Saturday, February 05, 2005

Zoloft on trial as teen faces murder charges

Outcome could impact drug's use with youths
NICHOLE MONROE BELL
Staff Writer
The boy stood over the bed, lifted the shotgun and squeezed. Once. Twice.
With two blasts, Joe Pittman, 66, and Joy Pittman, 62, were dead. They were killed as they slept, police say, by their 12-year-old grandson.
What leads a child to kill two of the people he loves the most -- an antidepressant drug or a malicious mind?
That is the question at the core of the Christopher Pittman murder trial, which begins Monday in Charleston. Pittman, now 15, is charged as an adult in the November 2001 Chester County, S.C., slayings and could face a maximum sentence of life in prison if convicted.
Pittman's lawyers and family will argue that the boy was depressed and had a reaction to the antidepressant Zoloft. But prosecutors describe the boy as a troubled child with a violent past.
The trial, which will be covered by CNN, Court TV and other news outlets, comes at the height of an international debate about the safety of antidepressant use in children and adolescents.
Experts say the case is one of the first times the antidepressant defense has been used for a child defendant. The defense has rarely succeeded when used for adults.
The U.S. Food and Drug Administration ordered in October that Zoloft and similar antidepressants carry boldface warnings saying the drugs increase the risk of suicidal thinking and behavior in some children.
Critics of the drugs, and Pittman's lawyers, say the drugs can also turn a child into a killer.
James Cohen, a professor at New York's Fordham Law School who teaches about psychology in criminal law, said a not-guilty verdict in the Pittman case would likely have major implications for drugmakers who could take a blow to sales and become the target of more civil liability lawsuits. Two of Pittman's lawyers are civil attorneys who have sued New York-based Pfizer, the maker of Zoloft.
"I think this is a perfect parallel to what's going on with the public debate on whether these drugs are safe," Cohen said. "If you get a jury saying the kid wasn't responsible because of the drug, that's going to have a devastating effect. ... It's going to be a magnet for legal work."
Zoloft is the No. 1 prescribed antidepressant in the U.S. market, and the drug's worldwide revenues in the fourth quarter of 2004 were $959 million, according to Pfizer. Physicians have written about 250 million Zoloft prescriptions since the drug hit the market in 1992 for a variety of psychiatric disorders, according to Pfizer.
Pfizer officials say they are watching the Pittman case closely.
"We're concerned it may get people who've really benefited to become hesitant to take the drug," Pfizer spokesman Bryant Haskins said. "Our biggest concern is our patients. ... We're certain (Zoloft) didn't cause this kid to kill his grandparents."
Pittman was prescribed Zoloft to manage mild depression after he moved from Florida in 2001 to stay with his grandparents. The boy's mother had abandoned him, and he was having trouble getting along with his father, doctors have testified. A week before the killings, a doctor doubled the boy's dosage to 200 milligrams a day. The day of the killings, he got into a fight with a younger child on the school bus and his grandparents disciplined him, according to testimony at pretrial hearings.
The maximum recommended dosage for Zoloft in depressed adults is 200 mg. The drug has not been been FDA approved to treat depression in children, but many doctors prescribe it for that purpose.
The defense team is arguing that Pittman suffered from "involuntary intoxication" of Zoloft, meaning the drug put him in a mental state in which he was unable to distinguish between right and wrong.
After the shootings, Pittman wrote a letter to the FDA, saying a voice in his head drove him to kill.
"I snapped. I took everything out on my grandparents who I loved so much," the boy wrote in the letter, which his father read at a February 2004 hearing in Washington. "Through the whole thing, it was like watching your favorite TV show. You know what is going to happen, but you can't do anything to stop it. All you can do is just watch it in fright."
Such defenses have rarely succeeded in the past because the research was unavailable and there weren't enough experts willing to testify for the defense, said Richard Southard, a former New York prosecutor who works in private practice as a defense lawyer. He thinks the failure rate will change, however.
"I think it's a viable defense," said Southard, who has appeared as a guest analyst on Fox News Live and Court TV for the Scott Peterson murder trial. "It's going to be used more and more frequently because of the media attention and the increased number of people being put on the drugs."
