D.C. Medical Board -- Letter of Complaint (1993)

August 20, 1993
3801 Connecticut Avenue, NW
Apt. 136
Washington, DC 20008

Warren Strudwick, M.D.
District of Columbia Board of
    Medicine
605 G Street, NW
Washington DC 20001

Dear Dr. Strudwick:

The following statement is intended to apprise the District of Columbia Board of Medicine of possible serious improprieties, relating to violations by various physicians licensed to practice medicine in the District of Columbia. Certain of the physicians, including my current treating psychiatrist, are associated with the Department of Psychiatry of the George Washington University Medical Center.

Previous versions of this letter were submitted to (1) Dr. Arthur Isack (tel. no.: 202 994-4083), Executive Director of the George Washington University Medical Center Medical Faculty Associates, on August 6, 1993, and (2) Ms. Betsy Ranslow (tel. no. 202 336-5500), Director of Investigations, Office of Ethics, American Psychological Association, on August 9, 1993.

I also submitted, on August 17, 1993, a version of this letter to Dr. Jerry M. Wiener, Chairman of the Department of Psychiatry, George Washington University Medical Center. I met with Dr. Wiener on August 19, 1993 to provide him, as a representative of the university, an opportunity to comment on this letter prior to submitting the letter to the Distinct of Columbia Board of Medicine.  Dr. Wiener acknowledged that he had  read the letter, stated that the content of the letter did no more than reveal my paranoia, and declined to investigate the matter. The action of Dr. Wiener, a representative of the university, in refusing to investigate possible wrongdoing by the herein named physicians associated with the George Washington University Medical Center Department of Psychiatry may constitute a ratification by the university itself of any and all possible wrongdoing by said physicians. Further, Dr. Wiener’s action in refusing to investigate this matter may indicate Dr. Wiener’s own complicity in the possible wrongdoing described below.

It is my belief that each of the following mental health professionals (with the possible exception of Stephen Stein, Ph.D.) has been in communication with attorney managers of my former employer, the law firm of Akin, Gump, Strauss, Hauer & Feld (“Akin Gump,” “employer,” “former employer,” or “firm”) and has divulged confidential mental health information to my former employer without my consent in violation of the confidentiality provisions of the (1) District of Columbia Mental Health Information Act, D.C. Code Sec 6-2002, and the (2) District of Columbia Health Occupations Revision Act of 1985, D.C. Code Sec. 2-3305.14(16).

The facts stated below are insufficient to establish that any of the named mental health professionals has violated any law or committed any ethical infractions. However, the facts viewed in their entirety present a curious picture.

The following statement sets forth facts relating to my psychological and psychiatric treatment history during the period January 1990 to the present.

1. Stanley R. Palombo, M.D.

(a) Dr. Palombo is a psychiatrist, licensed to practice in D.C. His office is located at 5225 Connecticut Avenue, NW, Washington, DC (tel. no.: 202 362-6004).  Dr. Palombo is an associate clinical professor of psychiatry at the George Washington University Medical Center.

(b) I had weekly consultations with Dr. Palombo during the period late January 1990 until early December 1990. I had two additional consultations--on February 28, 1991 and October 2, 1992 (the consultation on October 2, 1992 was arranged by Dr. Napoleon Cuenco, a George Washington University psychiatry resident, in connection with an evaluation by the George Washington University Medical Center prior to my commencing therapy at that institution in late October 1992).

(c) At the time of my therapy with Dr. Palombo I was employed at the law firm of Akin Gump in the capacity of legal assistant (paralegal). I was employed at Akin Gump from June 13, 1988 until October 29, 1991, at which time my employment was involuntarily terminated.

[Akin Gump terminated my employment after consulting Gertrude R. Ticho, M.D., a D.C. licensed psychiatrist and a GW clinical professor of psychiatry, who, according to the firm, advised the firm’s senior managers that a harassment complaint I had lodged against my supervisor and other firm personnel on October 23, 1991 and October 24, 1991, was the product of a psychiatric disorder (“ideas of reference”) and that I might become violent. The ex parte consult violated the American Psychiatric Association’s Goldwater Rule, which prohibits a psychiatrist from offering a professional opinion without (1) examining the individual in person and (2) obtaining a written consent to publish the opinion.  In 1995 (after this letter of complaint) the D.C. Code was revised to make it unlawful for a physician to "[fail] to conform to standards of acceptable conduct and prevailing practice within a health profession." See D.C. Code 2-3305.14(26).

