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Vitek v. Jones: transfer of prisoners to mental institutions.

In Vitek v. Jones, the United States Supreme Court interpreted the due process clause as requiring that certain procedures be followed before transferring prisoners to mental institutions. This Note analyzes the Court's reasons for concluding that the existing transfer procedures embodied in the state's commitment statutes infringed on the prisoner's liberty interests and, therefore, were constitutionally inadequate. It finds that not only was one of the grounds used by the Court to find a constitutionally protected liberty; inappropriate, but the calculus that the Court employed in mandating additional procedures was incorrect. This Note suggests alterative methods of holding the statutes unconstitutional, methods that would not lead to markedly different procedures for committing prisoners and civilians. Finally, the Note examines the procedures that the Court actually prescribed and discusses their implementation.

Civil Rights↗

Vitek v. Jones.

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Civil Rights↗

The Supreme Court looks at psychiatry.

An analysis of the attitudes of the U.S. Supreme Court toward psychiatry, as expressed in the Court's major opinions on mental health law from 1975 to 1983, reveals significant discrepancies from case to case. The explanation for these puzzling shifts in attitude lies outside the realm of mental health law, in the justices ' aversion to judicial involvement in professional decision making. A close examination of the cases demonstrates the Court's willingness to alter its rhetoric about psychiatry to support this overriding end. Psychiatrists' understanding of the Court and advocacy for their own and their patients' interests must take this broader issue into account.

Adult↗

Supreme Court decisions on mental health: a review.

Since the late 1960s mental health advocates have filed numerous lawsuits against mental health institutions in an effort to narrow the standards for civil commitment, improve the care of patients, and define patients' rights. While many of the lawsuits were successful in attaining these goals at the district and appellate court levels, review by the Supreme Court generally has resulted in decisions blunting the lower court rulings. The high court has rejected broadly worded lower court decisions on commitment laws, standards of proof in commitment hearings, and patients' rights. The court also has upheld the traditional reliance on decision-making by medical professionals. The author describes a number of these cases and their decisions and concludes that cases now before the Supreme Court very likely will result in decisions that strike a balance between the needs of the patients and those of treatment staff.

Adult↗

Accurate characterization of ofloxacin susceptibility with Enterobacteriaceae using a modified GNS F6 card and the bioMerieux Vitek System.

Routine antimicrobial susceptibility testing of Enterobacteriaceae using the Vitek System (bioMerieux Vitek, Hazelwood, MO) and the GNS-F6 card revealed discrepancies between the activity of ofloxacin and ciprofloxacin, primarily with isolates of Klebsiella pneumoniae. Specifically, during a one-year period, 12% of 618 ciprofloxacin-susceptible isolates were determined to be ofloxacin resistant with the GNS-F6 card. A similar problem, but one of lower magnitude, was observed with Serratia marsescens. That these represented false ofloxacin resistance results was confirmed by comparison of broth microdilution determinations of ofloxacin MICs with F6 results on a collection of 203 fresh clinical isolates of K. pneumoniae and 39 isolates of S. marsescens. The GNS-F6 card was then modified by the manufacturer to include a new formulation of ofloxacin and assessed using a collection of 224 recent clinical isolates of Enterobacteriaceae and Pseudomonas aeruginosa, and 78 stock cultures of enteric Gram-negative bacilli selected specifically because of disproportionately high rates of fluoroquinolone resistance. No ofloxacin false resistant results were observed with this collection when the modified GNS-F6 card was evaluated in comparison to a standardized broth microdilution MIC test. The current clinical version of the Vitek System appears to accurately assess ofloxacin susceptibility.

Anti-Infective Agents↗

Evaluation of the Vitek system to accurately test the susceptibility of Pseudomonas aeruginosa clinical isolates against cefepime.

A total of 300 recent blood stream and pneumonia isolates of Pseudomonas aeruginosa from 32 different medical centers in the United States were used to assess the accuracy of the Vitek System (GNS-107 card) for cefepime, a new "fourth-generation" cephalosporin. The Vitek System test result was compared to the consensus of the three other methods (reference broth microdilution, disk diffusion, Etest (AB BIODISK, Solna, Sweden)); and 271 of 300 consensus category of susceptibility sets were unanimous. The Vitek System produced a 25.3% error rate (5.3% false resistance, 20.0% minor errors). A consistent trend toward higher MIC results with the Vitek System was observed that produced a 15.3 to 21.3% lower susceptible rate compared with the other susceptibility test methods. The consensus cefepime resistance rate was only 4.3% compared to 14.0% for the Vitek GNS-107 card. The error was reproducible on triplicate repeat testing. These results indicate an unacceptable rate of false resistance being produced by the Vitek System when testing cefepime against P. aeruginosa strains. Alternative methods are suggested for this broad-spectrum antipseudomonal cephalosporin.

Bacteremia↗

Multicenter laboratory evaluation of the bioMérieux Vitek antimicrobial susceptibility testing system with 11 antimicrobial agents versus members of the family Enterobacteriaceae and Pseudomonas aeruginosa.

A four-center study in which a total of 1,082 recent clinical isolates of members of the family Enterobacteriaceae and Pseudomonas aeruginosa were examined versus 11 antimicrobial agents with the bioMérieux Vitek susceptibility test system (Hazelwood, Mo.) and the GNS-F6 card was conducted. In addition, a challenge set consisting of the same 200 organisms was examined in each of the four participating laboratories. Results obtained with the Vitek system were compared to MICs determined by a standardized broth microdilution method. For purposes of comparison, susceptibility categories (susceptible, intermediate, or resistant) were assigned on the basis of the results of both methods. The result of the broth microdilution test was considered definitive. The total category error rate with the Vitek system and the recent clinical isolates (11,902 organism-antimicrobial comparisons) was 4.5%, i.e., 1.7% very major errors, 0.9% major errors, and 1.9% minor errors. The total category error rate calculated from tests performed with the challenge set (i.e., 8,800 organism-antimicrobial comparisons) was 5.9%, i.e., 2.2% very major errors, 1.1% major errors, and 2.6% minor errors. Very major error rates higher than the totals were noted with Enterobacter cloacae versus ampicillin-sulbactam, aztreonam, ticarcillin, and ticarcillin-clavulanate and with P. aeruginosa versus mezlocillin, ticarcillin, and ticarcillin-clavulanate. Major error rates higher than the averages were observed with Proteus mirabilis versus imipenem and with Klebsiella pneumoniae versus ofloxacin. Excellent overall interlaboratory reproducibility was observed with the Vitek system. The importance of inoculum size as a primary determinant in the accuracy of susceptibility test results with the Vitek system was clearly demonstrated in this study. Specifically, when an inoculum density fourfold higher than that recommended by the manufacturer was used, high rates of false resistance results were obtained with cell wall-active antimicrobial agents versus both the Enterobacteriaceae and P. aeruginosa.

Anti-Bacterial Agents↗