Week 5 cross examination of psychiatry expert witnesses Dr Jonathan Phillips and Dr John Sydney Smith, and pharmacology expert Professor Ian Whyte
Dr John Gill and former psychiatrist John Herron were involved in the deep sleep therapy scandal at the Chelmsford Private Hospital (CPH) in Sydney that was the subject of a Royal Commission in 1989. Gill and Herron are suing HarperCollins Publishing 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 one more medical expert due to give evidence in week six from Monday 6 July 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 (CPH) 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
The expert evidence in chief was given in the form of written reports, which are not available to members of the public. The experts were cross examined by counsel for the applicants Sue Chrysanthou. The following therefore represents some of the challenges to their reports.
Forensic psychiatrist, Dr Jonathan Phillips
Dr Phillips has practised psychiatry since the 1970s, and was acquainted with Herron. He was cross examined for two days, primarily on the clinical management of complications that arose in the deep sleep therapy of ten CPH patients. However, he made the point that the issue was the deep sleep therapy itself as practiced at Chelmsford — there were no valid clinical indications for the use of a ‘potpourri’ of drugs in combination with large doses of barbiturates and its use on any patient constituted negligence and malpractice.
Dr Phillips told the court that muscle relaxant drugs are given to patients prior to ECT to reduce the risk of fractures. Sue Chrysanthou put it to him and several witnesses that Dr Bailey had designed his own ECT machine to deliver less electric current than other available machines. She said it used a gradual build up of current (Glisando effect) to produce a seizure. She put it to Dr Phillips that he couldn’t conclude that a muscle relaxant was necessary if the Glisando technique was used on a sedated patient.
Dr Phillips did not agree, and said it didn’t matter what current was used, ‘a fit is a fit is a fit’. He added that even an unconscious patient can have considerable muscle activity during ECT. He said the wisdom of the day, which has not changed in the years since, was that for administering ECT there needed to be sedation, appropriate muscle relaxation and delivery of oxygen.
Under reexamination by defence lawyer Tom Blackburn SC, Dr Phillips stated that the DST, as practiced at Chelmsford, could not be compared with other forms of narcosis therapy, including that of William Sargent in the UK, whose approach Bailey claimed to have based his therapy on. Dr Phillips said that narcosis therapy as practised by Sargent involved a relatively simple drug regimen based on the main tranquilizer chlorpromazine with the use of ‘carefully administered’ monoamine oxidase inhibitors to keep the person in a light trance. It was relatively light sedation over a period that did not exceed 20 hours per day and was light enough for the patient to be walked to the toilet.
The DST at Chelmsford was much heavier sedation 24 hours per day using a large number of pharmacological agents including barbiturates. Dr Phillips said it would have been impossible for any clinician to predict the effects of that combination of drugs. Elimination from the body would have been slow due to the relatively long half-life of some of the medications. He said the major medical risks for heavily sedated and immobile patients included pneumonia, pulmonary embolism and deep vein thrombosis, electrolyte imbalances, and urinary tract infections.
Dr Phillips also described the clinical note-taking by the treating doctors at CPH as ‘very bad.’ Mostly the doctors had made no notes in the patient’s clinical files. He said that was ‘very much out of kilter with reasonable standards’, and that doctors’ notes should have been in the file as necessary for communication between staff at the time and for review at a later time if necessary.
He also gave the opinion that a patient, MP, who died from complications had been misdiagnosed as having an ‘organic disorder’, when in his opinion she had an ‘existential disorder’ (related to her life circumstances) that could have been appropriately treated with talking therapies.
Dr Phillips said that another patient who initially refused to give consent for ECT on her admission, was unlikely to have been mentally competent at the time she eventually signed the form seeing she was under the influence of three different sedatives.
Mr Blackburn asked Dr Phillips to give his opinion as to whether Dr Gill’s actions amounted to negligence and malpractice, based on the assumption that Dr Gill a GP, was the administrator of CPH from the early 1970s onwards, and had administered DST to six of his own patients. The expert answered that he was of the opinion it did. Dr Phillips said that if Dr Gill had properly and dispassionately appraised ‘this complex and dangerous treatment of DST, he would not have allowed any other person to practice it in his hospital.’ He took issue with the ethics of Dr Gill admitting his own patients in a situation of obtaining money by ‘administering a most unusual form of treatment’ in a hospital he part owned.
Dr Phillips said that it remained his view that
deep sleep therapy was not a proper treatment to be used with any person, [whether an] adult or adolescent in 1974.
