October 12, 1999
3801 Connecticut Avenue, NW
#136
Washington, DC 20008-4530
Albert H. Taub, M.D.
Community Mental Health Center
3246 P Street, NW
Washington, DC 20007
(202) 282-2229
Dear Dr. Taub:
At my last consultation with Dr. Shaffer (October 6, 1999) we reviewed the issue of medication. Both Dr. Shaffer and I agreed that I might benefit from antidepressant medication. Dr. Shaffer stated that she did not believe that antipsychotic medication was indicated.
The enclosed statement reviews issues relating to my treatment history as those issues pertain to the prescription of antidepressant medication administered singly.
As you know, paranoid schizophrenia is considered a contraindication for antidepressant medication administered singly, not in combination with other drugs.
The enclosed statement raises ethical and legal questions about inconsistencies in my treatment at the P Street Clinic: specifically, the appearance that you offered a disingenuous and self-serving clinical assessment of me to the D.C. Medical Board (Dx: paranoid schizophrenia; Rx: Zyprexa) simply to evade further scrutiny by the Board.
There is a further concern that your previous (self-serving) clinical assessments and treatment recommendations now preclude your prescribing antidepressant medication, the appropriate medication from which I might derive genuine benefit.
Sincerely,
Gary Freedman
Statement of Albert H. Taub, M.D., Made in Contemplation of Medical Prescription
INFORMED CONSENT
I, Albert H. Taub, M.D., a physician licensed to practice in the District of Columbia, and an employee of the Government of the District of Columbia (Commission on Mental Health Services [CMHS]), make the following statement in contemplation of prescribing antidepressant medication to my patient, Gary Freedman, CMHS patient no. 230923.
Mr. Freedman has been determined by the U.S. Social Security Administration (SSA) to have been continuously disabled since October 29, 1991, the date of his job termination by a local law firm, where Mr. Freedman had been employed as a paralegal.
During the period September 1992 to June 1996 Mr. Freedman underwent out-patient psychiatric treatment at the George Washington University Medical Center Department of Psychiatry. Mr. Freedman was admitted to the CMHS in mid-year 1996, where he currently receives weekly psychotherapy with staff psychologist Nancy Schaffer, Ph.D. Mr. Freedman consults with me approximately once per month for the purpose of assessing his overall status as well as the indications for medical therapy.
On the basis of my consultations with Mr. Freedman, as well as the recommendations of his current psychotherapist, I believe that Mr. Freedman might derive limited benefit from a course of therapy on antidepressant medication (Paxil), for the symptom chronic low-grade depression or dysthymia.
I affirm that my current medical recommendation is appropriate, notwithstanding the following facts relating to Mr. Freedman's psychiatric treatment history and past employment difficulties.
1. I understand that the George Washington University Medical Center Department of Psychiatry (GW) diagnosed Mr. Freedman as suffering from bi-polar disorder (rule out: schizoaffective disorder) in September 1992, for which Mr. Freedman was prescribed lithium by his treating psychiatrist Suzanne M. Pitts, M.D., for an approximate two-week period in February 1993.
I understand that Mr. Freedman declined to take Haldol, a neuroleptic that was recommended by Dr. Pitts, in August 1993.
I offer no opinion as to the appropriateness of Mr. Freedman's psychiatric treatment in the period prior to his admission by the CMHS, in mid-year 1996.
I understand that Mr. Freedman's previous diagnoses (bi-polar disorder and r/o schizoaffective disorder) are considered contraindications for antidepressant medication administered singly, not in combination with other drugs.
2. I affirm that Mr. Freedman underwent comprehensive psychological testing at GW in May 1994. The testing was administered by a psychology intern (Yu-Ling Han) under the supervision of GW staff psychologist William Fabian, Ph.D. The bill for the testing, prepared by Dr. Fabian, states the diagnosis delusional (paranoid) disorder.
I offer no opinion as to the appropriateness of any psychiatric diagnoses assigned to Mr. Freedman in the period prior to his admission by the CMHS, in mid-year 1996.
3. I affirm that in February 1996 Mr. Freedman's treating psychiatrist at GW, Dimitrios Georgopoulos, M.D., diagnosed Mr. Freedman as suffering from paranoid schizophrenia, but that Mr. Freedman declined to take the (unspecified) neuroleptic recommended by Dr. Georgopoulos. See Letter dated February 14, 1996 from Dr. Georgopoulos to Mr. Freedman.
I offer no opinion as to the appropriateness of Mr. Freedman's psychiatric treatment in the period prior to his admission by the CMHS, in mid-year 1996.
I understand that Mr. Freedman's previous diagnosis (paranoid schizophrenia) is considered a contraindication for antidepressant medication administered singly, not in combination with other drugs.
