More on the recent death of our brother, Lyji Vaggs

by ray jackson, president, indigenous social justice association

more on the recent death of our brother, lyji vaggs, who died in the townsville hospital on 14 april.

the report by tony koch (below) tells as much as is allowed to be told, again all information going to the coroner's office and not to the family. woodham's 'not in the public interest rule' seems to be spreading.

lyji was distressed and traumatised enough without the cops being called in. as if that would be of any assistance, most of us freeze up when the cops are around us.

why the cops were called and not family members who worked at the hospital or even his mother who is able to calm him is yet to be learnt. that information is clearly marked on his chart.

instead he got some male staff who restrained him, it is said, by sitting on him or lying on him. i find it most unsatisfying that such proven dangerous practices were enacted by the male staff and it seems they did not know how dangerous such a restraining method was to the person being restrained.

and for the staff to then call in the police only added to his already high levels of distress and trauma. they also restrained him by hand-cuffing lyji. it is not yet clearly known what method of restraint the police used whist putting the cuffs on.

there is said to be cctv footage of the events and we can only hope that there were no problems with either the tape or the camera or its transport to the coroners office. we must remember that, as always, the police are in charge of the investigation and already the qld police union, and again without a shred of evidence to support their claim, have declared their members to be blameless.

the family now must go through that life-draining process of awaiting the coroner's pleasure to perform the inquest before more of the facts are made known.

the family have elected to have gracelyn smallwood, his aunt, a nurse and mental health advocate whilst also being an activist in aboriginal social issues including deaths in custody, as their representative. she at least has a comprehensive understanding of the methods of operation of all the systems involved.

again we extend our sincerest sympathies to the family, community and many friends of lyji vaggs.

fkj

A man who begged for help dies
INSIDE STORY: Tony Koch
From: The Australian
April 17, 2010 12:00AM

THE diminutive Aboriginal woman was the last to leave the hospital room.
She whispered a prayer, held her son's hand and kissed him gently on the forehead.

Debbie Lampton then pushed the button that turned off the life-support system, and her boy, Lyji Vaggs, slipped away.

The young man had been as good as dead for 24 hours.

On Wednesday, he arrived at the Acute Mental Health Unit of Townsville Hospital, begging to be admitted. While his family had coffee, thinking all was finally well and he would get the help he needed, Vaggs, 27, was told there was no bed available.

He reacted angrily. Security staff were called, along with police, who handcuffed him. Within minutes, he suffered respiratory failure and massive brain damage.

Vaggs's unanswered pleas for help expose gaping holes in treatment for mental health - an area conspicuously absent so far from Kevin Rudd's hospital reform package. The Prime Minister is tipped next week to announce further funding in a bid to further sweeten his bid for support from the premiers for Canberra's shakeup of the health system.

A father of three young boys, Vaggs was diagnosed with bipolar disorder and schizophrenia, and had been receiving treatment at Townsville Hospital for about two years.

For the past three weeks of his life, he had been telling his family that he was hearing voices. Repeatedly, he went to the hospital, asking to be admitted. Vaggs told anyone who would listen he needed help.

A gentle, church-going fellow, he was desperate for the attention of psychiatrists and nursing staff, but they kept saying sorry, there was no place for him in the small and overtaxed mental health unit.

Time after time, he was told to go home and take his prescribed medication.

But it wasn't enough.

On Tuesday, Vaggs returned to the hospital because of the urgency of the "noises" and, yet again, was sent on his way.

At some point, according to family members, the hospital finally sent a medical team to examine him at home. His aunt, Jenny Wyles, said yesterday: "It was their assessment that he really needed to be admitted, so that is what they told him. His wife, Stacey, got Lyji and their three little boys into the car and she drove him to the hospital, dropped him out the front and then parked the car.

"She took the boys to the nearby coffee shop and was waiting there to hear from her husband whether, at last, he was going to be admitted and treated. But the call she got was one telling her to come immediately to the Intensive Care Unit because her husband was not expected to live."

There, medical staff worked on Vaggs for 45 minutes in a desperate but futile bid to revive him. He had test after test, including an MRI, but in the end there was nothing to be done. A doctor told Stacey that her husband would never regain consciousness.

"She was told to get her family together and in a short time about 30 of us had gathered at the hospital and were waiting, hoping for some good news," Wyles said.

"Then a mental health doctor came into the room and told all of us that he could not figure out what caused Lyji to stop breathing."

Wyles' sister is associate professor Gracelyn Smallwood, one of Australia's most prominent indigenous academics and activists who has had 42 years' experience as a nurse, mostly in the mental health field.

She works shifts at Townsville Hospital and is completing a doctorate in indigenous mental health at James Cook University, where she is employed as an adviser on indigenous issues.

She has untiringly led protests about the 2004 death in custody of Palm Islander Mulrunji Doomadgee, but this time the victim was not just an indigenous brother, but her own "blood".

Yesterday, Smallwood was nominated by Vaggs' family to be their spokeswoman at a meeting in Townsville attended by Health Department and hospital officials, Queensland Crime and Misconduct Commission investigators, Police Ethical Standards branch officers and mental health officials.

She said the family was satisfied at this stage with the investigation into her nephew's death, but had insisted that an independent autopsy be conducted.

"We were assured that there is closed circuit TV footage of the restraining of my nephew by hospital staff and later by police, and that footage is in the hands of the coroner," Smallwood told The Weekend Australian.

"The provision of mental health facilities at hospital is a joke. There have been so many reports and investigations done, yet nothing has improved, and now we have a situation where a young man seeks voluntarily to admit himself and is killed.

"We don't want this to ever happen again to any patient, black or white, and is why a full and open inquiry must be held to establish who was at fault. It is appalling that there are not beds available to take patients who are crying out for help as was the case here with this gentle young man."

