am currently unemployed, but it has not been demonstrated that the remediation of the target symptoms of any drug might have prevented my job termination, encouraged me to seek employment, or allowed me to retain employment.

In the weeks prior to my job termination, in late October 1991, I asked my then treating mental health counselor, William D. Brown, Ph.D., whether I should be taking a tranquilizer. Dr. Brown advised me that I did not need a tranquilizer. The American Psychological Association (APA), which reviewed Dr. Brown’s handling of my case, found that Dr. Brown’s nonmedical psychological management did not warrant disciplinary action. See Letter dated September 23, 1993 from Betsy Ranslow (APA Director of Investigations--Ethics Office) to Gary Freedman: “I have now had the opportunity to carefully evaluate your complaint against William D. Brown of Washington, D.C. [based in part on Dr. Brown’s failure to make a referral for medical management to treat a delusional disorder]. Your complaint has been evaluated independently by the Chair of the APA Ethics Committee and by me. On the basis of a review of all of the information related to this matter, we have decided not to open this matter up for a formal ethics case and to close it under the provision of Part V, Section 5.4 of the 1992 Rules and Procedures.” The cited Rules prohibit a psychologist from treating a client where the severity of the client’s illness exceeds the psychologist’s competence. My symptomatology has remained unchanged since late October 1988.

23. I have repeatedly stated to both Dr. Pitts and to Dr. Georgopoulos that I am willing to take the anti-depressant Prozac, which was recommended by a previous treating psychiatrist, Stanley R. Palombo, M.D., in 1990. Dr. Georgopoulos and Dr. Pitts refused to prescribe Prozac on the grounds that Prozac is contra-indicated in my case. My symptomatology has remained unchanged since late October 1988.

24. My medical record at GW contains a recommendation that I take anti-depressant medication. See Report of Psychological Testing, approved by William Fabian, Ph.D., dated May 1994. Jerry M. Wiener, M.D. has expressly refused to comment on (or modify) any portion of the test report, including the recommendation that I be prescribed an anti-depressant. See Letter from Jerry M. Wiener, M.D. to Gary Freedman, dated October 4, 1994.

GARY FREEDMAN

cc: The Washington Post (tentative)
D.C. Board of Medicine (tentative)

If you were Dr. Sotsky wouldn't you have said to yourself upon reading this disturbing memo: "I need to meet with this individual. This is serious. Weapons of mass destruction? Murder? Paranoid Schizophrenia? Severe social isolation? Unemployment?" That was not Dr. Sotsky's response. This post cries out the question: "Why?"