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Biomedical subjects

S Rachlin

Publications and source records attributed to S Rachlin.

14 recordsLinked to original sources
PubMed1990

Imaging evaluation of children after falls from a height: review of 45 cases.

The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients. Head injuries (including skull fractures) occurred in 19 patients. Abdominal injuries were present in only one patient. Pneumothoraces were seen in four patients and lung contusions in two patients. Fractures of the pelvis, spine, and os calcis were uncommon. The height of the fall did not enable prediction of either the severity or type of injury. The authors recommend radiography of the cervical spine and chest alone in the initial evaluation of the injured child and greater willingness to obtain computed tomographic (CT) scans of the head in children than in adults. Radiographs of the pelvis, thoracolumbar spine, and lower extremities, as well as CT scans of the head and abdomen, should be obtained on a case-by-case basis, and not according to protocol, as is often the situation in adults.

Abdominal Injuries↗
PubMed1988

Litigating a right to treatment: Woe is me.

The right to treatment was first proposed by Birnbaum in 1960. While its constitutional basis may still be in doubt, it has found significant acceptance in state legislation and in lower court decisions. Defining, implementing, and quantifying this right remain elusive. For well over a decade, the case of Walter Woe has been litigated in the federal courts of New York. It represents a continuing effort to obtain a level of care for patients involuntarily hospitalized in the public sector equal to that provided for those admitted voluntarily to general and private hospitals. A precommitment right to refuse inadequate treatment is a novel extension of the right to treatment, with potentially significant implications, and is part of the continuing legal battle.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

The presence of counsel at forensic psychiatric examinations.

In virtually all situations involving forensic psychiatric assessments, the patient is represented by counsel. But does this fact entitle the lawyer to be present at the clinical evaluation? In a series of New York cases spanning a generation, judges have allowed presence of counsel at the psychiatric examination. The most common reason given for such a conclusion is to assure better cross-examination of the expert witness. Psychiatric evaluations mandated by law necessitate several guidelines different from those of the usual doctor/patient relationship. While we may have to accept the presence of attorneys in our consulting rooms, they should be observers only. To allow active intervention would distort the clinical process.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

From impartial expert to adversary in the wake of Ake.

In deciding Ake v. Oklahoma, the Supreme Court held that, when defendants demonstrate that their sanity is likely to be a significant factor at trial, the State must assure them access to a competent psychiatrist who will not only examine them but also render other assistance to the defense. There have been 28 known subsequent decisions in which appellate courts have ruled on the validity of Ake-based claims; in only four did the defendant prevail. The case nonetheless raises issues relative to the proper role of the psychiatric expert. The Supreme Court's decisions, although not introducing a new ethical topic, appear to be favoring a more adversarial posture, at least within certain parameters. I suggest that impartiality, independence, and advocacy need not be mutually exclusive concepts and that some of our traditional beliefs about what part we should play in criminal law may have to be modified and expanded.

Expert Testimony↗
PubMed1986

Unforeseeable liability for patients' violent acts.

Psychiatrists have been held liable for violent acts committed by their patients when more than an error in professional judgment could be demonstrated. The authors describe several recent court cases in which judges have ignored or distorted acceptable clinical practices, conceivably creating a new liability standard whereby a tragic outcome is considered the result of failure to apply appropriate judgment. Following discussion of the cases are recommendations for managing the risks attendant to psychiatric decision making today, such as gathering as much of the patient's history as possible, obtaining previous records, documenting clinical reasoning, and consulting colleagues. Reforms for the legal process are also suggested.

Adult↗
PubMed1986

Incompetent misdemeanants--pseudocivil commitment.

Prior to Jackson v. Indiana, psychiatric hospitalization of those found to be incompetent to stand trial often led to an inordinately long confinement, a particularly invidious consequence if the patient had been accused only of a misdemeanor. After a highly publicized murder perpetrated by a patient originally in this category, New York State instituted a rather cumbersome set of procedures designed to assure several layers of review, including involvement of the legal system, prior to increasing privileges or discharging someone committed pursuant to a criminal court order. The effect of this new law on patient care is examined by looking at the hospital course of 52 incompetent misdemeanants at one state facility. They are demographically and clinically quite similar to a control group of persons civilly committed, except for an increased length of inpatient stay. When compared with those sent to the county penitentiary after conviction, the study population differs on several important parameters. Looking like a patient, the incompetent misdemeanant is, however, treated more as a criminal with no indication that public safety is thereby increased or that individual therapeutic objectives are enhanced.

Adult↗
PubMed1979

Patients without communities: whose responsibility?

The authors conducted a study at an urban state hospital to determine if a patient's place of residence--within or outside the hospital's service district--was reflected in the admission rates or the quality of care received. No differences between in-district and out-of-district patients could be found on any parameter studied. The authors believe the results support the unique role of the state hospital as a facility that accepts its mandate as a referral of last resort.

Attitude of Health Personnel↗
PubMed1978

When schizophrenia comes marching home.

Deinstitutionalization of the chronically mentally ill has only recently been recognized as a phenomenon which may not be in the best interests of the patients involved. The reasons for this include the lack of adequate community-based resources for domiciliary, treatment, and rehabilitative services, plus the response of society to deviant behavior. However, the most fundamental problem is likely to be the severity of the illnesses with which we are concerned, so that the solution cannot be as simple as the sending "home" of the long-term patients. Prevention of institutionalization is seen as a more feasible goal than its cure. This requires a comprehensive program incorporating, among other things, a recognition of the necessary role of the mental hospital, and the need to improve the quality of care provided therein.

Aftercare↗
PubMed1977

Countersymbiotic suicide.

In the course of studying the outcome of treatment for severely disturbed schizophrenics on a special ward, the authors encountered three instances of suicide with many features in common. All three cases involved young Hispanic male patients who demonstrated pathologically symbiotic relationships with their mothers. None had a history of overt suicide attempts prior to their actual death by jumping. These incidents occurred while the patients were en route to, or at, the maternal home on an unauthorized leave from the hospital. We present the case histories and offer a dynamic interpretation. In each case, it is likely that the underlying desire was to kill the mother. This either was not permissible or, alternatively, the patients' ego boundaries were not sufficiently clear to permit differentiation of self and mother. The patients saw any attempt, short of suicide, to loosen the symbiotic bond as being futile, hence, our terminology of the event as "countersymbiotic suicide."

Adolescent↗
PubMed1975

Civil liberties versus involuntary hospitalization.

The authors examine the issue of involuntary hospitalization for mental illness with particular reference to legal rights and civil liberties. Follow-up data of patients treated on a closed ward, as well as other available evidence, indicate that society is not ready for the abolition of involuntary hospitalization. The authors believe that the most fundamental right of the patient is that of adequate treatment, and therefore this should take precedence over an absolute right to liberty.

Attitude↗
PubMed1975

One right too many.

Explore the source record for details and available documents.

Commitment of Persons with Psychiatric Disorders↗