Psychiatrists Liable for Millions in Civil Suits
The stakes in the debate over recovered memories therapy ratcheted upward in October with the indictment of five health care professionals, including two psychiatrists, in Houston. Charged in a 60-count indictment-believed to be the first of its kind in the United States-the former staff members of the now defunct dissociative disorders unit at the Spring Shadows Glen Psychiatric Hospital are accused of perpetrating a "scheme to defraud by allegedly falsely diagnosing patients with multiple personality disorder caused by their alleged participation in a secret satanic cult"; this according to Larry Eastepp, an assistant United States attorney for the southern district of Texas.
In a press release outlining the conspiracy and mail fraud charges, the government is claiming that the defendants "brainwashed" patients, including children, into "relating false experiences and memories about the cult, and that false medical records were created to substantiate the false diagnoses and treatment." The alleged conspiracy resulted in millions of dollars in insurance payments, Eastepp asserted. The charges stem from an investigation by the FBI and the Pension Welfare Benefits Administration of the Department of Labor.
Charged in the case were Judith A. Peterson, Ph.D., a licensed psychologist and former clinical director of the unit; Richard E. Seward, M.D., a psychiatrist and the clinic's medical director; George "Jerry" Mueck, the former hospital administrator; Gloria Keraga, M.D., a psychiatrist responsible for admissions to the unit; and Sylvia Davis, M.S.W., a licensed psychotherapist specializing in a form of therapy called psychodrama. Memorial Healthcare System, which now owns what was once Spring Shadows Glen Psychiatric Hospital, is not connected to the allegations in the indictment.
Each of the 60 counts in the indictment carries a maximum penalty of five years in prison and a $250,000 fine, and, if convicted, the defendants would face sentences under federal guidelines that include no parole provisions. The severity of the charges reverberated through the mental health community, with some practitioners claiming the federal government has now criminalized psychotherapy.
The allegations in the indictment center around the course of treatment proffered to patients who recovered memories of satanic ritual abuse. The indictment claimed that patients were diagnosed with multiple personality disorder and treated for the illness based on "unsubstantiated and unrealistic allegations and abuses, including satanic ritual abuse and cult activity." It then goes on to allege that the defendants conspired to create fraudulent medical records in order to obtain insurance payment.
Critics of repressed memories theories, who have coined the counter-malady of "false memory syndrome," consistently argue that mental health practitioners induce memories of abuse through inappropriate treatment regimens. The indictment lends some credence to these claims by accusing the defendants of fraudulently eliciting "statements of satanic ritual abuse and cult activities from the admitted patients, through nontraditional treatment modalities, including the use of leading or suggestive questions during therapy sessions while the patients were: under hypnosis; under the influence of a drug or combination of drugs; isolated from their families, friends and the outside world; denied certain privileges and freedoms, including uninterrupted sleep; held down by excessive or medically unnecessary physical restraints; or, otherwise by the use of techniques commonly associated with mind control and 'brainwashing,' in order to conduct their fraudulent insurance payment enterprises."
The prosecution will now have to prove beyond a reasonable doubt that the treatment methods used by therapists engaged in recovered memories therapy have no merit-a difficult task considering that the issue has polarized the medical community for years.
The nonprofit International Society for the Study of Dissociation (ISSD), a Glenview, Ill.-based organization that represents approximately 1,000 psychiatrists, psychologists and other mental health practitioners, criticized the government for criminalizing what to them is a civil issue regarding standards of care. Claiming the indictment will have a "chilling effect on psychotherapy," the organization also said that by prosecuting the case, "the federal government is indicating their willingness to set standards for diagnosis and treatment."
The criminal indictments come at a time when psychiatrists and other mental health practitioners have received a drubbing in civil courts by individuals suing after retracting memories recovered during therapy. In October, a jury in a Houston federal district court awarded Lynn Carl, a 46-year-old mother of two, $5.8 million after she underwent years of treatment based on recovered memories of satanic ritual abuse. The verdict against Keraga, one of the defendants in the criminal case, was handed down after the other defendants either settled or were dropped from the case. According to Skip Simpson, Carl's Dallas-based attorney, Keraga agreed to a settlement after the verdict for an undisclosed sum.
During the course of the trial, Carl testified that the psychotherapy she received dredged up memories of perverse forms of abuse including cannibalism, murder and rape. Her two children were also hospitalized for a year, according to Simpson, who told Psychiatric Times that their own lawsuits are scheduled for trial next February.
By the time Carl's ordeal-including two years of hospitalization-was over, she ended up divorced from her husband and on the verge of suicide. Carl recounted the fateful moment when she slit her wrists, only then realizing she had been misled. "All of a sudden it hit me upside the head; I couldn't do this to my kids and I wouldn't let those therapists win," Carl said in an Aug. 9 Houston Chronicle article. She is now remarried to her former husband.
The fantastic nature of the allegations is what generates the high exposure in these cases, Simpson said. Ultimately, like every other malpractice case, the primary issue is the standard of care, he added. But when tales of torture, murder, rape and mayhem that stretch the imagination to the breaking point fill the courtroom, jurors are not easily convinced that therapists acted in the best interests of their patient.
"What happens is when you have a group [of therapists] that get up on the witness stand and say that they believe that there was a cult; that people were eating babies; that there were many murders; that there were boxcars of dead bodies; and that people were roasting and stripping down cadavers and eating them for lunch with the cult, 12 Texans want to hear a little bit more about what you did to corroborate that," Simpson said.
"When jurors asked psychiatrists, 'Did you believe it yourself?' and when the psychiatrists said that they did, in fact, believe it and told their patients that they believed it, then it was simply a matter of waiting for the jury to come back and give you millions of dollars. It will happen every time."