Nursing staff told The Weekend Australian that Vaggs became "boisterous" after he arrived at the public hospital about 2pm on Wednesday, prompting reception staff to call the police. But, according to one account, at least six security and hospital orderly staff confronted the agitated young man before the police arrived.

The hospital staff physically restrained Vaggs, and some of them were seen sitting and lying on him on the floor of the mental health reception area.

Then the police turned up. Vaggs was handcuffed and given three injections of "an anti-psychotic drug", the family says.

At this point, horrified medical staff realised he was no longer breathing. The registrar of the hospital has confirmed to the family that Vaggs received injected doses of medication before his breathing stopped. He was rushed into the ICU, and his wife called.

Smallwood questions why the police were called at all.

"This was three o'clock in the afternoon and there were plenty of security and male staff around, and for this young man to be manhandled and then to see the boys in blue, it would have just heightened his anxiety and psychosis," she said. "The staff at the hospital have Lyji's chart and it is clearly marked by his mother that if he ever goes off, he calms down just by hearing her voice. There were dozens of indigenous people including mental health nurses and even members of Lyji's family at the hospital at that time, and none was called.

"His mother wasn't called, his wife wasn't called - nobody was called except the police. We are not talking here about a troublemaker, but a gentle person who was an Assembly of God parishioner and his uncle, Pastor Brian Lampton, is head of the church here.

"Our legal team is going to pick this up from Monday, after the family meets on Sunday."

Comments

Let me start by expressing my deepest condolences to Lyji's family and community. This is a shocking loss.

I would like to comment that it's important we remember that this death is also an example of the human rights violations that occur daily in our ntaional mental health services. Do not let us lose sight of the way Lyji was injected three times, against his will, with "anti-psychotic drugs". These are VERY POWERFUL neuroleptic drugs that have been described by leading world physicians as comprable in their adverse side-effects, only to chemotherapy medications.

What Lyji met at that hospital is not unusual for people who approach metnal health services when they are in their most deperate, helpless and frightened state. How anyone could respond in this way to a fellow human being in emotional and psychological crisis is beyond belief.

Many of us have been damaged in some way by the woeful response of our mental health services to people in crisis. We survivors are many and we are appalled by Lyji's death. For those who seek to campaign on this issue I ask that you reach out to your mental health social justice allies and we can collaborate in our journey for justice.

Again, I express support and solidarity with Lyji's family and community.

Hi,

I'm not of aboriginal descent, in fact i'm not even an Australian but after reading this article I am both shocked and appalled. I feel, however that the real issue is not one of 'aboriginal solidarity', but one of the appalling way in which the Australian government treats all of its mental health services. If staff had been properly trained, as they are in the UK, they would not of had to restrain Lyji, or even inject him. The issue that needs to be raised is one of solidarity for the training and provision of mental health services to avoid something like this from happening again.

Once again i wish to convey my deepest condolences to Mr Vaggs' family,

Owen Pugh

Earlier this decade in the UK there were a series of deaths of patients in acute, general adult psychiatric wards. For the most part these were previously fit young
men and women. They had become disinhibited or aggressive, difficult for nursing staff and trainee psychiatrists to manage. They had been restrained and treated with high-dose antipsychotics, usually by injection into a muscle. Inquiring into what was going on, the Royal College of Psychiatrists issued a consensus statement in May 2006 (1).
Unfortunately, many nurses and doctors working at psychiatry’s front line still think that “more is better”. They are scared when their patient becomes aggressive, so that sedating him becomes is their first priority. Another injection is given, and another, before the first dose has been metabolised, so the concentration of drug in the patient’s body builds up, often to highly toxic levels. In reality, more isn’t better. There’s a “low ceiling effect that ties in nicely with receptor occupancy studies suggesting saturation of receptors at low doses”(2). Higher doses
only injure the patient, and may kill him. Unexpected death with high doses of antipsychotic medication has long been recognised. These drugs affect the heart muscle itself. They also interfere with the orderly progression of electrical impulses throughout the chambers of the heart that causes it’s contraction. Technically, the QT interval on the electrocardiogram (ECG) becomes prolonged, and the devastating result is called torsade de pointes.

The executive summary and recommendations of the RCPsych’s consensus statement should be required reading for all psychiatrists, psychiatric registrars and nurse unit managers working in our public hospital psychiatric wards. Here are some of those findings and recommendations:

“There is no convincing evidence base for the use of high-dose antipsychotic medication in the management of persistent aggression associated with psychosis, or for relapse prevention in psychosis”
“Current evidence does not justify the routine use of high-dose antipsychotic medication in general adult mental health services, either with a single agent or combined antipsychotics”
“A link has been postulated between antipsychotic drugs and ventricular tachycardia and sudden death”
“Services should be structured, managed and resourced to preclude or minimise the perceived need for high dose”
“Each service should establish the audit of antipsychotic doses as a matter of routine practice”

This is too important an issue, and it affects too many of us directly or indirectly, to leave it for the medical directors of our psychiatric units to manage. We all need to have a basic understanding of psychotropic drugs and their risks. If our psychiatric wards are to become safe, places of healing instead of dangerous places, of trauma or unexpected death, then we all need to make it our business.

I hope this may be of some help to the Vaggs family.

Dr Ben Crane, MB BS, BSc (Hons), MRCPsych, FRANZCP,
Consultant psychiatrist in private practice

References:

(1) “Consensus statement on high-dose antipsychotic medication”, Council Report
CR138, May 2006, Royal College of Psychiatrists, London
(2) “Antipsychotic polypharmacy – confusion reigns”, Editorial, The Psychiatrist,
February 2010, Vol 34, Issue 2.