In April, a Santa Cruz, Calif., jury acquitted a 28-year-old man of attempted murder and assault after his lawyers argued that an adverse reaction to Zoloft caused him to hit a longtime friend in the head with a weapon in 2002, according to an article in the Santa Cruz Sentinel. Prosecutors argued that the drug wasn't in the man's system when he was arrested, the newspaper reported.
The prosecutors in the Pittman trial will make a similar argument. They say Pittman knew what he was doing and tried to conceal the crime by setting the house on fire, then fled in the family car with his dog. When deputies found him, he told them a man had killed his grandparents and kidnapped him.
Experts say the jury's willingness to accept Pittman's defense will hang, in part, on his behavior before and after the slayings.
Prosecutors say that before the slayings, Pittman was a runaway who once stabbed a bull with a dart and fired a BB gun into a house. Defense lawyers say the boy was nonviolent despite his difficult family life and bouts with mild depression.
To succeed, Pittman's lawyers will also need to bridge the gap between the clinical studies on Zoloft and Pittman's actions, experts said. Although a growing body of research questions whether the drugs can increase the risk of suicide in adolescents, experts say there is no research showing the drug puts children at risk of committing a homicide.
"Before when you first started hearing this (defense), juries dismissed this without a thought," Southard said. "Now, they're more open to the defense. They've heard some of the negative publicity about these drugs."
Nichole Monroe Bell: (803) 327-8511; nbell@charlotteobserver.com.
Therapists' Sexual Misconduct CloakedFRONT PAGE TAMPA TRIBUNE By LENNY SAVINO Published: Jan 28, 2005 She was depressed and needed help, so she went to a psychiatrist. The psychiatrist, Jose Anibal Cruz, flirted with her from the woman's first visit, a state Department of Health report states. She returned for another appointment and began seeing Cruz regularly. Soon Cruz was hugging her. Next he asked for pictures of her in a bathing suit or nude, the report states. She complied. Before long, they began having an affair. Both were adults. The woman was 31; Cruz was 52. State law presumes that patients being treated for mental or emotional difficulties are vulnerable and specifically forbids psychotherapists such as Cruz from having affairs with them. Doing so is a felony, with a first offense punishable by up to five years in prison, and a second by up to 15 years. Cruz has not been charged with violating this law, however, and neither have more than 100 other therapists suspected of having similar relationships with patients, Health Department records show. The reason: A Health Department office responsible for policing the therapists has been failing to notify prosecutors of such cases even though another state law, passed in 1992, requires it to, according to a newly released report from the department's inspector general. That notification law extends far beyond therapists and applies to every health care provider in Florida requiring a state license: chiropractors, physical therapists - even nursing home administrators, hearing aid specialists and masseuses. Each of these professions is state regulated. In some cases, the overseer is a board; in others, it is an office within the Health Department. The law requires each of these bodies to do two things when an impropriety is alleged. First, an administrative investigation must be initiated. If this leads to a finding that the allegation is true, the regulating authority then metes out a punishment. This can range from a fine or a period of occupational supervision to license revocation. Second, the law says any allegation that might be criminal - sex-related or not - must be reported to prosecutors. The question now is how many of these regulatory bodies have been complying - and, if any others have not been, how many more criminal referrals have been missed. To find out, Health Secretary John O. Agwunobi has ordered a sweeping paper chase. Department investigators are combing through the files on every disciplinary case the agency or one of its satellite regulatory bodies has investigated since 1992. There are 24,000 of these, the department says. The files on them are in a state warehouse. The department won't say how many files have been examined so far or how many remain. Nor will it say how many investigators are involved in the review. The files can be thick. Each typically contains legal documents describing the complaint and containing statements from witnesses, an administrative judge's finding of facts in the case and a final order. Depending on how many investigators the department uses, the review could take several months. Statute Of Limitations As the investigators work, other embarrassments have emerged. For example, not only is the criminal referral requirement spelled out in Florida law, it is detailed in a written Health Department policy adopted in 2002. In addition, another statute requires that a criminal case be prosecuted within a certain time frame - three years in the case of most felonies - a period often called the statute of limitations. If the deadline is missed, the accused is relieved of criminal responsibility and no longer can be tried. In the vast majority of cases found so far involving sexual activity by psychotherapists, this deadline has passed, meaning the therapists involved are exempt from being criminally charged and tried. Cruz's case was one of these. Health Department investigators launched an administrative inquiry that ultimately led to the revocation of his medical license, but they failed to refer the matter for criminal prosecution. The breakdown was discovered last summer when a private citizen sent a public records request to the department. Nobody knows yet how many such therapists - psychiatrists, psychologists, licensed social workers and family counselors such as ministers - have escaped prosecution. In the report released last week, the department's inspector general suggested there are scores of them. The Health Department office that is supposed to have been making the criminal referrals in the cases involving the therapists is the Medical Quality Assurance Consumer Services Unit, the report says. The report does not find fault with any individual in this office. Supporting documents suggest the referral failures were a consequence of poor management and supervision, perhaps combined with the fact that the unit has been attached to three Cabinet-level departments since the late 1990s. Agwunobi is so appalled by what the inspector general found that last week he demoted the unit's chief and transferred her to a nonsupervisory job, Health Department spokeswoman Lindsay Hodges said. Remaining unit staff will be ``revising policies and procedures, retraining staff and taking disciplinary action where appropriate,'' Hodges said. Prosecutor Errs The Cruz case occurred in Miami and was remarkable on several counts. For one thing, Cruz's relationship with the patient went undetected for eight years, the Health Department file on the case shows. Cruz went to some lengths to avoid being found out. For example, after office visits, he often took the woman to a motel for sex and registered using a fictitious name, the file states. Not even hospital stays interrupted the trysts, the file alleges. Cruz hospitalized the woman five times. Before seeing her on rounds, he would call ahead and ask her to be in the shower when he arrived. More sexual activity would follow, the file states. The relationship ended only when the woman told a friend about it. The friend urged her to contact authorities and a lawyer. The lawyer had Cruz videotaped as he escorted the woman to the motel. The lawyer, Kevin T. Smith, notified the Health Department, triggering the administrative investigation. This led, three years later, to the revocation of Cruz's license. Not once in all this time did the department alert local prosecutors to the case. Smith told the Miami-Dade County State Attorney's Office about it, however, and another failure occurred. An assistant prosecutor compared the facts of the case with the wrong statute and told Smith to forget it - that under the law, Cruz had not done anything criminal. Cruz maintains his innocence, says Jon Pellett, a Tampa lawyer who represented him during the Health Department's administrative inquiry. "We found evidence that the complainant was not credible or believable,'' Pellett said. ``The administrative judge disagreed.'' For instance, Pellett said, attendants at the hospital checked patients every 15 minutes, making it unlikely Cruz would have observed his client showering. Nevertheless, Cruz agreed to an out-of-court settlement in a civil lawsuit the woman brought, Smith said. He will not discuss details. The Price Patients Pay A patient's attraction to a psychotherapist is not uncommon, experts say, but resulting sexual relationships can be severely damaging. ``The offer by a psychotherapist of an intimate sexual relationship is initially perceived by many ... as the opportunity for an ideal, special relationship,'' wrote psychologist Philip Boswell, of Coral Gables. ``When later, as generally happens, the relationship is lost, the client's reaction is frequently catastrophic and often qualifies ... as a post-traumatic stress disorder.'' Guilt and shame caused by therapist manipulation, Boswell added, frequently can lead to depression and self- disdain for being so gullible. Anger also can result, along with ``massive ... confusion, and enormous distrust of therapy, therapists or even intimate relationships in general.'' The unreferred cases of this type that have come to light so far include several in the Tampa area. Records show that among the accused are: * Mental health counselor Marvin Kassed, of New Port Richey, accused administratively in 2000 of hiring a former patient, having a sexual relationship with her and disclosing confidential information to her about other patients. Kassed took a plea deal under which he did not admit or deny the allegations but agreed to two years' probation, $4,900 in fines and investigative fees, and a weekly review by a Health Department psychotherapist of his cases involving female patients. Kassed was accused in a similar case