It will be instructive for the reader of A Death in the Hospital to learn more about how Seth was being “treated” in the Intensive Care Unit of the Allen Pavilion.
What is an Intensive Care Unit and what is its function in a Hospital? The I.C.U. is designed for the sickest and most desperately ill of patients. The Staff, Physicians, and Nurses, are supposed to be trained and skilled in the management of the most serious of Medical situations. They are dealing with patients who are desperately ill and at the borderline between life and death. Only the most skilled of clinicians should be working in an I.C.U., since they literally are holding the patient’s life in their hands.
It is from the deposition taken by our Lawyers of the then young and recent Medical School graduate, Dr. Laurel Mayer (Hecht) that the reader can gain a glimpse of the horror our son faced in the I.C.U. of the Allen Pavilion of Columbia Presbyterian Hospital in the City of New York.
As we said in Who Killed Seth Speken, Dr. Tom Bertsch identified himself as the “Director of the I.C.U.” (a lie, since he was still a resident at the time). Although presenting himself as a fully trained I.C.U. Physician was not true, he did know the correct treatment Seth should have received. His order read (see above): “rather over sedate and intubate than undersedate and seizure.” There were no orders from him to apply restraints.
Seth had a human and legal right to have Dr. Bertsch’s orders carried out. The treatment he should have had was, in fact, quite simple. He should have basically been put to sleep, monitored closely, and then gradually woken up once his body had completed withdrawing from Xanax. Certainly, an intern could have done this, but should have been supervised closely at the bedside on to how to do it.
It is tragic, both as his parents as well as individuals in the Medical field, to read Laurel Mayer’s deposition and see just what she did to our son.
Who was Laurel Mayer (Hecht) at the time, on August 24, 1993, when she became Seth’s “Doctor?” From her deposition, we learn that Laurel Mayer had graduated the Albert Einstein Medical College in the Bronx, New York in June of 1993. She then began her Medical internship at Columbia Presbyterian Hospital at the end of June. Her first rotation was on a 14 bed Hospital unit for AIDS patients. She did this for two and a half weeks. She then went on vacation.
Sometime in the first or early second week of August, 1993, Laurel Mayer was then given the responsibilities of being an intern on the Intensive Care Unit of the Allen Pavilion, a division of Columbia Presbyterian Hospital.
Now what should this have meant? It should have meant that her role as an intern was basically to watch how senior clinicians were ministering to desperately ill patients – patients hovering between life and death. Any actions that the I.C.U. intern were permitted to take, should have been under the closest supervision by these senior Physicians.
But, a close reading of Laurel Mayer’s deposition reveals just the opposite! A reading of her own words reveals that she was given the responsibilities of a Physician, fully trained and seasoned in critical care Medicine. It was as though at her graduation from Medical School she was told, “You are now a Physician. You can do anything in Medicine and Surgery -even Neurosurgery. Here’s the knife.”
When Seth arrived in the Intensive Care Unit at around 2pm on August 24, 1993, Laurel Mayer indicated that she was part of a “team,” whose responsibility was to care for him. The resident, Dr. Tom Bertsch did write an order giving the correct direction as to how Seth should have been treated. This order was very brief, but specific and correct. He directed that Seth should have been put deeply asleep. In this deep sleep, Seth would not have been in misery.
He would not have been shaking violently in his bed, repetitively slamming his legs against the illegal restraints, that led to the pulmonary emboli that were to kill him. He would have been at rest and calm. It is so important to achieve this state in the patient in withdrawal, that if necessary, the patient should be hooked up to a respirator. That is, a tube should be put into the patient’s trachea and he/she should be connected to a device that pumps air into and out of the lungs at a steady rate.
The reader of Laurel Mayer Hecht’s deposition is left with a major question. Why was Dr. Bertsch’s order not carried out to the letter? The one and only conclusion is that Laurel Mayer was left on her own to try her hand at becoming a Doctor. There is absolutely no indication that anyone senior to her was supervising her.
