Dr. Arun Guha?

Let me remind those who are speaking because of the shortness of time I have to enforce the five-minute rule very strictly.

Thank you for joining us today.

DR. GUHA: Thank you. My name is Arun Guha and I begin by applauding you for your decision to hold this public hearing because I believe that this is the only way that you can start getting a glimpse of the true problem which is enormous. You would not get it in the literature or interviewing hospital personnel or researchers themselves.

I am a little disappointed that you do not have investigative powers to follow through on some of those but I have a suggestion to make. You could ask each of the presenters for waiver of patient confidentiality and then interview some of the physicians. Most of them work for either NIMH or work for some NIMH funded government agency. If they refuse to talk to you that itself should be used.

The point I am making is that my experience shows and there are other experts who say that there is a conspiracy of silence in the medical community and there is no reason to believe that you will get true information from just talking to them.

My second suggestion is that you should think both tactically and strategically. By that I mean that the root cause of the problem is not just absence of regulations. In my particular example that I am going to tell you in a minute the regulations are there but they are simply ignored.

Vera mentioned that research subjects are recruited in emergency rooms. That is what happened to my son and I will come to that in a minute.

By strategic solutions I mean that you really should look at the root cause of the problem which is that in the medical community such unethical behavior is socially acceptable. When this happens everybody else knows it is happening. There is no protest from within the community itself to stop this. I have made a specific suggestion of how to handle the problem. It may not be the best one but I may not have time to discuss it. I would like to talk about that later on.

Let me now come to my case history. My son, age 26, died at the UCLA Neuropsychiatric hospital in November of '93. He had really no reason to be there. He was of sound body and sound mind with a Harvard MBA and a brilliant career. He was in Kuala Lampur, Eurasia where he felt ill. He probably had a viral ill with a sore throat, difficulty in sleeping and so on. He was in a Hilton hotel and ordinarily when you are in an American hotel outside the country you still believe that you are getting the American standard of care. So he saw a center inside the hotel so he walked in and he was given five medications.

He reacted to one and he did not know anything about those medications at this time and if you like I can go into the details but I am trying to save time by not going into this now. He reacted to the one medication and he became delusional. Not psychotic but delusional because the medication was a dopamine blocker. So it does not fit the standard definition of psychosis followed by excess dopamine.

Unfortunately for him when he reached the United States on Thanksgiving Day I went down to Los Angeles and got him into the UCLA medical center. It was deserted. The only evaluation he got was from a first year resident who did not have his license to practice, wholly untrained and did not have supervision. As a matter of fact there was no attending physician for five days.

I have given you the documentation of an interview with the medical director of UCLA/LBI, who himself had agreed that my son's admission was never reviewed by an attending physician.

This untrained resident did not know what to do so he decided to put him on involuntary hold and put him as an inpatient. He could have cured him of his symptoms by a matter of hours by an antidote, by an antinergic (?) drug such as clozatine (?). That did not happen because nobody looked at him.

The next day when I went in I found him in a terrified state. What had happened he described to me is that somebody had been coming into his room at night flashing a flashlight on his eyes until he was supposed to open his eyes and then leaving. It was happening every 15 minutes. I did not believe him. I did not believe him. We did not think that this was possible and that it could be happening.

Later that evening a very senior nurse, the second highest ranking nurse, Janette Allen (?), told us that, yes, that is happening. That is the practice. That is the policy. I had a long debate with her about how could this be happening. How could this be policy? And she explained that this was clinical practice of this hospital in this unit. For four days I had been debating and arguing and pleading and begging with the residents and nurses that this does not make any sense. For four days both my son and I let them know it.

After his death on the fifth day on Monday we had an interview with Dr. Barry Guzay (?) who is the director of adult psychiatric and in charge of the unit. He was in a state of shock himself because clearly he had not anticipated something like this happening. He answered many of our questions as if in a trance and I am sure that he was speaking mostly the truth. He did not have the mental state at that time to really think through and call up his answers.

We asked him about this night monitoring and he said, "Yes, standard procedure. A flashlight was shown in front of his eyes. Eye contact was made." He was the first person to use the word "eye contact" and we knew that what my son was describing was true. But even then we had believed falsely that it was part of the clinical protocol and we had been looking for a policy, clinical policy statement, from the hospital that says that and we did not find any. And we had expert opinion from the medical board and so on that there is no clinical reason for doing that and then we discovered that Dr. Guzay had been involved in sleep deprivation research. Apparently some psychiatrists still believe that that can be helpful to people with mental depression.

In our court filing that we have made under penalty of perjury we are accusing Dr. Guzay of conducting a totally clandestine research without even a shadow of informed consent which he conducted on my son.

And in terms of other comments that were made before I have run probably the most extensive letter writing campaign. We have gone to OPRR and when you talk about OPRR I hope the commission will look at the resources available to OPRR compared to the problem and the drug company monies and the NIMH funding, and some sort of a comparison to that.

Somebody talked about the attorney general.

DR. CHILDRESS: I will have to ask you to bring it to a close. We are --

DR. GUHA: Unless there are any questions I am done.

DR. CHILDRESS: Okay. Questions?

I take it in this particular case they would make an argument that this was clandestine research by a maverick investigator that had not gone through regular channels?

DR. GUHA: We believe that Dr. Barry Guzay had standard orders that anybody walking in and who was diagnosed with mental depression should be put under this protocol. The person who did that was totally untrained. He believed that he would get a pat on the back from his boss by doing so. And it was Thanksgiving weekend and there was nobody else available. I have provided documentation of most of this stuff.

DR. CHILDRESS: And we do appreciate the thorough report that we have. We have not -- we just received it this morning so we will look forward to reading it very carefully. Thank you for sharing it with us today.

MR. CAPRON: Are other people missing attachment 3 if you look back here? There is a page that says attachment 3 but there is nothing after it.

DR. GUHA: I did it at 12:00 midnight last night so I might have --

MR. CAPRON: But if it is something you want us to see we may need to look at it.

DR. GUHA: I will send it in.

DR. CHILDRESS: Thank you.