25 – 26 June 2020 – Cross examination of psychiatry expert witnesses, Professor Pat McGorry and Professor Ian Hickie
Dr John Gill GP, and former psychiatrist John Herron, who were involved in the deep sleep therapy and electroconvulsive therapy scandal at the Chelmsford Private Hospital in Sydney in the 1960s and 1970s, are suing HarperCollins Publishers Australia and ABC journalist Steve Cannane for defamation over a 28 page chapter of Cannane’s book Fair Game: The Incredible Untold Story of Scientology in Australia.
See this link for the trial’s listing details at the Federal Court in Sydney.
Links to my other blogs on this trial are at the end of the post. Chelmsford nurses are still giving evidence with several more medical experts due to give evidence in week five from Monday 29 June 2020.
DST – deep sleep therapy at Chelmsford
Deep sleep therapy (DST) is a psychiatric treatment in which drugs are used to keep patients unconscious for extended periods. The height of its use was from the 1930s to the 1960s.
DST was practised (in combination with electroconvulsive therapy (ECT) and other therapies) by Harry Bailey between 1962 and 1979 at the Chelmsford Private Hospital in Sydney. As practised by Bailey, deep sleep therapy involved long periods of barbiturate-induced unconsciousness. Wikipedia
Dr Bailey and John Herron had continued DST combined with ECT until 1979. The Chelmsford hospital was partly owned and managed by Dr John Gill.
Cross examination of medical experts
Prof. McGorry’s evidence in chief was given in the form of an affidavit, Prof. Hickie’s was in the form of an expert report. Neither documents are publicly available. The experts were cross examined on their evidence by counsel Sue Chrysanthou. The following therefore represents some of the challenges to the experts’ reports.
Professor Pat McGorry
Professor Patrick McGorry, a former Australian of the Year, is Professor of Youth Mental Health at the University of Melbourne, and a Founding Director of the National Youth Mental Health Foundation (Headspace). He has authored over 600 peer reviewed articles.
Professor McGorry gave evidence that he was a medical student in the 1970s and did not see any scholarly literature on DST during those years because its use was marginal. He first became aware of the Chelmsford scandal via media coverage, but said that the adverse events at Chelmsford have been referred to in psychiatry training until recent years.
Ms Chrysanthou asked the Professor whether studies published in reputable medical journals from the 1920s through to the 1990s on sedation therapy were a reliable basis for information on whether or not a doctor should practice it. He answered that ‘you’ve got to have a critical mind.’ He said that some published research has value and some is flawed, ‘especially at that time, probably most of it had lots of methodological problems… Just because it’s published in a medical journal doesn’t mean it’s correct.’ He said that a doctor should definitely not change their practice ‘on the basis of one or two articles published in a journal. You should look at what the whole body of evidence over a period of time suggests.’
In response to further questioning along those lines he added, ‘people should have realised that this was pretty ridiculous to put people to sleep for 20 hours per day and very risky and shouldn’t be done… You should use your common sense and have some judgment about these things.’
Ms Chrysanthou referred to a book on a history of radical treatments for mental illness, Great and Desperate Cures by Elliot S. Valenstein. She raised that a lot of psychiatrists were desperate to do something to relieve the suffering of psychiatric patients.
Professor McGorry answered that such a spirit can be dangerous.
You’ve got to have a scientific and a Hippocratic approach — first do no harm — and I think that’s what was lacking at Chelmsford… The whole point of this case to me is that [therapies such as DST] persisted well beyond the period when it was obvious to everyone that they were dangerous and not useful.
Ms Chrysanthou suggested that it was unfair for the Professor to compare his view as it stands in 2020 with the view of doctors practicing those therapies in the 1970s. McGorry answered that as a young doctor in the 1970s he was able to make up his own mind on high risk therapies based on what he read at the time, ‘including some of these pretty flawed textbooks… It was a scientific era, they should have been more critical and they should have observed the harm that was occurring to patients.’
In response to a passage from Great and Desperate Cures that suggested medical innovations involve risks, he replied, ‘if you haven’t got really good scientific evidence to justify it then the risk benefit ratio has to be the key thing that you weigh…’ He quoted an aphorism, ‘the duty of the doctor is to cure sometimes, to relieve often and to comfort always’ and added ‘that’s what you do when you have people who have intractable or severe conditions, you don’t expose them to risk or harmful and desperate cures like these people did.’
Professor McGorry said that he had read Cannane’s book, not in relation to the defamation case, but because ‘Scientology is a thorn in the side of everything we do and a nasty cult that’s been harming the world for decades.’ He said he was ‘delighted to see Steve Cannane write an exposé of it.’
In reexamination, the lawyer for the defence, Tom Blackburn SC, returned to a section on ‘prolonged narcosis’ in a 1973 medical textbook referred to by Ms Chrysanthou. Ms Chrysanthou had suggested that the therapy’s inclusion in the text indicated that it was an accepted therapy at the time. Mr Blackburn read out a short passage, ‘continuous narcosis has few advocates today. Its place has been taken by other forms of treatment.’ He asked the Professor whether he thought the section was intended to be a complete and comprehensive guide to the correct application of narcosis therapy in 1973.
McGorry answered that it looked like an overview, and that the text advocated an approach that entailed sedation for 20 hours per day whereas the version of therapy practiced at Chelmsford involved continuous sedation 24 hours a day. The text included no advice on drug dosages and other clinical considerations.
Professor McGorry reiterated that ‘do no harm’ is the number one scientific and ethical principle in the practice of medicine.
Professor Ian Hickie
Professor of Psychiatry, Ian Hickie is Co-Director of Health and Policy, at the Brain and Mind Centre at Sydney University Medical School, a NHMRC Senior Principal Research Fellow and was an inaugural Commissioner on Australia’s National Mental Health Commission from 2012 – 2018.
Ms Chrysanthou asked Professor Hickie if he was aware of papers on sedation therapy published in reputable medical journals from the 1920s to the 1950s, but he replied that by the 70s those studies were no longer useful, in effect because ‘the movement away from non specific sedative treatments was well advanced in the 1970s.’
Chrysanthou asked which conditions he assumed were indicated for deep sleep therapy when he was considering matters for his report. The professor answered that he could not see that any conditions would be appropriate for deep sleep therapy at that time.
I don’t believe there were any indications in the 1970s for deep sleep therapy.
Professor Ian Hickie
He said that by then, more specific treatments that posed lower risk had emerged for each of the psychiatric conditions counsel had named.
Professor Hickie added that occasionally sedation is indicated in cases of life-threatening psychiatric events ‘but only for short periods.’ He said that the 1960s into the 1970s saw the development of many classes of drugs (including anti-depressants, anti-psychotics and new forms of sedatives) that meant that there was ‘no indication for anything even mildly resembling deep sleep therapy’.
In relation to Dr John Gill’s role, Ms Chrysanthou suggested it would have been improper for a general practitioner to question the treatment provided by a specialist. Professor Hickie replied that it could not be argued that it was a reasonable treatment, and that ‘any doctor would challenge another doctor’ over such a high risk approach. He added that the operator of a hospital has a responsibility to know what treatments are being provided there, the conditions those are being provided under, and whether it’s reasonable to provide the treatment in the first place. He said that it’s up to the operator to have or provide sufficient medical expertise to make that assessment and any medical practitioner would understand there were significant risks to that degree of unconsciousness in patients over prolonged periods. It was the responsibility of the hospital operator to ensure ongoing quality assurance and patient safety.