Releasing medical information and reports to you

LINKS

Releasing medical information and reports to you: I can send you a lot of information on this gentleman but I would like to limit myself and be selective so that we don�t waste resources. I think it will be a good idea for to let me know how you would be using the specific medical information that I will provide you. The fact that I have become his guardian ad litem as well places legal obligations upon me so before I release any personal confidential information to anyone I need to ascertain credibility and secure confidentiality partly because in the wrong hands that information can be used against him in his divorce proceedings and several other legal proceedings that have been initiated against him, especially when used with some distortion. I am sure you understand that concern of mine clearly. What I mean here is to obtain your professional affiliations and credentials and also the names and titles of the people who you work with and might refer us to in order to obtain additional information that will be of help in undertaking the necessary rehabilitatory steps. I am however not intending to hide any critical information from you which could be used to help him and rehabilitate him. Ideally the information that you seek would have best been obtained through an official assessment at G. F. Strong. I would appreciate if you could somehow facilitate that.

In short the particulars of the head injury and other trauma of Dr. Pradeep K. Verma are as following:

Date: November 30, 1996

Location: Waterloo Detention Centre Cambridge ON

Glasgow Coma scale: 4 (?) [inferred from the chart description] I don�t think at this stage it really matters. The medical records of the emergency room where he was initially assessed are not being released to us. We are working on obtaining them.

Length of coma : 4 days after the injury [held in the medical assessment cell of the jail]

Neuropsychological Assessment: Never done yet, Being planned in May 2002. Dr. Jones of Nanaimo has been contacted but refused to assess him. Preliminary limited mental status assessment by Dr, Michel Dunn on 12 September 2001 determined that he is legally incapacitated to manage his legal and financial affairs. This was ordered by the Public Trustee office but I have additional concerns which I think are best evaluated through an official O. T. assessment. I would appreciate if you could somehow facilitate an O. T. assessment and if possible the psychological assessment.

Occupational/physio assessment summaries: I do understand that such assessments are pretty helpful. But in keeping with the theme of intentionally denying him medical care for several years in Ontario (between 1996 and 2000) and then in B.C. since his arrival in August 2001, there has not been any such assessment conducted despite repeated requests to various physicians and other social support agencies. I am glad that June Herrington is taking such interest in him although she too seemed pretty frustrated and told me that there is nothing available in Nanaimo and that he should move back to Vancouver, which I will be prepared to so only if I can be assured that adequate arrangements for his personal safety and supervision of his medications can be done. A couple of months ago Dr. Irvine did refer Dr. Verma for a physiotherapy assessment and intervention for the neck and back pain but due to the hurdles in obtaining an interpreter for the initial assessment the appointment had to be postponed. There was one made for October 10, 2001 which had to be cancelled because the physiotherapist was unwell and Ms. Alexandra Walker was forced to make an undesired trip to the place as she had kindly agreed to assist with the interpretation (ASL) during the assessment.

Pharmacological interventions: In the past a variety of drugs like anticonvulsants, benzodiazepines, analgesics, anti-migraine therapies, antidepressants, antipsychotics etc. have been used but rather haphazardly and with a sloppiness that is nothing but a disgrace to the health system in Canada. I would not treat a dog with that type of nihilism and sloppiness but the G. P.�s in Canada are nothing but a pathetic breed of humans. That is all I would say at this time about the medical community of the country besides the fact that he has been hated by them both in Ontario and B. C. and there are reasons to believe that the medical and judicial establishment is in fact responsible for this vicious assault on Dr. Verma because they did not like his points of view. It is sad that factors like personal hatred, racism and bigotry have lead to destruction of Verma family and loss of a superb neurologist to the Canadian community.

The issue of possible seizure problems: needs some careful observation and analysis. There are records of grand mal seizures in the couple of years following the injury. But since 1998 when periodically he was under the care of his mother his generalized seizures were infrequent but he never took Tegretol consistently as there were problems getting the medication and of reminding him to take the medication. His current seizures are most likely complex partial ones with confusional behaviour, serious difficulty in communicating (which he does through sign language or keyboard use only - due to his aphasic deficit and agrapha etc. ) some jerking of right hand and face and erratic behaviour, not eating properly and getting somewhat catatonic etc. He has had a couple of normal EEGs in the past but I don�t consider that much investigation adequate. There has never been a sleep deprived, sphenoidal or other specific tests done for complex partial seizures. It is also possible that these seizures are basal ganglia seizures because hypoxia was an important mechanism of injury because he was asphyxiated during the rape and head being smashed on the concrete floor and the walls. There is a significant element of psychiatric insult and emotional and psychologic/psychiatric sequelae. Distinction as to how much of the condition is psychogenic and how much organic has been an ongoing debate undertaken at several platforms without any definitive conclusions partly because of inadequate assessment which in my view has been intentionally withheld.

Complex migraines: A complicating element to the above mentioned�basal ganglia seizures� is prolonged episodes of migraines (status migrainous) which I believe is indistinguishable from complex partial seizures and often show overlap. These issues are sufficiently complex to be outside the understanding and skills of even most neurologists in Canada let alone the general practitioners who obviously don�t have any handle on his situation and basically refuse to help him or evaluate him.

