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The modus operandi : "Have you ever noticed that if you have a bad pain in the guts and you bang your head against a brick wall hard enough and long enough you completely forget about the pain in your guts ?"

Case 98 died recently of stomach cancer and had never been a patient at Chelmsford Private Hospital but he did have an impact on The Chelmsford Saga due to what he said at the 1988-90 Royal Commission.

Some background to the case

Poor unfortunates who got onto the Chelmsford doctors' "conveyer belt to psychiatric hell" did not all end up in the doctors' own private hospital in the northern Sydney suburbs. The simple fact of the matter was that the good doctors did not have much in the way of equipment there. Sure they could strap patients down and apply electroshock And they had beds into which patients drugged into a deep coma could lie for days soaking in their own excreta in the care of partly trained nurses. But when it came to monitoring the condition of their patients ... well they did not have much equipment, and certainly were not set up for surgery.

Patients were often shipped out by ambulance, before they died from the combined chemical and electrical assaults on their body, to a public hospital at Hornsby around 10kms to the north. There they were patched up - if possible - no questions asked ! The regulators in the NSW Health Commission had done their job it seems. As was noted by a CVAG advocate, the design of the private hospital's doors and corridors allowed patients dead or alive to be rapidly wheeled out to a waiting ambulance. And reports of what was going on, over the nearly two decades that the "conveyer belt" was running, were being dutifully filed in Health Commission filing cabinets by very senior Health Commission Officers indeed.

Doctor Bailey's Casebook

Case 98 in Dr H. R. Bailey's casebook was a man suffering from a very serious psychiatric condition - a stomach ulcer - which he had had since 1962 - it was indeed a recurrent problem. Antacids having failed, the sky was now the limit for treatment options. (This was 1975 so it was no good expecting a diagnosis involving Helicobacter pylori.)

In any event as Case 98 had been put in contact with Dr Bailey the problem clearly had to be inside the cranium not somewhere along the GI tract. To find out what was going on Dr Bailey got his patient booked in with Dr. Evan Davies, a very senior psychologist at the University, who followed his normal practice by showing the patient some ink blots and getting the patient to do some psychometric tests. As usual Dr Davies' tests found the patient to be in urgent need of intervention. This was the power of Dr Davies' scoring system in his use of the tests. He was always able to find out what was wrong and so confirm an initial diagnosis. So the next step was that Case 98 was put in the care of that very senior fellow Dr. John L. Dowling (M.S., F.R.C.S., F.R.A.C.S ) of the University of New South Wales at Prince Henry Hospital for a lobotomy. The patient was not informed of the lobotomy, (no need to cause extra stress and upset to the poor man after all those problems with his ulcer!) all he knew was : "They're going to put a couple of needles in my head." The magic word used by Dr Bailey being cingulotractotomy.

The wonder breakthrough in 'holes in the head' surgery

Drs Bailey, Dowling, and Davies had presented the wonderful results of their innovative treatments at an international medical conference in Europe and also published in journals. One of a series of such publications being in The Medical Journal of Australia , "Studies In Depression III" (p366-371 of the August 1973 edition)

Assured that the treatment he did not understand was a proven one and had been carried out with great success on many other patients over a decade the patient of Case 98 followed doctor's orders and went under the knife (or rather under the drilling machine). A pair of portholes were drilled in his skull and parts of his brain inside destroyed (one area on each side) Below is a CT scan (left-hand image below) where you can see the two destroyed (dark) areas of brain tissue, one each side, in the frontal lobes (towards the top of the picture). The side view X-ray shows 4 metal support clips put in as 4 white marks towards the top left of the skull, where the access portholes were made.The front view X-ray shows the portholes more clearly and 3 of the 4 clips can be seen, again they show up as small white rectangles.

             

Then onto THE ROYAL COMMISSION ...

Years later Case 98 would travel hours each day for about 2 years expecting, as a victim, to be given the opportunity to tell the Royal Commission about the effects of the quite unnecessary psychosurgery. But he never got the chance. He had at that point great respect for the legal system and for judges and even tried 'to do the right thing' as he saw it in defending the dignity of the Royal Commissioner at one point. This resulted in Mr Barry Hart who was the spokesperson for the Chelmsford victims (who had been subjected to drugs and ECT but not psychosurgery) being ejected from the hearing room. Having been told of the terms of reference Case 98 confidently sat and waited for arrangements to be made for him to give evidence. Soon after the Royal Commission reported Case 98 was shattered to be told that it was all over , and that he would not now be able give evidence.

He was so insensed by being tricked in this way by the judge that he wrote open letters to the Human Rights Commission and to the NSW Judicial Commission but to no effect. He got nowhere at all against "NSW Inc."