Simpson may be right. In a front-page article last month, The New York Times reported that the insurance companies for two Chicago psychiatrists and Rush-Presbyterian-St. Luke's Hospital in which they worked paid Patricia Burgus, a mother of two, $10.6 million to settle claims arising out of years of therapy for repressed memories. Elva Poznanski, M.D., chief of child and adolescent psychiatry at the hospital, and Bennett G. Braun, director of the psychiatric trauma unit, did not admit liability and bristled over the settlement.
Calling the huge payout a "travesty" forced by his insurer, Braun said in the Times article, "A patient comes into the hospital doing so bad that she belongs in the hospital, and after several serious events in the hospital, which I can't disclose because of patient confidentiality, she was discharged and is doing much better. Where's the damage?"
Braun, the founding, former president of ISSD, has long been the target of critics, especially the Philadelphia-based False Memory Syndrome Foundation (FMSF), a group that has for years waged a public information and lobbying campaign to discredit recovered memories therapy.
Pamela Freyd, Ph.D., FMSF's founder and executive director, essentially declared victory in the organization's September newsletter, saying, "The growth of the recovered/repressed memory movement has been stopped; the number of new lawsuits against parents based only on recovered/repressed memories is negligible. What is happening in the legal area now is critical to how the mopping up will proceed."
That is exactly what has some psychiatrists concerned. David Spiegel, M.D., a professor of psychiatry and behavior science at Stanford University Medical School in Palo Alto, Calif., and a nationally recognized expert on posttraumatic stress and psychotherapy research, said in an interview with Psychiatric Times that the huge verdicts and possible criminal liability in the "extreme" cases could "spill over onto the mainstream."
"What I do worry about is that there is such a vigorous, aggressive anti-psychotherapy tinge to some of this," Spiegel said. "I'm not worried about the Texas case, and I'm not worried about the Chicago case, because I think these were outliers where there are serious questions about what they were doing. I am worried, though, that there is a militant, aggressive advocacy group that is encouraging all kinds of restrictions on therapy, including requirements for disclosures, consent forms and restriction on ordinary, everyday, sensible psychotherapy, and that part of it bothers me."
John Bush, the executive director of the Texas Society of Psychiatric Physicians, acknowledged that after the National Medical Enterprises scandal-in which the psychiatric hospital chain was ultimately convicted for numerous violations of federal law arising out of alleged abuses in connection with its treatment of patients-the backlash included legislation that, in the view of psychiatrists, inappropriately restricted the use of electroconvulsive therapy. Following the Carl case and the criminal indictment, Bush anticipates that "the enemies [of psychiatry] will take anything and then take it further."
"I know that there will be something that comes out of this. I don't know what it will be," Bush said. "We object to the legislature practicing medicine." He is concerned that while issues surrounding recovered memory therapy require medical research, the development of practice guidelines and the enforcement of professional standards-situations that cause the legislature to micromanage the practice of medicine-create poor precedent.
But for John Cannell, M.D., a private practice forensic psychiatrist in Los Osos, Calif., who testified for the plaintiffs in the Carl case, the day of reckoning for therapists who lead patients on what he views as "fantasy journeys" that have no therapeutic value has been long in coming. He disagrees that taking a firm stance in the "egregious cases" will lead to attacks on competent practitioners. Rather, cases like Carl's seek to prevent the damage that can be caused by inappropriate interventions.
"The cult doctors in Spring Shadows Glen and other places around the country believe in this transgenerational, organized satanic cult that the FBI has found no evidence for, and that seems to exist only in the minds of a number of patients and therapists," Cannell said. "As I listened to the trial unfold, what was happening to Lynn Carl and her family was that they were being interrogated by these doctors to try to find out where the satanists were."
Cannell, who is also a staff psychiatrist at California's Atascadero State Hospital but whose comments only reflected personal opinions, said that the murkiness pervading the treatment of what is now called dissociative identity disorder is a result of the absence of sufficient empirical understanding of the mental illness.
"We should be cautious about any process in which we begin the conversation by asking the other person whether they believe in it," Cannell said. "When I practice psychiatry it has to be more than a belief, I hope."
"Medicine has never attempted, before the recovered memory phenomenon, to destroy families," Cannell said, describing his view of what some psychotherapists are doing to patients. "There is nothing healing about encouraging a woman to discover these vicious memories and confronting, for example, her elderly father then watching the destruction. ...That's politics."
Louis Jolyon West, M.D., a professor of psychiatry at the University of California, Los Angeles School of Medicine who is considered an expert in cult behaviors, agreed that "there are certainly some recovered memories that ought to raise the index of suspicion more than others."
Nevertheless, he also urged that the profession avoid intransigence. "With regard to satanic cultic activity, there's a tendency to take a position of all or nothing when the answer is only to be generated by continued digging for the truth," West said. "The danger for science is that we become arbitrary and think that we have all the answers when we don't. In our field there are still many spheres in which we don't have all the answers yet."
(In October, the Royal College of Psychiatrists in Britain issued guidelines warning psychiatrists not to try to uncover forgotten memories of childhood sexual abuse through hypnosis, dream interpretation or regression therapy, according to an article from the British Press Association. Under the guidelines, psychiatrists are encouraged to "share with patients whatever doubts they may have about the historical accuracy of recovered memories of previously forgotten abuse." The report recommends that psychiatrists be wary of accepting uncorroborated claims of previous sexual abuse by people who show signs of multiple personality disorders. However, mandatory reporting is considered "entirely appropriate when children spontaneously describe current or recent abuse"-Ed.)