Tinnitus: A serious handicapping element of his condition is tinnitus which was assessed recently by Drs. Amanda Maloney (Vancouver) and David Cheung (Nanaimo) between March and September 2001 has led them to conclude that the head injury has been severe enough to cause a central type of deafness and tinnitus which is essentially intractable and incurable. NO Medications are likely to help hence not prescribed. I am intending to obtain a neuro-otology consultation with Dr. Brian Westerberg at the tinnitus clinic in Vancouver which I have not been able to arrange. May be you can help me with that as well. Intense tinnitus complicated by migraines and possible seizure like episodes which can be prolonged (?hours to weeks) have been rather incapacitating and leading to a misdiagnosis of acute psychosis, personality disorders etc. I do not believe that has any serious psychiatric problem other than may be some elements of Post Traumatic Stress Disorder (PTSD). Some recommendations were made to help him which included a psychiatric assessment and relaxation therapy etc.

The extent of a plegic condition: He is ambulatory and in fact able to even run well if not too confused and dizzy etc.

Visual impairment: An optometrist in St. Thomas and another in Kitchener have recorded right sided hemianopsia with him which when put together with the aphasic syndrome and the right hemiparesis which is mostly resolved now would place the major elements of focal injuries to the left hemisphere but we need to place some right hemisphere injuries as well to explain his temporal (time) and spatial disorientation which is again rather incapacitating. His acalculia and short term memory deficit are also serious lobar dysfunctions that need assessment and documentation. It is easy to determine the visual field loss but he has not been tested for it since his coming to B. C.

Painful conditions: Intense bouts of right sided jaw pains which tend to come along with the migraines which are also always right sided are a serious concern of mine due to my fears of aneurysm etc. He has never had a carotid angiogram although an MRI in Spring of 1997was normal as was a CT scan. Unfortunately both were done several weeks after the initial trauma which could explain the low yield as also the diffuse nature of the insult through hypoxia.

Family history: is rather unremarkable except that a nephew is autistic and his brother who is an anaesthetist had been treated for depression. His father died in the summer of 1998 after a failed open heart surgery for mitral incompetence and CHF resulting from IHD due to adult onset diabetes and hypercholesterolemia.

Long term prognosis: I am lead to believe by Dr. Cheung and others that the injury has improved as much it possibly could without neuro-psychiatric intervention with anti-depressants or similar psychotropic medications and possibly a well tailored anticonvulsants regimen. I would not believe anyone if I was told that there is a possibility of substantial improvement in his neurological deficits now that it is over 5 years old. If one is to believe the hypothesis proposed by some psychiatrists that the clinical syndrome that we are dealing with here is largely a dissociative state akin to a Multiple Personality or conversion reaction type state (which has lead several psychiatrists to believe that he has something called a Ganser�s Syndrome) it is likely that he could return to normalcy which I would pray happens for at least the sake of his children. I do not know of any physician who has assessed him adequately enough or in fact is skilled enough to be in a position to offer a sensible assessment and a convincing prognosis of the condition. Getting a proper diagnosis has been a nightmare and all the �specialists� see only a window about him and no one has even attempted to put all the pieced together except for may be Ms. June Herrington..

Video tapes: Given that plegic element is not a major element of his clinical picture and the seizures show only subtle motor components and the confusion is detected only if one tests his communicative skills (with which he does not cooperate well possibly from the deterioration in his level of alertness) it is not going to help you a lot to send you a videotape. He can actually pass as pretty normal person if he is viewed by a casual observer as is true of his autistic nephew as well.

I hope this would serve as in introduction to Dr. Verma�s condition. I will be glad to forward some selected copies of dozens of �assessments�that have been undertaken on him although I don�t think any one of them is worth the paper (from 10 to 13 sometimes) that they are typed on.

ASL practice classes: As a part of the collaborative efforts of Ms. Alex Walker of IDHHC, of Ms. Ingrid Tanasichuk of VIVRS and of Ms. June Herrington of NBIS some steps are being taken toward the rehabilitation of Pradeep Verma and I am obliged to all of these people. I am presently attending American Sign Language classes along with Dr. Verma every Wednesday afternoon which has been a substantial help to both of use provide by the complements of IDHHC- Nanaimo who have also provided a TTY telephone line to meet his communication needs and Ms.Tanasichuk is looking into obtaining a laptop computer or PDA for him while NBIS people are looking for a place where he can have nursing supervision where he can begin his medication regimen. Financing his medical care has been a serious obstacle and I hope with the appropriate guidance and may be some possible vocational guidance and rehabilitation some long term arrangements would be made.

Mystries of the brain of Kevin Chappell: during my own recovery I had come across some articles on people with head injury who are left with a variety of cognitive and communication related deficits. I have recently read the story of Kevin Chappell (by Cathy Cook) published in July 2000 issue of the Reader�s Digest. I hope a review of that article would be very helpful to anyone willing to understand his condition instead of simply giving up on him and not believing that his clinical presentation is theoretically impossible one. I can forward a copy of that article upon request. The only difference in the clinical picture of Kevin Chappell and Pradeep Verma is that his syndrome is visually based and he can not read properly while Pradeep who unable to hear properly has the auditory counterpart of the exact same condition. The locus of neither has been clearly established yet. May be we don�t have the technology to detect those at this time and will hopefully find these out one day. That makes it imperative that accurate records of his clinical progress are maintained for the progress on head injury rehabilitation but in my experience serious attempts are being made to refuse to make those records.