The D.C. Department of Human Rights admitted in June 1993 that Akin Gump sought and was provided by Dr. Ticho an ex parte psychiatric opinion about my mental health and stability. The facts admitted by the District are sufficient to find that Dr. Ticho violated the APA’s Goldwater Rule and that Dennis Race and Malcolm Lassman suborned that violation.

Dr. Ticho advised me in a note written on her letterhead that (1) she never saw me in private consultation and that (2) she never spoke with Dennis Race. In two telephone conversations (July 1993 and October 1993) I had with Dr. Ticho she denied the facts found by the D.C. Department of Human Rights.]

(d) Early in my therapy with Dr. Palombo I formed the belief that Dr. Palombo was in communication with attorney managers of Akin Gump, my employer, and that he divulged confidential mental health information to my employer on a regular basis without my consent. I believe that confidential mental health information was shared with supervisory employees at Akin Gump who used the confidential mental health information to harass me.

(e) I advised Dr. Palombo that I believed he was in communication with my employer, and, on one occasion, became angry when I pressed the issue.  Dr. Palombo stated that I should treat my belief as a fantasy, and that we could proceed to analyze my belief as if it were fantasy.

[See Brief of Appellee District of Columbia, Freedman v. D.C. Department of Human Rights, D.C.C.A. no. 96-CV-961 at 10 (Sept. 1, 1998) (“During 1990, it appeared to Freedman that his coworkers were using words and phrases that he had used during private sessions with his psychiatrist [Dr. Palombo].  From this, Freedman infers that the psychiatrist was discussing his case with firm management. R. 345. The psychiatrist denied that he had any communication with members of the firm. R. 345“).]

(f) I advised Dr. Palombo of other beliefs I held, including the belief that my employer had regular and frequent communications with my sister, Mrs. Estelle Jacobson, who lives in New Jersey (tel. no.: 609 727-3295). (My sister denies ever having communicated with my former employer). I advised Dr. Palombo that I believed that my employer had an informal agreement with the then manager of my apartment building (3801 Connecticut Avenue, NW), Ms. Elaine Wranik, whereby Ms. Wranik inspected my apartment daily, without my consent, and reported her findings back to attorney managers of my employer, Akin Gump. I also advised Dr. Palombo that I felt I was a victim of harassment by co-workers at Akin Gump.

(g) Dr. Palombo did not advise me of his diagnosis.

(h) Dr. Palombo suggested in a general way that I might derive benefit from medication. He discussed the indications for an anti-depressant or minor (benzodiazepine) tranquilizer, but did not prescribe any medication. Despite the seemingly paranoid (psychotic) nature of my belief system, Dr. Palombo did not suggest at any time that a major tranquilizer (antipsychotic) might be indicated.

(I) Courts in certain jurisdictions have held that the failure of a psychiatrist to prescribe appropriate medication where indicated, and to rely, instead, on "talk therapy” constitutes malpractice.

[I neglected to say that I discussed with Dr. Palombo the possibility of my taking lithium for possible bi-polar disorder. I recall Dr. Palombo saying that there was a doctor in his building who could administer the necessary blood tests. See GW Initial Assessment performed by Napoleon Cuenco, M.D. (September 1992), which refers to the fact that a previous (unidentified) psychiatrist had recommended lithium.

I met with Dr. Palombo in late August 1993 to discuss this letter of complaint. I asked Dr. Palombo why he did not suggest that I take anti-psychotic medication in 1990 while I was in therapy with him. He explained the reason was that I was working, with all that implied about my ability to function notwithstanding my seemingly paranoid beliefs.]

2. Stephen Stein, Ph.D.

(a) Dr. Stephen Stein is a psychologist whose office is located at 3000 Connecticut Avenue, NW, Washington, DC (tel. no.: 202 745-2556).

(b) I had one consultation with Dr. Stein, on March 15, 1991, with the intent to enter therapy with him.

