Tuesday, June 19, 2007

Doc reviewed Tiller records

Full 44-Min. Video Interview of Dr. Paul McHugh and Transcript

Some excerpts from the transcript of an interview. You can click on the link above to view the interview and read the entire transcript.

First, let's establish that he isn't some fly-by-night who can't get attention doing anything else but sitting interviews with Operation Rescue:
Paul R. McHugh was educated at Harvard College and Harvard Medical School with further training at Brigham and Women’s Hospital, Massachusetts General Hospital, the Institute of Psychiatry, University of London, and the Division of Neuropsychiatry at the Walter Reed Army Institute of Research. After his training he was eventually and successfully professor of psychiatry at Cornell University School of Medicine, Clinical Director and Director of Residency Education at the New York Hospital, Westchester Division, Professor and Chairman of the Department of Psychiatry at the Oregon Hills Scien – Service – Science Center, rather. He was Henry Phipps Professor and Director of the Department of Psychiatry and Behavioral Center at Johns Hopkins University School of Medicine and Psychiatrist-In-Chief at Johns Hopkins Hospital from 1975 to 2001. The Johns Hopkins University School of Medicine named him University Distinguished Service Professor in 1998. Dr. McHugh was elected to the Institute of Medicine, National Academy of Sciences in 1992.
How did he get involved in this?
I became familiar with it because I was called by Attorney General Kline and asked if I would look at the records and to see whether I could confirm or reject the idea that those records demonstrated that the women involved in the abortions were in danger of suffering a substantial and irreversible impairment if the pregnancies continued, impairment of a psychiatric kind.
Was anybody's privacy violated?
The names, and some of the vital details in the sense of them, were not available on those records. Those were redacted out so that the point was not to identify them as a particular person, but to identify the state of mind that they were in and the examinations that were performed and the adequacy of those studies to reach the conclusions that the doctors had reached.
This is more privacy than patients get when the medical board is reviewing documents. Their names are not redacted during the review process, and are only redacted at the point where public record documents are generated.

So what was going on with these women?
We’re talking, you know, 26 to 30 weeks into the pregnancy. Well, the mothers were expressing great senses of distress and worry about their future. They were tearful and preoccupied with the idea that only an abortion would help them. They said that they were sad and frightened and they spoke about fears that their future life would be changed. They expressed ideas that they were not being given adequate support, and that they felt that the abortion would help them.
So lack of adequate support, and not anything wrong with the women themselves, was what sent them tearfully packing for Wichita. These were not sick women. They were stressed out women.

What kind of evaulations were these women given to conclude that abortion was appropriate for them in their circumstances?
These records that I was shown were very inadequate psychiatric records. Okay? They were not thorough, detailed, pages-long understandings of the biographies, backgrounds, states of mind, and particular directions that these young women were suffering from. There was no clear work of – in those records – that would be construed as capable of giving you a full picture of the mental condition of these women. They highlighted certain kinds of things, which, out of context, were hard of course to appreciate, but were sometimes of a most trivial sort, from saying that, “I won’t be able to go to concerts,” or “I won’t be able to take part in sports,” to more serious ones, such as, “I don’t want to give my child up for adoption.” But at no time could you see and understand the future of these individuals and in what way they should be seen as full people, people capable of being helped in this situation. Rather, they were highlighted for certain kinds of, well, preoccupations and concerns. Some of them would be construed as trivial and others would be construed as serious. A trivial one would not being able to go to a rock concert. A more serious one would be to say, “I am going to be worried about the life of this child later on in life. But notice, I could pick out only bits and pieces of this. This is not a – none of them represented a full psychiatric history.
Was Tiller giving them conscientious consults, with proper arrangements for follow-up, given their distress, which he insists was so severe that only abortion could help them?
And by the way, as well, there was no plans being made for these young women, whether they were going to be aborted or not, to be seen and followed up and giving counsel and support and kindness and doctoring, to help they readjust.
What assessment did Dr. McHugh make of the evaluation and care provided to these women?
I’m quite confident that 100% of psychiatrists would say that those are not irreversible conditions since most of their practice is taking care of exactly those things and restoring people to their mental health. We, we do that all the time. And again, that’s why I’m saying that the surprising thing was that if it was believed that these were the proper diagnoses – by the way, I think these women were all in a demoralized state of mind. You – these diagnoses become almost interchangeable, at least on the evidence that’s produced here. They’re all fundamentally demoralized young women and what they needed was support, help, care, and long-term treatment for the situation that they had – that they were – in which they felt abandoned, so that they could once again feel as they should feel, that their future is rich.
....

As I say, when I look at the records, as far as I can tell, all these young women were very similar in the sense that they were all demoralized, and what other diagnostic term you wanted to give it was almost interchangeable on the basis of these records. They were discouraged, fearful, worried young women who needed support, and would express a variety of ideas in that context to win what they were liking for, and that’s – that’s the way to understand these people, in my opinion. And a thorough psychiatric examination, and a thorough and adequate psychiatric plan was needed by them and was not received – here, anyway.
What kind of verification was Tiller obtaining that abortion, and only abortion, could prevent these women from suffering irreversible and permanent harm?

