This past spring, a probate court ordered a 26-year-old man in Connecticut to undergo electroconvulsive therapy (ECT) and involuntary medication at Yale New Haven Hospital.
The man, identified only as John Doe, secured the Connecticut Legal Rights Project (CLRP) for his defense in the appeal. The hospital’s attorneys argued for a dismissal, citing the patient has a conservator who must agree.
The defense rebutted that state law allows conserved individuals to challenge such cases on their own even if their conservator disagrees.
Gina Teixeira, JD, Doe’s attorney at CLRP, contended state law requires less intrusive treatment before implementing the procedure. Patients also have 30 days to appeal an order like this one, but there is no automatic stay. For Teixeira, that was part of the problem.
“When a landlord wants to evict a tenant, there is a stay in the law so they don’t lose their housing,” she said. “That was missing here. This case helped us see this was a glaring omission. What happened in this case was just wrong.”
While the defense was successful in substantiating the appeal, they won the battle but lost the war. The probate court file was sealed which meant case transcripts were unavailable during the appeal.
With the lack of automatic stay, ECT was administered before the next hearing in early June. Connecticut’s state law prohibits this kind of therapy without a patient’s informed consent. However, if medical professionals—in this case, the head of the hospital and two physicians—determine this is the best treatment, the patient’s wishes may be dismissed.
Doe is currently an inpatient at the Greater Bridgeport Community Mental Health Center, a 40-bed facility part of the Department of Mental Health and Addiction Services (DMHAS). Teixeira said DMHAS prides itself on patient care but believes care was absent in this case.
“The hospital could have allowed the patient to pursue the appeal,” she said, “but instead they aggressively fought him and forced him to undergo ECT against his will under an order that was found to be invalid. That is not consistent with a recovery-oriented, patient-centered agency.”
ECT, also known as shock therapy, is generally accepted by the wider medical profession but still considered controversial. The American Psychiatric Association states it is a medically supervised treatment used for bipolar disorder, schizophrenia, catatonia, and severe depression in patients who have not responded to previous treatment.
It is done under anesthesia with mild electric currents delivered to the brain through electrodes to bring about a controlled, motionless seizure. Numerous studies have shown its efficacy in treating these patients.
Eric Brueckner, DO, assistant professor of psychiatry at the UConn Health Center in Farmington, said ECT is the best treatment for a patient who has been unresponsive to initial therapies.
It can also be administered for other health issues. There have been good results from ECT in patients with epilepsy, Parkinson’s disease with dementia and mania, and Alzheimer’s disease with aggression.
“In general, 75 percent to 80 percent of patients get better with ECT,” he said. “By far, it’s the best treatment for efficacy. It gets the most people better. Period.”
Teixeira’s client had not previously received shock treatment but was reluctant because of possible short-term memory loss. Brueckner acknowledged those concerns as a side effect of ECT. He said it can happen, but typically within six months all memory is restored. Permanent memory loss is rare. However, he was adamant that ECT should not be used against a patient’s will.
“If the patient has the capacity to consent to ECT, understands the risks, and can make sound medical decisions for themselves—with the vast majority of patients it’s a mutual decision. Unless it’s a strange situation like they say they don’t want it, but they clearly need it,” he remarked. “But patient’s rights are paramount. Anyone with a modicum of decision capacity—if they don’t want it, it’s not happening.”
Teixeira said her client clearly communicated that he did not want ECT. He identified side effects associated with ECT that are well known, and he secured legal representation to appeal the probate orders. So why the push from hospital personnel?
“We never really got an answer to that,” she said. “I think this causes more harm than good.”