Death of a Patient
Photo by Aldo Mauro
Twenty-six-year-old Sujon Guhas death in 1993 nearly cost UCLAs esteemed Neuropsychiatric Institute Hospital its accreditation. Now, details of what might have gone wrong during his four-day stay at the teaching hospital are emerging for the first time in Los Angeles County Superior Court.
The coroners report ruled that Guhas death was a suicide, but his parents, Arun and Kajal Guha, say their son was not depressed and would never have killed himself. The family alleges that Guha was an unwilling participant in sleep-deprivation experiments and that UCLA tried to cover up their mistakes by making their sons death look like a suicide.
UCLA hospital staff have vehemently denied any wrongdoing, and contend that Sujon was paranoid, psychotic, suicidal and possibly homicidal when admitted to the hospital. Both sides attempted to settle the wrongful-death case out of court. In 1994, the university rejected the familys proposal to settle the case for $600,000, to establish a scholarship in Sujons name and to write letters of reprimand to all involved in treating him. The next year, UCLA offered to settle for $400,000, establish a scholarship in Sujons name, and write confidential letters of reprimand. The Guha family rejected the offer.
Sujon Guha was taken to the hospital by his father on November 25, 1993. The Harvard graduate had became disoriented and delusional while stopping over in Los Angeles on his way back home to San Francisco. His parents say Sujon was suffering from symptoms caused by a toxic reaction to the anti-nausea medication metoclopramide while overseas on business in Kuala Lumpur. Sujon worked as a marketing manager with Vitel, a telecommunication company based in Mill Valley, California.
Sujon, after an examination in the hospitals emergency room, was placed on involuntary hold for 72 hours. On November 29, four days after being admitted to the hospital, he was found hanging from a belt in his hospital-room closet. The belt had been given to him two days earlier by a nurse.
The trial, which started February 17, is expected to continue into April. During opening arguments, Guhas attorney, Dale Galipo of Encino, alleged that the hospital included Sujon in sleep-deprivation experiments without his informed consent. As part of the experiment, Sujon was given the antidepressant drug lithium and awakened every 15 minutes during the night by someone shining a flashlight into his eyes, according to Galipo. He said hospital workers were testing the theory that disrupted sleep brings some patients out of depression.
Sujon Guha was experimented on, and that experimentation was significant to his death, Galipo told a jury of eight women and seven men. Sujon was happy, successful and close to his family. There is no reason why Sujon would have killed himself.
UCLA attorney Joe Hilberman of Fonda & Hilberman of Los Angeles said Sujon had told hospital staffers that he had been depressed for almost a year about work and the recent death of his grandmother. They say he killed himself during a psychotic episode. The night checks, Hilberman argued, were routine and involved looking in on patients with a flashlight to make sure they were breathing and safe. He said that flashlights were not pointed at Sujons face as the plaintiffs alleged. Although lithium was found in Sujons blood, UCLA insists that it was not administered by the hospital. In addition, Hilberman argued, the autopsy found that Sujon had killed himself with the belt. Sujons family said that they did not recognize the belt and that Sujon wore jeans that were tight-fitting.
The Guhas are in denial, said Hilberman. They are Hindu, and in the Hindu culture suicide is unacceptable because it prevents a soul from being reincarnated one of the worst mortal transgressions in the religion.
What is not contested is that UCLA was openly involved in sleep-deprivation experiments on the same ward for 10 years, until 1993. But according to UCLA, sleep-deprivation experiments had been stopped before Sujons admittance to the hospital.
The Guhas also contend that UCLA was negligent in treating their son. They claim that Sujon was never given a complete exam by an attending physician in his first 24 hours at the hospital, as required by law. Further, when his 72-hour hold had expired, they say, Sujon was coerced into agreeing to a longer stay. His family says he was in a confused emotional state and could not make an informed decision. According to UCLA, if patients still need treatment after 72 hours, they can volunteer to stay or be detained for up to 14 days.
Guhas attorney also argued that Sujons death was not adequately investigated. Hospital staff cleaned up the death scene, and the police were not called until 20 hours later, at 2:15 p.m. the next day. The coroner was not informed until the following day, when the police called. UCLA insists that there was no need for an investigation, because everyone agreed that Sujon had hanged himself. Also, hospital staff cleaned Sujon out of respect, so that his father wouldnt have to see Sujon like that, Hilberman said.
Regardless of the outcome of the case, Sujons death has had an effect on the hospital. In 1994, the state Department of Health Services cited the hospital for not reporting the death immediately, and for failing to fully examine and evaluate Sujon within 24 hours. The state also required the hospital to ban belts for patients and to put in collapsible clothes-hanger bars in closets.
Sujons death also prompted an investigation that same year, by the Joint Commission on the Accreditation of Healthcare Organizations, that resulted in UCLAs Neuropsychiatric Institute Hospital receiving conditional accreditation, a standing given to only 1 percent of hospitals in the United States. In 1996, the hospitals full accreditation was reinstated.
This is not the first time UCLA hospital staffers have had to answer questions about informed consent. In 1992, a lawsuit filed against UCLA and two of its leading doctors over research alleged that it caused the apparent suicide of one participant and permanent psychological damage to another. The once highly acclaimed study, called the Development Processes in Schizophrenic Disorders Project, took place in the campus-based Aftercare Clinic (now the Aftercare Program) from 1980 to 1992. Researchers recruited more than 100 subjects, most of whom had been enlisted after being admitted to area hospitals for psychosis treatment. Patients were first given an antipsychotic drug to steady their schizophrenia, and then the medication was withdrawn. The objective was to help clinicians learn which patients needed medication and at what prescribed amount.
The lawsuit, filed by the family members of Gregory Aller and the late Tony LaMadrid, alleged that researchers knowingly allowed Aller and LaMadrid to lapse into unnecessary psychotic episodes. In addition, the lawsuit claimed that the researchers lied to participants and their families about the real reason for the study, then altered medical and office records to hide possibly damaging information. The case was thrown out because of a missed deadline a five-year limit on bringing the dispute before a jury but the decision has since been overruled and the case is expected to go to court in Santa Monica in October. Federal regulators found that UCLA researchers omitted certain vital elements required as part of informed consent, according to findings released in 1994 from the federal Office for Protection From Research Risks.
Galipo said the same issues led to Sujon Guhas death.
Sleep-deprivation experimentation is at the center of this case, said Galipo, in an earlier interview. It relates to the care he was getting at the facility, and more important, it was a substantial factor in the cause of his death. The fact is that they wouldnt let him sleep at night, giving him lithium. There is no question that was the cause of his death.
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