Monday, January 16, 2006


Jim Frank, Attorney, Advocates for the Mentally Ill

State, judge clash over patient
Drug was ordered for schizophrenia, but agency contends it is too costly.

By Janet E. Williams
The Indianapolis Star

B.W.s best hope for overcoming the crippling symptoms of schizophrenia and living outside Central State Hospital is a relatively new drug called Clozaril.
So far, the price tag has kept the anti-psychotic drug beyond his reach. Clozaril costs several times more than other drugs; and as a result, only a chosen few at Central State receive it.
That could soon change. Municipal Court Judge Steven Elchholtz ordered hospital officials last month to provide B.W. with the costly drug within 60 days. At a hearing today before Eichholtz, attorneys for the hospital are expected to argue that the judge does not have the right to order the costly medicine.
B.W. is identified only by his initials because records for mental patients are confidential.
It's the first time in Indiana that a judge has ordered officials at a state hospital to provide Clozaril, a drug that has worked wonders on scores of mental patients for whom other treatment has failed.
Advocates for the mentally ill, such as Dee Janik of Protection and Advocacy Services of Indiana, applaud Elchholtz's ruling. For them, this is a right-to-treatment issue --- mental patients are entitled to the best possible care.
B.W. is just one of hundreds of patients in state mental hospitals who might benefit from Clozaril, which has fewer side effects than other medications and offers dramatic improvements from symptoms, Janik said.
Officials from the Indiana Family and Social Services Administration say Eichholtz was playing doctor and overstepped his authority when he ordered the Clozaril for B.W.
Furthermore, the state cannot afford the cost of the drug which is $400 a month, compared with $100 a month for other medications, officials say.
They are planning to appeal and are asking Eichholtz to delay implementing the order. A hearing on that motion is set for this afternoon in Municipal Court 3. The case began as a routine review by Eichholtz of the order to commit B.W. to the state hospital. B.W. through his attorney, James Frank, was asking to be released from the hospital. and the judge convened a hearing to consider the request.
At the hearing, Dr. Steven Conant. B.W.'s psychiatrist, testified that his patient's symptoms were serious enough that he still needs to be hospitalized. The doctor said B.W. can't function independently.
Schizophrenia is a disorder In which patients have distorted thoughts and delusions.
After describing the treatments B.W. has received, Conant said B.W. would be a good candidate for Clozaril. it could reduce his symptoms enough so he could move to a group home. It hasn't been prescribed because of the cost. Conant said. adding. "We don't have the funds to prescribe this for a number of clients for whom we feel it is appropriate."
Up to 75 patIents are good candidates for Clozaril. he said. About 24 currently receive It. hospital officials say.
Conant suggested It could be less expensive for the state to spend the money on Clozaril if It would mean allowing patients to live outside the hospital.
Eichholtz. after ruling that B.W. still needs to be hospitalized, ordered the state to place him on Clozaril within 60 days.
Kathy Gregory, an attorney for the Division of Mental Health, said Eichholtz cannot order a specific treatment as he did In B.W.'s case. Once the judge orders a patient's commitment, mental health officials then determine where and how the patient should receive treatment, she explained.
Said Rachel McGeever, counsel for the family and social services administration: "We wouldn't argue that in the best of all worlds, we would want to provide Clozaril to all who need it." However, the agency must work within its budget and for now, Clozaril is too expensive to be widely distributed. McGeever said. Those budget limits are determined by the legislature and the governor's office.
Barry Irons, director of community services at Central State, said the hospital's medical director and a team of doctors review patient records to determine who will be placed on Clozaril. So patients who don't receive Clozarii are on other drugs like Haldol. one of the most commonly prescribed medications for schizophrenics. Haldol costs about $100 a month, Irons said.That drug has side effects that Include dryness of the mouth. restlessness, drowsiness and severe muscle cramping. Irons said. And it doesn't work on many patients.
Clozaril doesn't have those side effects because it works on a section of the brain that governs emotions and instincts, said Dr. Michael Kane, a consultant to the Division of Mental Health. All of the other drugs. including Haldol. work on the part of the brain governing motor functions. In about 1 percent of all patients, Clozaril causes agranulocytosis - a lowering of the white cell count that leaves the patient susceptible to infection and death. Kane said. So, the manufacturer of Clozaril, Sandoz Pharmaceuticals Corp. of Fairfield, N.J., requires weekly blood tests to monitor the white cell count. That's part of the reason the drug is so expensive.
Now, if Eichholtz's ruling is upheld on appeal, the state could be compelled to find the money to provide patients at the state's mental hospitals with Clozaril. Said Kane: "You're talking about hundreds of patients who could arguably benefit from this medication. It could reduce their symptoms, improve their quality of life."

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