(c)  I advised Dr. Stein of various of my beliefs, including my belief that my previous psychiatrist, Dr. Palombo, had been in communication with my employer, and that my employer had solicited the opinion of various experts concerning my autobiography, a writing I had prepared in October 1988.  Dr. Stein appeared to be incredulous.  Dr. Stein stated that he thought it advisable that he not treat me, apparently because my belief system suggested to him that I might suffer from a serious psychological disturbance that was beyond his competence.  Dr. Stein referred me to a psychiatrist, Dr. Norman L. Wilson.

3.  Norman L. Wilson, M.D.

(a)  Dr. Norman L. Wilson is a psychiatrist licensed to practice in the District of Columbia.  His office is located at 4025 Connecticut Avenue, NW, Washington, DC  20008 (tel. no.: 202 362-8660). Dr. Wilson is an assistant clinical professor of psychiatry at the George Washington University Medical Center.

(b)  I had one consultation with Dr. Wilson, on March 21, 1991, with the intent to enter therapy with him.

(c)  I advised Dr. Wilson of my belief that my previous psychiatrist, Dr. Palombo, had been in communication with my employer.  Dr. Wilson assured me that he would never divulge confidential mental health information, and stated that to do so would violate the D.C. Mental Health Information Act.

(d) Dr. Wilson employs hypnotherapy in his treatment and advised me that he would employ hypnosis as part of his treatment of me, despite the fact that my belief system might suggest that I suffered from paranoia.  Paranoia is considered a contraindication for hypnosis; the induction of hypnosis in a paranoiac is known to result in psychotic decompensation in certain cases.

(e)  Dr. Wilson did not state that he thought that medication might be indicated in my case.

(f)  On the day after my consultation with Dr. Wilson I formed the belief, based on words and phrases used by co-workers at Akin Gump, that Dr. Wilson had been in communication with my employer.  I thereafter advised Dr. Wilson that  I had decided not to continue my therapy with him.

4.  Lewis A. Winkler, M.D.

(a)  Dr. Winkler is a psychiatrist licensed to practice in the District of Columbia.  His office is located at 1226 31st Street, NW, Washington, DC  (tel. No.: 202 337-3444).

(b)  I had three consultations with Dr. Winkler, in April 1991.

(c)  I advised Dr. Winkler of my belief that my previous psychiatrist, Dr. Palombo, had been in communication with my employer.  Dr. Winkler assured me that he would not divulge confidential mental health information, and that to do so would violate the D.C. Mental Heath Information Act.

(d)  Dr. Winkler ascribed my belief system to grandiosity.

(e)  Dr. Winkler employs hypnosis in his treatment.  Dr. Winkler stated, however, that he had reservations about the use of hypnosis in my case because of the possibility that I might suffer from paranoia.

(f)  Dr. Winkler did not state that he thought that medication might be indicated in my case.

(g)  I formed the belief that Dr. Winkler was in communication with my employer, and terminated my therapy with him.

5.  Lawrence C. Sack, M.D. [deceased]

(a)  Dr. Lawrence C. Sack is a psychiatrist licensed to practice in the District of Columbia.  His office is located at 3801 Connecticut Avenue, NW, Washington, DC (tel. no.: 202 363-6962).

[I resided in the same building as of May 1991 when I consulted Dr. Sack.  Dr. Sack seemed surprised when I told him I resided in the same building.  I had seen Dr. Sack innumerable times in the building during the previous seven years.  Dr. Sack's office was located on the lobby level of the building.]

(b) I had three consultations with Dr. Sack, in May 1991.

(c)  I advised Dr. Sack that I believed that my previous psychiatrist, Dr. Palombo, had been in communication with my employer.  I stated my belief that Dr. Sack, himself, might be in communication with my employer.  Dr. Sack interpreted my belief in terms of the resistance and stated: “You see how easy it is for you not to tell me certain things if you believe that I am in communication with your employer.”

[It’s interesting to note that Dr. Sack’s observation can be turned on its head: “Dr. Sack, you see how easy it is for you to violate the D.C. Mental Health Information Act if you, as a psychiatrist, are permitted to attribute my beliefs to a pathological intrapsychic process.”]