six years earlier, fined $1,000 and ordered to attend an ethics course. * Family counselor Richard Bernstein, of Tampa, accused administratively in 1998 of using so-called family therapy sessions to draw the mother of a patient into a one-year sexual relationship. Bernstein admitted the allegation and accepted a $1,000 fine, a one- year ban on female patients and five years' probation. * Mental health counselor Richard Fedora, of Dunedin, accused of sharing a hotel room with a female patient at a weekend symposium on hypnosis in Daytona Beach. Although the patient had just been discharged from treatment for alcohol and drug abuse, she got drunk at the hotel's pool bar and was returned to the room by other guests. After telling Health Department investigators that he tried to ``counsel her all weekend,'' Fedora accepted a plea deal under which he did not admit or deny wrongdoing but got three years' probation and a $3,000 fine. Kassed and Bernstein did not return telephone calls seeking comment. Fedora said he agreed to a plea deal just to end the torment of dealing with the investigative process. "After this complaint dragged on for almost 3 1/2 years,'' he said, ``I told my attorney to do whatever it would take to negotiate an end to the nightmare of this complaint. The plea I agreed to is on record, even though it is not true.'' 'A Public Hazard' If Health Secretary Agwunobi is appalled by the scope of the breakdown, so is state Rep. Dan Gelber, D-Miami Beach. "I think it raises very significant issues,'' Gelber said. "The idea that they're not ... referring what appear to be bona fide allegations for prosecution is deeply troubling. It's a public hazard.''
Gelber, a federal prosecutor for 10 years, has asked the Miami-Dade County State Attorney's Office to look into the Cruz case. A supervising prosecutor with the office, Josh Weintraub, said he had briefed his staff on the right statute to consult if any similar cases surface, but whether anything else can be done is problematic. The statute of limitations likely expired in the Cruz case Aug. 17, 2004, the same day the Consumer Services Unit issued an administrative ruling finding him guilty and revoking his medical license and exactly three years from the day he was videotaped registering for a room at the motel. As they continue sifting through files, Health Department investigators are telling local prosecutors about every case they find, even those that no longer can be prosecuted, Hodges said. Not only does the law still require notification, she said, the information ``may still be of great value in future investigations and prosecutions.'' About a dozen referrals have been received so far by Pinellas-Pasco State Attorney Bernie McCabe. One involved a therapist who had been prosecuted without a Health Department referral and acquitted. The rest involve cases in which the statute of limitations has expired. ``If the statute ... has expired,'' McCabe said, ``there's nothing we can do.'' Six cases have been referred to the Hillsborough County State Attorney's Office, spokeswoman Pam Bondi said. The statute has expired on most of these, too. Crusader Pressed State For List of Possible ViolationsPhoto of Ken Kramer, captioned: Ken Kramer, of the Citizens Commission on Human Rights, says there likely are more violations then the state has revealed. Save for the persistence of one person, Ken Kramer, of Clearwater, the Florida Department of Health might not be telling prosecutors about alleged sexual improprieties involving psychotherapists. Kramer is chief researcher for the Citizens Committee on Human Rights, an organizations found by the Clearwater based Church of Scientology in 1969. Kramer says the church no longer finances it. Scientology opposes many of the holdings of modern psychiatry and psychology. The Committee’s primary mission is to monitor misconduct by psychotherapists, Kramer says. It maintains a Web site – http://www.psychsearch.net/public_records.html - with a list of more than 1,100 therapists who have been the subject of disciplinary proceedings in Florida. Kramer, 48, works without pay at the committee’s one-story storefront office in Downtown Clearwater. The organization s has two paid staff members, about 200 volunteers and 500 members statewide, he says. Kramer began wondering last year whether the health department was complying with a 1992 state law requiring it to notify local prosecutors of cases involving alleged sexual contact between therapists and patients and sent the department public records requests on the subject in July. “They couldn’t find anything” at first, Kramer says. He kept at it. Finally, the department sent him evidence of about 100 cases that should have been referred but hadn’t been, Kramer says. He thinks there are more. “The Department of Health is up to their eyeballs in crimes committed by psychotherapists,” Kramer says. He has found evidence in one document suggesting department officials “are fearful that if they report all crimes they would overwhelm state attorneys offices” across Florida, he says. Department spokeswoman Lindsay Hodges says the agency is “grateful to Mr. Kramer for bringing this matter to our attention.”