Patient Number 98 .. and his view of Dr Bailey

Trepanning was one of the earliest surgical operations.
It was practiced by ancient Egyptians and some South American tribes. It seems the surgery was undertaken to "Let foul spirits out of the head".

But CVAG is not aware that any evidence exists to show that drilling holes in the head was used as a treatment for stomach problems, even if when one has drilled the hole one then pokes about inside to see what happens.

So in the 1960s to the late 1970s Drs Bailey and Dowling were indeed breaking new ground. Indeed as Justice Fisher found in the Hart v Herron case in 1980 in the NSW supreme court (over a deep sleep therapy civil case in negligence), when a doctor does something in medical care that no one else does, he can do no wrong in the eyes of a NSW court, for it is he who sets the standard of care.

CVAG also notes that no medical expert since seems to have had the fortitude to question Dr Bailey's methods and treatments in reply. Dr Bailey's publications and claims in the various scientific medical journals remain unquestioned for others to follow and to impress their patients with. (Such are the pillars that today's medical science is built upon ?)

drilling into the head c.1811

 

Summing up

A confused patient was used to get the CVAG silenced at the Royal Commission.

The Royal Commission was able to turn a blind eye to a whole area of surgery that the Chelmsford doctors were involved in, and a whole class of victims seem to have been permanently shut away from public view.

In a major and rather thick report about the way mental illness patients were being managed the Australian Human Rights Commission gave a page or two to the Chelmsford scandal. The focus of their efforts seem to be on the right of all Australians to get as much access to mental health services as possible. It would seem that to reject treatment (as Case 98 viewed his situation over treatment, once better informed by press and radio items resulting from much work by the CVAG) that one's medical professionals (and thus 'betters') have deemed as needed is Un-Australian, perhaps even indicating one to be 'a suitable case for treatment' ?

The 'system' showed it was very capable of defending itself. An official NSW government health investigator who found out too much about the psychosurgery that was going on got the sack. And when he, then with others, tried to get the NSW ICAC (Independent Commission Against Corruption) to look into the matter, and the higher death rate applicable to the psychosurgery patients, including child patients, of the Chelmsford doctors, the result was that the Commission served him and the others a fine cup of tea in a bone china tea service but explained that they had the final discretion under their Act and would not be investigating the matter at all.

The other 'independent' NSW authorities including the NSW Judicial Commission are not required to explain their findings to the public and found nothing wrong and no judicial officer at error. The NSW Psychologists Registration Board could find nothing wrong with the practices of Dr Evan Davies and seems to have silenced an ABC radio journalist who made some adverse observations about the matter.

The claims for the treatment were based on the 'before' and 'after' testing methods of Dr Evan Davies. The Royal Commission has a whole volume on his testing, which was identified as having the same scientific validity as tarot card or tea leaf reading. But at the same time his practice has been fully endorsed by the officials of the psychological profession in NSW. It is perhaps for such reasons that none of the Chelmsford doctors were ever subjected to any disciplinary action. Complaints were lodged against Dr Evan Davies, the most recent being in the 1990's, indeed the brand new NSW Health Care Complaints Commission (formed in 1994) was asked to process complaints about him. After many months they reported back to the complainants that they were unable to do an investigation because Dr Davies had just died.


Justice Slattery

Justice Slattery's 2 year long Royal Commission did produce a multi-volume report. Its main achievement would seem to be that it fills around 50cms of linear bookshelf space in many NSW libraries

 

But Science marches on !

Twenty five years later the workings of the brain may still be very much a mystery to science but this has not stopped the surgical methods to get at it being refined.

"Stereotactic surgery without opening the skull and without blood (even the patient's head doesn't need to be shaved) is possible with a revolutionary technique called radiosurgery. The destruction of nervous or vascular tissue inside the brain is achieved by projecting thin and powerful beams of ionizing radiation, coming from several angles around the patient's head. They are produced by linear accelerators, machines used in high energy particle physics, or by sources of radioactive cobalt (the "gamma knife", developed in the 60s by the Swedish neurosurgeon Lars Leksell). In this way, radiation energy concentrates into a single, small point inside the brain, while the surrounding, healthy tissues are spared damage. Despite all this technical progress, however, psychosurgery is practiced less and less. The problem is no longer a technical one; or a lack of knowledge of what to do. The problem is of ethical and political nature. Psychosurgery will never be performed "en masse" as the old lobotomy, without evaluation of precise indication. "
From: The History of Psychosurgery Author: Renato M.E. Sabbatini, PhD Source: Brain & Mind Magazine, June 1997

...and of course that was just what Dr Davies claimed - That his tests had scientific validity and gave precise indication of the condition the patient was suffering from. So have we moved forward at all or not ?