(d)  Dr. Sack did not state that he believed that medication was indicated in my case.

(e) I formed the belief that Dr. Sack was in communication with my employer, and terminated my therapy with him.

(f)  Dr. Sack is a past president of the Washington Psychiatric Society.

[Dr. Sack's undergratuate and medical degrees were from Harvard.  He had graduated first in his class at a private prep school.  I once saw him on TV testifying at a Congressional hearing about mental health issues.  Dr. Sack's widow has a strong Jewish identification.  His son Robert is a psychiatrist and his daughter, the last time I read about her, had plans to become a radiologist.]

6.  William D. Brown, Ph.D.

(a)  William D. Brown, Ph.D. is a psychologist whose office is located at 1025 Connecticut Avenue, NW, Washington, DC (tel. no.: 202 833-8792).

(b) I had twenty psychotherapy sessions with Dr. Brown during the period May 29, 1991 through October 8, 1991.

(c)  I advised Dr. Brown of various of my beliefs, including the belief that he was in communication with my employer, that my sister had regular and frequent communications with my employer, and that the then manager of my apartment building inspected my apartment daily and reported her findings back to my employer.

(d)  Dr. Brown denied that he was in communication with my employer, and attributed my belief to a lack of trust.

(e)  Dr. Brown is a hypnotherapist, and on one occasion attempted to induce hypnosis despite the fact that my belief system suggested that I might suffer from paranoia.

(f)  On April 26, 1993 I filed a complaint against Dr. Brown with the American Psychological Association, Office of Ethics, 750 First Street, NE, Washington, DC 20002-4242 (tel. no.: 202 336-5500).  Ms. Betsy Ranslow, APA Director of Investigations, is currently processing the Complaint against Dr. Brown.

A brief summary of the Complaint reads:

During the period May 29, 1991 to October 8, 1991 I had 20 weekly psychotherapy sessions with William D. Brown, Ph.D. Dr. Brown’s handling of my case suggests one of two conclusions, either of which raise the possibility of a breach by Dr. Brown of the American Psychological Association’s (APA) Ethical Principles of Psychologists, as amended June 2, 1989. Dr. Brown’s handling of my case suggests that he breached APA Ethical Principle 2 re: Competence in that he failed to recognize the boundaries of his competence and the limitations of his techniques by continuing to treat a patient with apparently delusional (paranoid) ideation who might have been more appropriately treated by a psychiatrist.  In the alternative, Dr. Brown’s handling of my case suggests that he breached APA Ethical Principle 5 re: Confidentiality in that he engaged in repeated nonconsensual communications with my employer during the course of therapy upon which he concluded that my seemingly persecutory ideation was in fact not delusional and which communications were the basis of his decision not to recommend that I undergo a psychiatric evaluation. Any nonconsensual communications with my employer would also have violated the District of Columbia Mental Health Information Act and would subject Dr. Brown to possible criminal prosecution for the commission of a misdemeanor.

___________________________________________

On October 24, 1991 I complained to attorney managers of Akin Gump that I was a victim of harassment by co-workers, supervisory personnel, and attorneys.  On October 29, 1991 I was terminated by Akin Gump.  Mr. Dennis M. Race (202 887-4028), an attorney manager of the firm, advised me that he was unable to substantiate my allegations of harassment and that there appeared to be a lack of fit between me and other firm personnel.  Mr. Race advised me that two supervisory employers stated that they found me difficult to work with, that they could not work with me, and that they were afraid of me.  I was later apprised, in documents filed by Akin Gump with the D.C. Department of Human Rights and Minority Business Development, that Mr. Race had determined, in consultation with two mental health professionals, including a psychiatrist, that I was paranoid and potentially violent.  Mr. Race determined that to allow me to remain on the firm’s premises might constitute negligence.

The psychiatrist who Dennis Race claims to have consulted, Dr. Gertrude R. Ticho (tel. no. 202 244-2113), denies, in a letter written to me dated July 4, 1993, ever having communicated with Akin Gump.  I have never met Dr. Ticho.  Sheppard Pratt Preferred Resources (tel. no.: 202 429-1950), Akin Gump’s Employee Assistance Program provider, the other mental health resource that Dennis Race claims to have consulted, states in a letter written to me dated July 14, 1993 that it has no record of any communications with any Akin Gump managers, including Mr. Race, concerning my case.