http://tampatrib.com/News/MGBW7X4SO4E.html State Remiss To Not Report Misbehaving Health Workers
Published: Feb 2, 2005I n 1992 the Legislature passed a law requiring the Florida Department of Health to notify prosecutors of accusations made against health care professionals that could be criminal in nature.Yet it seems that department investigators and supervisors either didn't know about the law or ignored it altogether.
An investigation launched last July revealed that no one had notified prosecutors of more than 100 instances when patients had accused psychiatrists, psychologists, doctors, nurses, massage therapists and others of sexual improprieties. The question now is how many criminal violations were missed in the 24,000 other disciplinary cases investigated in the last 13 years.
The department is guilty of blatant neglect, if not worse, because most of the cases discovered during the initial investigation can no longer be prosecuted. The statute of limitations - the deadline under which criminal charges could have been brought - has run out.
State law makes it a felony punishable by up to five years in prison for psychotherapists to have sex with their patients, yet most of the 100 complained about will escape prosecution because the department dropped the ball.
It's not that health department employees failed to investigate the complaints. But they appear to have focused solely on discipline, even in some cases where criminality seemed obvious. It is inexcusable that they would not turn over the information they obtained to the proper charging authorities.
Last week Florida Department of Health Secretary John O. Agwunobi demoted the woman who led the division that was supposed to notify prosectors, and he ordered a review of all disciplinary cases since 1992.
``As a department charged with regulatory authority and empowered by public trust, we must quickly find ways to assure that these lapses in compliance never happen again,'' he wrote to acting deputy secretary Linda Keen.
That's a start. But Agwunobi should personally take charge of making sure this decade of departmental neglect comes to an end.
http://www.sptimes.com/2005/02/02/State/Health_agency_gives_p.shtml By Associated Press Published February 2, 2005
TALLAHASSEE - State Health Secretary John O. Agwunobi said Tuesday that 24,000 disciplinary cases investigated by the department since 1992 are being sent to prosecutors to determine whether investigation of any crimes should be pursued.
The move follows a report released last week by the Department of Health's inspector general that found the department apparently failed to formally refer to prosecutors cases in which doctors, nurses, pharmacists and other health practitioners may have committed criminal acts.
Agwunobi said police and prosecutors likely were already aware of many of the cases, because the allegations were reported first to them.
Under state law, when the agency is notified about questionable behavior by a health care professional it licenses, it is supposed to determine whether there is probable cause to proceed with discipline. Then, if there is reason to believe a crime may have been committed, it is supposed to notify prosecutors.
The department couldn't show it did that in many cases, the inspector general found. The law has required reporting of potential criminal violations by health care practitioners since 1992, but the responsibility was in other agencies until 2002, when it was given to the Health Department.
Agwunobi said in an interview that his agency had a "clear obligation" to do it and didn't. He said he was "embarrassed, not a little angry, and very disappointed" about the failure to do so.
Agwunobi said department officials decided to refer to prosecutors all 24,000 cases in which officials had found probable cause of some sort of misconduct since 1992. He said prosecutors are best able to determine whether a crime may have been committed and if so, whether the statute of limitations has run out.
From now on, any case where there's probable misconduct will be referred to prosecutors, Agwunobi said.
The inspector general's investigation was prompted by a member of the public who requested information about psychologists accused of sexual misconduct and asked for documentation about referrals to prosecutors. That documentation couldn't be produced by the Health Department in many cases.
The Tampa Tribune last week identified the person who sought the records as Ken Kramer, a researcher for the Citizens Committee on Human Rights, an organization founded by the Church of Scientology in Clearwater, which opposes many tenets of modern psychiatry and psychology.
Kramer told the Tribune the committee's primary mission is to monitor misconduct by psychotherapists.

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