[T]he law requires in Kansas that two doctors do look at them and there was a second doctor, and there was always a letter from the second doctor that would say in her opinion as well these women suffered – could potentially suffer from irreversible and substantial of a bodily function. This is mental bodily function – a bodily function construed in mental terms if the abortion – if they didn’t receive and abortion. But again, that letter was not – did not come with the kind of pages of psychiatric study, evaluation, biographical details, an understanding of the person on which – from that record you can confirm that opinion.

... Well, at least from the record, that second opinion rested upon a description of the – it rested, let’s say, it rested upon an encounter with the young woman and a statement of her present state of mind. So it was an opinion derived in much the say way from the statements of the patients themselves about how distressed they were.

.... I wouldn’t describe it as highly detailed. I would describe it as brief, symptom-only based, and – and unsubstantiated in its prognosis on the basis of a rich, detailed study of the young woman and her potentials. .... And one wonders, looking at this, why some consideration isn’t being made to employ them for the benefit of these patients. And so the conclusion that imposes itself upon – I can’t say that it’s a conclusion that – that necessarily – the conclusion is these young women came here for an abortion, and the effort on the part of the psychiatric assessment was to support that idea that an abortion is appropriate, rather than considering the alternatives, the risks and benefits of this to the person in her life.
So was there any evidence that these women had undergone any sort of psychiatric evaluation whatsoever?
All the files justified the abortions on the patient’s present state of mind of being distressed and social proposals that this person’s life would be less successful, less developed, less opportune if this child were born, and those are not psychiatric reasons, those are social reasons.

....

On the basis of these records, I wouldn’t be satisfied with any specific diagnosis, and in point of fact, a diagnosis probably doesn’t capture the issues before you in these women. A diagnosis is a pigeonhole. These – to really understand these women, I believe that you would draw up a full history of them and formulate them as people in distress and trouble. And so what I — my diagnosis, if pinned to the wall on that, would not be a simple psychiatric diagnosis, it would be that these are demoralized people, discouraged, depressed in the sense of being discouraged and disheartened – those kinds of feelings, and I would identify them as that kind of person. Okay? Rather than subject them to a psychiatric diagnosis like major depression or acute stress disorder, because it wouldn’t carry the meaning of what was there. But these records that I had are so inadequate that I couldn’t confidently support either the diagnoses given or these ideas that are impressions that come across from the few descriptions of the women there.

....

I think that a psychiatrist would say – would all agree that these are inadequate records for laying out a psychiatric diagnosis and a psychiatric plan. And it’s a psychiatric plan that’s needed here. And a psychiatric plan that is being proposed be solved by an abortion. That’s – that’s what is intended in these files, and they’re inadequate.
What was Dr. McHugh's conclusion?
All I can carry away from this is that by these criteria, no person who would want an abortion – a late-term abortion would be turned away from that. And so I presume that – that the idea here is to justify that surgical procedure, and these records on a psychiatric basis do not so justify it.
Well, what would this guy conclude is appropriate for these women's well-being then, if not abortion?
But when you say that someone will end up an uneducated person, that is not a psychiatric diagnosis. That is a social prediction. Okay? And – and by the way, a social prediction certainly doesn’t have – as we know in our country – does not have to be fulfilled, if we offer social support. The occupational future, the person will fear family disapproval, words of that sort. Those are all social reasons. I don’t mean to say that if you do loose out in your education, that’s not harm, but it’s a social harm and those kinds of things should be treated in a social fashion. And by the way, re-supporting the individual, re-moralizing her, giving her her strengths, her self, she then as we know, can independently demand the kinds of support that – that comes, and that she would be entitled to.

....

Those are direct quotes from the records, sample notations from Dr. Tiller. “She was forced to carry to term she would end up an uneducated person without occupational skills and have multiple other pregnancies,” and the like. Well, all of those things are social predictions, and obviously become subjects, interests, concern – but I’m saying, and we psychiatrists would say, will be avoided if we can get this person once again to feel what she’s entitled to feel, namely that she’s an independent individual with rights and proper approaches to her life. If you think, and teach her, that the only thing that can be done here is that this viable human being has to be killed in order for her to have anything in her future, that’s a lesson – that’s a social lesson that may well, in my opinion, prognostically take from her the sort of sense that she can overcome hurdles that life brings her. Now, that’s not a psychiatric opinion that I’ve offered you, either. But it – it’s a social attitude or an approach to women in our county that, in my opinion, is more meaningful than proposing that if they carry a viable child to term that their educational opportunities are lost and they end up fundamentally having multiple pregnancies, multiple sexualities – that their sexual life is lost as a meaningful way, that they will never flower and blossom. If anyone were saying that in another context about a woman, he would or she would be, you know, chased out of court.

....

I’m only saying here that the records carry with them by the statements that I drew out from you, give the impression – give the impression that a hopeless attitude is depicted going along with the hopeless feelings that the patient has and brings to the clinic. Doctors are supposed to give hope to people and support to people, and they have to believe that such hope is to be found in them. And usually, by the way, for psychiatrists anyway, I can tell you that that kind of hopeful attitude comes out of taking the full history of the person, noticing not simply what life has imposed upon her, but what she has brought to life, what her strengths are. If we approach a psychiatric problem as though there are only deficits, rather than assets for a person, we will never have an optimistic and a future-oriented therapy for people. We’ve got to see their assets as well as their vulnerabilities to bring them on, and those don’t come across in these records.

In other words, they're worthwhile human beings with strengths, and they deserve better than to have two more professionals certifiy their own low sense of self-worth and ability to cope with life.

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