On February 4, 1992 I filed a Complaint with the District of Columbia Department of Human Rights and Minority Business development (DOHR; tel. no.: 202 939-8740) alleging that Akin Gump’s decision to terminate my employment was unlawfully based on the perception that I was homosexual, in violation of the D.C. Human Rights Act of 1977, as amended.  DOHR’s investigation of the Complaint [Docket No. 92-087-P(N)] is pending.  The DOHR case investigator is Mr. Donald M. Stocks; the Director of the DOHR is Ms. Margie A. Utley.

In its Response to the DOHR Complaint, dated May 22, 1992, Akin Gump states that its decision to terminate my employment was based in part on consultations with a counselor from its Employee Assistance Program provider, Sheppard Pratt, and the statements of a psychiatrist (later identified as Gertrude R. Ticho, M.D.) who, Akin Gump claims, advised the firm that my thinking was dominated by paranoid ideas of reference and that I was potentially violent.  As stated above, both Dr. Ticho and Sheppard Pratt deny ever having communicated with any attorney managers at Akin Gump.

7.  Napoleon Cuenco, M.D.

(a)  Dr. Cuenco is a psychiatry resident licensed to practice medicine in the District of Columbia.  His office is located at the George Washington University Medical Center, 2150 Pennsylvania Avenue, Washington, DC  20037 (tel. no.: 202 994-4078).

(b)  In September 1992, about one year after my job termination on October 29, 1991, I underwent a two-hour evaluation with Dr. Cuenco.

(c)  During the course of the evaluation I restated the various systematic and unsubstantiated beliefs I had formed regarding the actions of Akin Gump management, including my belief that Akin Gump had been in communication with the various mental health professionals I had consulted.  At the conclusion of the first evaluation session on September 1, 1992, Dr. Cuenco deferred the diagnosis.  At the conclusion of the second evaluation session on September 8, 1992, Dr. Cuenco assigned the diagnosis bi-polar disorder, despite the predominance of seemingly paranoid ideation in my case.

(d) During the course of the evaluation session on September 1, 1992, Dr. Cuenco questioned me about any instances of past violent behavior, apparently to determine my propensity for violence.

8.  Suzanne M. Pitts, M.D.

(a) Dr. Pitts is a psychiatry resident licensed to practice medicine in the District of Columbia.  Her office is located at the George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, Washington, DC  20037 (tel. no.: 202 994-4078).

(b)  I am currently in therapy with Dr. Pitts.  I began weekly consultations with Dr. Pitts on October 26, 1992; twice weekly consultations were instituted in late January 1993.

(c)  In about February 1993, approximately ten weeks after the therapy began, Dr Pitts prescribed lithium to treat what she believed were manic-depressive symptoms.  I stopped taking the medication after about 10-14 days, and advised Dr. Pitts that I believed that lithium was not indicated in my case.  During the course of the lithium therapy, I underwent a lithium assay to determine my serum lithium level.  I was charged $23.00 for this diagnostic test.  I protested the fee with the Medical Director of the George Washington University Medical Center, Dr. Keith Gheezi (Tel. no.: 202 994-1000).  I advised Dr. Gheezi that I believed that lithium had been misprescribed.  Thereafter, GW waived the fee for the lithium assay.

(d) I have advised Dr. Pitts that I continue to hold certain beliefs that might be termed paranoid.  (Notwithstanding my seemingly-paranoid ideation, I have been diagnosed as suffering from bio-polar disorder, DSM-III 296.70.  Dr. Pitts has to date declined to prescribe anti-psychotic medication).

[Dr. Pitts discussed with me her plans to prescribe Haldol, an anti-psychotic drug, on August 26, 1993, a few days after I mailed this letter.]

The beliefs that I have related to Dr. Pitts include the following, namely that:

(i) My former employer has been in communication with each of the mental health professionals I consulted during my employment and that the mental health professionals informed my former employer of the content of each of  these sessions.  None of the metal health professionals admitted, when asked, that they were in communication with my former employer.