Deep sleep therapy as it was practiced at Chelmsford ‘was not an appropriate therapy to be used with anybody,’ he said.
Dr John Sydney Smith, psychiatrist, medicolegal consultant
Dr Smith was an expert witness in the civil proceeding brought by patient BH against Dr Herron in 1979. In the 1980s he wrote to members of parliament, the police and the College of Psychiatrists requesting official investigation of the events at CPH. He was also a witness at the Chelmsford Royal Commission in 1989.
He told the court, ‘I believe I’m an impartial witness,’ in reply to Chrysanthou’s, suggestion that he’d agreed to give expert evidence ‘to advocate on behalf of one side.’
When she asked whether he believed he could be impartial against Dr Herron, Dr Smith replied that from the time of Hart v Herron civil proceedings he believed that Dr Herron and Dr Bailey were putting patients’ lives at risk, and ‘for that reason I then approached the Attorney General, the Minister for Police, the Minister for Health and the various colleges’ to investigate the treatments at Chelmsford ‘before other people were hurt.’
Asked whether he was discussing allegations about CPH with Jan Eastgate (of Scientology’s anti-psychiatry front the Citizen’s Commission on Human Rights) at any time in the 1980s, he said he remembered having one phone call from Jan Eastgate or some other Scientologist, but ‘it was a very brief call because I had no time for the Citizens Commission for Human Rights or the Church of Scientology.’
Based on CPH clinical notes, Dr Smith formed the view that patient BH didn’t have a pervasive mental illness or any other pervasive illness, but rather an adjustment reaction and therefore did not have the accepted indications for narcosis therapy. BH’s DST ended in an emergency transfer to Hornsby General Hospital with a provisional diagnosis of bilateral pneumonia. He was later also found to have suffered a pulmonary embolism. Dr Smith was of the view that BH had a 50% chance of dying by the time he arrived at Hornsby, partly due to the delay in treatment.
Another patient, MP (described by Dr Phillips as having had an existential disorder) was also rushed to Hornsby Hospital from CPH, but later died. Dr Smith’s opinion was that her death was caused by an abdominal obstruction resulting from the DST.
Professor Ian Whyte, clinical toxicologist and clinical pharmacologist
Ms Chrysanthou put it to Prof. Whyte that he had not conducted a literature review on the efficacy of narcosis therapy in relation to various indications. Professor Whyte answered that the only indication he could find for the use of the sort of doses of barbiturates that were being used in Chelmsford at that time was to ‘attempt to induce barbiturate coma for the management of life threatening head injury as a last resort.’ He added that the evidence suggested that it was not beneficial.
Chrysanthou then asked if he’d read scientific papers where psychiatrists had used narcosis therapy to treat mania, depression, schizophrenia and alcoholism. The professor replied, ‘not with doses that match these.’ He said that according to the literature he’d found, narcosis therapy used ‘less agressive sedation.’
Professor Whyte said that that there was such a high risk of adverse events associated with the DST drug regime
the benefit would have to be enormous to make it worthwhile… I found there was no evidence that there was such benefit.
The professor told the court he had been provided with death certificates for the DST patients who’d died at Chelmsford to help him prepare a report to the Chelmsford Royal Commission. He said that he and another expert, Professor Henry, found that the death rate in the patients who had DST was about 17 per 1000 hospital admissions, as opposed to 6 in 1000 hospital admissions of people who’d overdosed on barbiturates deliberately or otherwise as outpatients.
In reexamination, Professor Whyte told the court that the DST drug regimen should have been administered in a closely controlled circumstance, due to the risk of lethal complications including respiratory failure, pulmonary embolus and acute kidney failure. He added that while there are drugs available to reverse the effects of other sedatives, ‘we don’t have an antidote that you can give to reverse the effects of the barbiturate.’ The patients on the DST regime therefore required ‘one to one nursing care with frequent hourly observations of vital signs at a high dependency or intensive care environment’ where there was access to suction, oxygen and the facility to be intubated and ventilated.
Day 9: introduction to the case
Day 10: defence opening address
Days 11 – 13: cross examination of author Steve Cannane
Weeks 3 and 4 Chelmsford hospital deep sleep therapy patients give evidence
Expert evidence from psychiatrists – part one – Professors Patrick McGorry and Ian Hickie
Expert evidence from psychiatrists – part three – Professor Gordon Parker
Two former nursing staff give evidence
Former Matron Smith gives evidence
Former Matron Fawdry gives evidence