So, what then was her preparation for the serious Medical responsibilities she was now given? What was there in her training that prepared her for the placing of our precious son’s life in her hands?
It is so heart-wrenching for us, Seth’s parents, to read her responses to these questions. Over and over in her deposition, when asked just how she “learned” to treat withdrawal in the way she did, she would state only, “I don’t remember.” She did not “remember” reading anything about benzodiazepine and specifically Xanax withdrawal, she did not read the Physicians Desk Reference about Xanax or Ativan, and in fact she did not consult anything in the Medical literature about what she was now permitted to do.
What Dr. Laurel Mayer (Hecht) did remember at her deposition was that she was given the authority to order Ativan for Seth “without consulting a more senior person.” This means that it was her “call” as to how to treat our son with no one supervising. If the nurses felt he was “too agitated” or if she considered this to be the case, she was now Seth’s “Doctor” and could treat him as she saw fit.
But, tragically, she was following the wrong course of treatment! In fact, her “treatment” required the use – we know now – of “deadly restraints.”
As part of her admission orders to the I.C.U., Laurel Mayer wrote an order for “5-point restraints.” Dr. Mayer never cancelled these deadly restraints and they continued to be applied to Seth until the evening of August 26, 1993, the night before Seth died.
While Laurel Mayer was given the authority by Columbia Presbyterian Hospital to order restraints be put on our son, in response to a question as to whether she knew the risks, her only response was, “I don’t know.”
But while Laurel Mayer seems to have totally ignored the ICU “Director’s” order to sedate, she must have gotten some advice “somewhere.” After all, she had almost no clinical experience, and had done – paraphrasing her own words – absolutely zero reading about how to treat withdrawal.
A clue to this puzzle can be found by a close reading of the deposition of Dr. Eric Collins, now the Medical Director of Addiction Services, Columbia Presbyterian Hospital. Dr. Collins, then a second year resident in Psychiatry, seems to have been involved in the treatment decisions going on in the Intensive Care Unit of the Allen Pavilion. Why a resident in Psychiatry should have been involved giving direction on how to treat what amounted to a critical care issue in a Medical unit, is another question.
But in his deposition, it was Dr. Collin’s position that Seth should not be sedated. It was his opinion that sedating Seth would even have been dangerous. The young Dr. Collins opined that patients in withdrawal are “not generally sedated.” This would put them at risk of not breathing. Rather, a dose of a benzodiazepine – such as Ativan – should be administered that kept the patient’s vital signs stable and kept them generally “comfortable.”
But there is one problem with this approach. When the patient in withdrawal is not deeply sedated, they can become seriously agitated and, as was the case with Seth, flail about in the bed. They can shake, attempt to get out of bed, strike out at others – in other words, they can be a risk to themselves and their caregivers. Then, not being deeply asleep, the patient must be restrained for protection.
This was exactly what occurred with our son when Laurel Mayer ignored the ICU “Director’s” order and followed the advice of the second year Psychiatric resident, Eric Collins.
But the treatment advice followed by Laurel Mayer was medically wrong since it required the use of restraints. Legally, restraints can only be used when there is no other “least restrictive treatment.” This is what the New York State Law stated in 1993. The Hospital also provided a protocol to our Lawyers (which they would not release to us) that said the same thing.
On deposition, Dr. Collins admitted that in August of 1993, he did not know the Law about restraints and was never taught that his own Hospital had a similar protocol. Were he to have known this, he would have known that the only correct treatment – as ordered by Dr. Bertch – was for Seth to be put deeply asleep with no deadly restraining. Were it necessary to so deeply sedate Seth that his breathing was affected, he could have easily been placed on a respirator.
Mary E. Bongiovi, M.D., Ph.D., is an Associate Professor of Psychiatry at Columbia Presbyterian Hospital and Director of the Four Center, a clinical research unit at the New York State Psychiatric Institute in New York City.
On August 25, 1993, she was then entering her last year of Psychiatric residency training, as the Chief Psychiatric Resident. On that day, she took over from Dr. Eric Collins the responsibilities of being the Consultation Liaison to the Intensive Care Unit of the Allen pavilion, where Seth lay tied up in restraints.