[Brief of Appellee District of Columbia, Freedman v. D.C. Dept. Human Rights, D.C.C.A. no. 96-CV-961 at 10 (Sept. 1, 1998.]

(ii)  My former employer has been having regular communications with the Department of Psychiatry, George Washington University Medical Center, where I am currently in therapy.  My treating psychiatrist, Dr. Pitts, denies that such communications are going on.

(iii)  My former employer had an information agreement with the former manager of my apartment building, Ms. Elaine Wranik, whereby the manager would inspect my apartment daily, without my consent, and report her findings back to my employer.  I believe that the stated inspections were occurring at least as of March 1989 and continued until about early February 1992.

[Brief of Appellee District of Columbia, Freedman v. D.C. Dept. Human Rights, D.C.C.A. no. 96-CV-961 at 8 (Sept. 1, 1998).]

(iv)  My former employer, without my consent, gained access to my apartment on January 2, 1990, prepared a video-tape of my apartment, and sent a copy of the video-tape to my sister, who lives in New Jersey.

[Brief of Appellee District of Columbia, Freedman v. D.C. Dept. Human Rights, D.C.C.A. no. 96-CV-961 at 9 (Sept. 1, 1998).]

(v) My former employer has had regular and frequent communications with my sister, Mrs. Estelle Jacobson (609 727-3295).  I believe that the communications began in about late October 1988 and continue to the present.  My sister denies ever having communicated with my former employer.

[Brief of Appellee District of Columbia, Freedman v. D.C. Dept. Human Rights, D.C.C.A. no. 96-CV-961 at 5 (Sept. 1, 1998).]

(vi)  My former employer has submitted a copy of my autobiography to various experts including Professors  Peter Gay at Yale, Fritz Stern at Columbia, and Harold Bloom at New York Un diversity and Yale.  I believe that my former employer has also consulted, and submitted a copy of my autobiography to, Dr. Ernst Ticho [deceased] and Dr. Gerald Post, two local psychiatrists, as well as Dr. Anthony Storr [deceased]  in the United Kingdom.  (I provided a copy of the autobiography to my current treating psychiatrist, Dr. Pitts.)  I also believe that Mr. Robert S. Strauss, a founding partner of the firm of Akin Gump and former U.S. Ambassador to Russia, gave a copy of my autobiography to former U.S. Secretary of State, James Baker in June 1991.

(vii) My former employer arranged, without my knowledge or consent, to have an Akin Gump supervisor employee, John D. Neary, consult with one of my former psychiatrists, Dr. Stanley R. Palombo, on April 16, 1990.

(viii)  My former employer shared with supervisory employees confidential mental health information obtained from various mental health professionals whom I consulted.  I believe that these supervisory employees proceeded to use the confidential mental health information to harass me.

(ix)  I believe that during the entire period of my employment at Akin Gump I was harassed daily by co-workers, attorneys, and supervisory personnel, including my immediate supervisor, Mrs. Christine Robertson.  Akin Gump management maintains that it was unable to substantiate my allegation of harassment, and contends that its consultation with a psychiatrist, Gertrude R. Ticho, M.D. (who denies ever having communicated with Akin Gump management) led it to conclude that my ideation is dominated by paranoid “ideas of reference” that are the product of a serious mental disorder that renders me potentially violent (or violent) and not suitable for employment.

On April 9, 1992 an Akin Gump co-workers, Mrs. Patricia McNeil, was terminated by my former supervisor Mrs. Christine Robertson.  On March 6, 1993, Mrs. McNeil filed an action in federal court alleging that her termination by Akin Gump was because of her race, and therefore in violation of Title VII of the Civil Rights Act of 1964.  The Complaint in the action, styled McNeil v. Akin, Gump, Strauss, Hauer & Feld (U.S. District Court, District

[In fact, it was Akin Gump Personnel Administrator Laurel Digweed who terminated McNeil, not Robertson.]

[I am unable to locate the remainder of this letter at this time.  I recall that I sent a copy of the letter to GW trustee Sheldon S. Cohen, Esq. at Morgan, Lewis, and Bockius and to GW trustee Harold Baker, Esq. (deceased) at Howery & Simon.  Neither individual responded.]