4. I affirm that the U.S. Social Security Administration re-certified Mr. Freedman's disability claim in mid-year 1997 on the basis of a written clinical assessment provided to the agency by Mr. Freedman's treating psychiatrist at CMHS, Dr. Singh.
5. I affirm that I am aware that Mr. Freedman forwarded a letter dated January 24, 1998 to Dr. Singh (and copied to the Office of Independent Counsel, Kenneth W. Starr, Esq.) asserting that Mr. Freedman had been informed by his CMHS treating psychiatrist, Dr. Singh, on January 19, 1998, that it was the opinion of Dr. Singh as well as attending physician Steven D. Quint, M.D., that Mr. Freedman did not suffer from paranoid schizophrenia or any illness for which medication is indicated.
I offer no opinion as to the truth of the matters asserted in the said letter.
6. I affirm that I became Mr. Freedman's treating psychiatrist in early August 1998, and that shortly thereafter I recommended that Mr. Freedman take the neuroleptic, Zyprexa. Mr. Freedman declined to take the medication as I recommended.
7. I affirm that I advised the District of Columbia Board of Medicine (James R. Granger, Jr.) in writing, in response to a complaint filed by Mr. Freedman, that Mr. Freedman suffered from paranoid schizophrenia, an illness of long-standing duration, for which I had recommended a neuroleptic, which Mr. Freedman refused to take. See Letter dated February 22, 1999 from Albert H. Taub, M.D. to the D.C. Board of Medicine (James R. Granger, Jr.) ("In view of Mr. Freedman's long record of mental illness (paranoid schizophrenia) I recommended antipsychotic medication which he refused . . . .")
I understand that the diagnosis paranoid schizophrenia is considered a contraindication for antidepressant medication administered singly, not in combination with other drugs.
8. I affirm that Lisa Osborne, Mr. Freedman's CMHS psychotherapist (July 31, 1998 to September 3, 1999), prepared a Treatment Plan, per CMHS protocol, dated August 1999; the Treatment Plan, which I approved, states Mr. Freedman's current diagnosis as: Axis 1 -- rule out ("r/o") paranoid schizophrenia, r/o delusional (paranoid) disorder; Axis 2 -- narcissistic personality disorder. I affirm that I met with Mr. Freedman together with Lisa Osborne on September 3, 1999, at which time Mr. Freedman reviewed and signed the Treatment Plan.
I affirm that I cannot now certify with certainty that Mr. Freedman suffers from paranoid schizophrenia; and that Mr. Freedman's current diagnosis, as stated in his current Treatment Plan, reflects a change in the diagnosis I reported to the D.C. Board of Medicine in February 1999, eight months ago.
I understand that the diagnosis paranoid schizophrenia is considered a contraindication for antidepressant medication administered singly, not in combination with other drugs.
9. I affirm that Mr. Freedman continues to hold a body of beliefs, including the belief that he is under surveillance by his former employer as well as the President of the United States. I affirm that these beliefs are genuine and long-standing, but that, consistent with Mr. Freedman's current Treatment Plan, these beliefs do not support the diagnosis paranoid schizophrenia or any psychotic mental illness.
I affirm that I am aware of a letter dated July 31, 1999 that Mr. Freedman forwarded to Robert S. Bennett, Esq., the president's attorney, that evidences the genuine and long-standing nature of Mr. Freedman's beliefs.
10. I offer no opinion as to whether antidepressant medication, which I now recommend, might affect Mr. Freedman's suitability for employment per SSA rules.
I recommend antidepressant medication for Mr. Freedman for the symptom of chronic low-grade depression only.
11. I affirm that I am aware that Mr. Freedman's former employer, the Washington, D.C. office of the law firm of Akin, Gump, Strauss, Hauer & Feld, terminated Mr. Freedman's employment in October 1991 because of concerns about Mr. Freedman's mental health and stability, including the potential for violence. I am aware that the firm's termination decision was made in consultation with a psychiatrist, Gertrude R. Ticho, M.D. I am further aware that the employer's stated reasons for the termination were deemed genuine by the District of Columbia Department of Human Rights and Minority Business Development, as affirmed by the District of Columbia Court of Appeals, Freedman v. D.C. Dept. Human Rights, D.C. no. 96-CV-961.
(notary's signature and stamp)
__________________________________
ALBERT H. TAUB, M.D. (date)
PATIENT CERTIFICATION
I, Gary Freedman, affirm that I have read the above informed consent statement, and that I understand the purposes for which Dr. Taub recommends that I take antidepressant medication to be administered singly, not in combination with other drugs.
__________________________________
GARY FREEDMAN (date)
I certify that I met with Dr. Taub on October 15, 1999; that Dr. Taub refused to sign the above statement; but that I agreed to take antidepressant medication (Paxil), relying on Dr. Taub's professional opinion that the above concerns are not valid contraindications for Paxil.
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