It will be instructive for the reader to understand Dr. Bongiovi’s thinking and clinical judgment about the “care” that was being delivered to Seth.
Again, as with Drs. Sagman, Mayer, and Collins, Mary Bongiovi had no understanding of the dangerous of restraints. This then young Psychiatrist in training defended the use of the deadly restraints. In her deposition, she claimed (under oath) that the rules of the New York State Office of Mental Health “did not apply” to patients on Medical units.
What cleverness, under what must certainly have been a trying moment when faced with the questioning of a Lawyer skilled in the art of Depostion! Mary Bongiovi was then asserting that a human being in distress could be tied up in one situation, but not in another. Abuse could be permitted when Medically expedient.
But where did she come up with this idea? Her first response was that she had learned this from her teachers. Later, however, she admitted that essentially this was her own idea and she had neither read nor consulted any of her supervisors as to “how frequently they (ie, the restraints) needed to be reassessed for the need for restraints” (for patients not on a Psychiatric unit)
It is frightening to learn that Mary Bongiovi, then the Chief Psychiatric Resident of one of the world’s premier training programs for future Psychiatrists did not know that restraints could even be dangerous.
It is of interest that one of the duties of the “Chief Resident” is to teach other residents
In her role as the Consultation Liaison Psychiatrist to the Medical Intensive Care Unit of the Allen Pavillion (in what has been referred to as a “resident run hospital”), what did Mary Bongiovi think about the Medical regime being followed by the Intern, Laurel Mayer?
She obviously thought that the right treatment was being pursued because Seth was not asleep – and therefore, in restraints! It was Mary Bongiovi’s opinion that it would have been “dangerous” to put him to sleep. In a nonsense statement, she then claimed, “…you’re unable to assess his level of consciousness.” She, too, was totally unaware of the correct treatment of delirium.
In understanding, in detail, what was happening to our precious son, a thought of Sir William Osler comes to mind. “He who studies medicine without books sails an uncharted sea…”
Mary Bongiovi, Eric Collins, Laurel Mayer, and the others, were on an uncharted sea. It must have ultimately been a “learning experience” for them and they have done well for themselves in life – Seth, however, their “learning material,” is dead.
As President of the Medical Staff of Columbia Presbyterian Hospital in the City of New York, Mary E. Bongiovi, M.D., Ph.D., is now a “power.” Also as a result of her hard won learning and skill, she was appointed Director of the Four Center research unit of the New York State Psychiatric Institute in 2000. Along with the National Institutes of Mental Health, the Institute is one of the premier research centers in the world. Dr. Bongiovi’s unit specializes in research involving children and adolescents.
It should be noted that in late 2004, the British Broadcasting Corporation produced an expose centered around the New York State Psychiatric Institute and their alleged experimentation of HIV+ children. The BBC eventually disavowed their expose, but one of their lead researchers, in a long document on the Internet, reports that the facts uncovered were true. If true, the actions of the Doctors involved were nothing less than those reported by Dr. Lifton in “The Nazi Doctors.”
Was Dr. Bongiovi, whose expertise is in research on children, involved in this. Who knows?
So, the decision of the students, Laurel Mayer, Eric Collins, and Mary E. Bongiovi meant that Seth was placed in restraints that led to pulmonary emboli and his death. The reader might ask: Were there no fully trained supervising Physicians around who were looking at all this?
There are no notes when Seth was in the I.C.U. by the “mysterious” Dr. Robert Goodman. But, from testimony given during his deposition, Dr. David L. Sagman was familiar with what was being done to Seth in the I.C.U. on August 24, 1993.
Dr. Sagman, who at that point was the Chief of the Neurological Service of the Allen Pavilion since 1988, had made a diagnosis of “modified withdrawal” on 8/22/93. However, no vigorous and correct treatment was begun.
But Dr. Sagman was aware of how the student physicians were attempting to treat Seth’s withdrawal in the I.C.U. He believed that the treatment was correct and did not even review the orders. When asked why, he responded that the orders had been written by a “qualified Psychiatrist.” The “qualified Psychiatrist” was only a second year Psychiatric resident.
Later, during the deposition, the Chief of the Neurological Service then admitted that while he knew the Hospital had a restraint protocol, but he was “not familiar with it.”
The most senior clinician in the I.C.U., in other words, did not know what he was doing. Neither he, nor any of the other “missing” attendings knew that 66 hours of immobilization by the illegal restraints required Seth to be given Heparin to prevent the blood clots that killed him. The treatment of Seth was left to the young intern Laurel Mayer. As a result of her treatment, or rather lack of treatment, Seth died. He is dead. The life of his parents and sisters is irrevocably changed.
This tragedy occurred 18 years ago. Subsequently, there were significant developments in the lives of several members of the Columbia Healthcare Team responsible for our son’s death.
As detailed elsewhere in our website, Dr. Noah Berkowitz got “out of town” to the National Institutes of Health before he could be deposed about his role. Dr. Robert Goodman was never deposed (or even mentioned) and is now the Chairman of Neurosurgery of Beth Israel and Roosevelt Hospitals.
And what of Dr. David L. Sagman? He eventually retired from the practice of Medicine and Neurology and moved to the Hamptons where he actively pursues his hobby of wildlife photography.
Dr. Eric Collins and Dr. Laurel Mayer Hecht remain at Columbia Presbyterian Hospital to this day. Even though their actions in Seth’s care amounted to what can only be called a “reckless endangerment” of his life, which led to his death, both were eventually given the honor of being Herbert Irving Scholars. This came with a cash award of $60,000 per year for 3 years.
Dr. Eric Collins is now the Medical Director of Addiction Services and Associate Professor of Psychiatry at Columbia Presbyterian Hospital. Presumably he has now studied the restraint protocol, understands how to safely withdraw patients, and no longer ties people up.
Dr. Laurel Mayer Hecht is now also an Associate Professor of Psychiatry at Columbia. Her specialty is in eating disorders.
Dr. Laurel Mayer Hecht is also on the Board of Directors of the Jewish Orthodox Feminist Alliance (JOFA). This is an organization that seeks to improve the status of women within traditional Judaism. The founder of the organization, Blu Greenberg (also from the Riverdale section of the Bronx, as was Seth), tragically lost her son Jonathan when a 19 year old sped through a light and killed him while he was riding his bicycle. Laurel Mayer and this young man shared something in common. Though they did not know what they were doing, they were both reckless when it came to human life. However, Dr. Laurel Mayer Hecht’s carelessness lasted for many days. She saw Seth struggling in restraints, and was aware that his kidneys were shutting down. There is no indication she asked anyone senior to her if the “treatment” she was delivering to him was correct.
We, Seth’s parents, recognize that the young student Physicians did not intend to kill Seth. Tragically, the teaching of Sir William Osler, in many ways the founder of modern Medicine, that “…students must be taught at the bedside” was totally disregarded by their teachers. Though they did not know it, the way they chose to treat Seth was totally reckless and ended his life.
What upsets us the most, after 18 years, is the cascade of lies that continues to this day. As what happened to Libby Zion, the Hospital chose to pile lie upon lie as to what they did to our son. There has never been any admission of guilt in spite of the mound of evidence we have presented about what they did to Seth.
The closest to an admission we ever received was from a prominent Rabbi in Riverdale who told Seth’s mother “Dr. Berkowitz (who attended Yeshivot Har Etzion in Israel) will talk if he is given immunity from prosecution.”
Dr. Laurel Mayer Hecht is part of a Rabbinic family. She, more than anyone, should understand the need to tell the truth so that others might be saved. Rabbi Abraham Heschel’s message must be understood: “Of All the Crimes Committed During the Holocaust, the Greatest was the Crime of Silence.”
Stephanie and Ralph Speken
August 18, 2011