September 7, 1993
3801 Connecticut Avenue, NW
Washington, DC 20008
Warren Strudwick, MD
District of Columbia Board
605 G Street, NW
Washington, DC 20001
Dear Dr. Strudwick:
Further to my letter to you dated August 20, 1993 I enclose a copy of the psychiatric assessment, dated September 24, 1992, prepared by Napoleon Cuenco, psychiatry resident at the George Washington University Medical Center. The psychiatric assessment chart was provided to me on September 2, 1993 pursuant to the patient disclosure provision of the District of Columbia Mental Health Information Act.
You will observe that the 4-page chart includes only one (somewhat vague and impressionistic) reference to paranoid thought processes: “He has paranoid ideations which occasionally bordered on a delusional level.” (Mental Status Examination, page 3).
My belief that previous mental health professionals whom I consulted had been in communication with my former employer, the law firm of Akin, Gump, Strauss, Hauer & Feld, is reported without comment: “Patient reportedly terminated whenever he felt that the therapists were in communication with his employers [sic] or were no longer helpful to him.” (Psychiatric History, page 2).
Treatment recommendations (p. 4) do not refer at all to paranoia but focus instead exclusively on “unresolved grief,” “sexual orientation,” and “interpersonal difficulties.” Further, it would appear from the context of Dr. Cuenco’s recommendations that a neuoleptic is recommended for hypomanic symptoms and not for paranoid symptoms. (Note that a sentence on p. 2 of the chart contains a misstatement of a material fact: “Patient reports that one of his former psychiatrists [Stanley R. Palombo, MD] recommended a trial of Lithium and neuoleptic because of concerns that he may be manic depressive.” In fact, on no occasion did Dr. Palombo recommend a neuoleptic; he did on one occasion state his willingness to prescribe Lithium.)
Prior to the first evaluation on September 1, 1992 I had submitted to GW’s Department of Psychiatry a copy of my autobiographical sketch, which was, in turn, submitted to Dr. Cuenco, presumably by attending psychiatrist, Daniel Tsao, MD. At the commencement of the evaluation session on September 1, 1992 Dr. Cuenco acknowledged that he had read the writing. One section of the writing details various of my unsubstantiated and systematic beliefs that centered on my former employer. Specifically, the writing refers to my belief that my former employer had been in communication with one of my former psychiatrists, that I was a victim of harassment by co-workers, that my former employer had been in communication with my sister, and that my former employer had sent a copy of the autobiographical sketch to various experts. The writing also suggests by implication tat Mr. Robert S. Strauss, a founding partner of the law firm of Akin Gump, Strauss, Hauer & Feld, my former employer, had taken some special interest in me.
Despite the systematic and unsubstantiated nature of the aforementioned beliefs, suggestive of a paranoid (delusional) disorder, Dr. Cuenco did not examine these beliefs in detail at the evaluation conducted in September 1992. Also, the enclosed chart indicates that these seemingly paranoid beliefs did not figure in Dr. Cuenco’s treatment recommendations. One wonders why Dr. Cuenco chose largely to ignore what should have appeared to be a systematic delusional thought process suggestive of a paranoid disorder.
A copy of the relevant portion of the autobiographical sketch, which Dr. Cuenco acknowledged having read, is enclosed.
The Medical Board's Disposition of the Complaint: