14/02/1975.

Thank you very much for your letter regarding Dr. Risto Delev ( your file no: G-10254-1).

I have some ambivalent feelings regarding my role in the whole affair. I will tell you the two sides to it. I must confess that it is hard to believe that conscientious psychiatrists will commit someone to a psychiatric hospital without having sufficient reasons for it. At the same time, I am absolutely convinced that the case histories that Dr. Delev has sent me, are so badly written that they do not justify either the admission, the transfer from Quebec to Montreal, or the continuous treatment in St-Jean-de-Dieu. They do not show what has really been done, who has ever made a reliable psychiatric diagnosis, why was the man treated and what has been achieved through hospitalization. I would like to believe that a serious legal attack could be made on formal grounds, namely that the documentation is faulty. All the parts of a good documentation, particularly of a stay which was as long as Dr. Delev's, are non-existent: there is no (1) Referral slip, (2) admission note, (3) ca! se history, (4) course in hospital notes, (5) documented transfer slip, (6) reassessment of the case history in St-Jean-de-Dieu (he has apparently been sent to Montreal, to be reassessed by a psychiatrist speaking Serbo-Croatian language !) and (7) the dates of the course of illness in St-Jean-De-Dieu. (8) Finally, we don't find the reasons why the patient has been discharged at that given moment : Has he improved, has he been cured? All these questions cannot be answered. Consequently, the burden of the proof, should be laid on these people who kept Dr. Delev in hospital.

I believe that this division (formal vs factual) should be strictly kept. I feel that Dr. Josif Divic's letter, does not make this strict division. At times even, it is not clear what he is actually saying: Is he talking about formally unfit documentation or is he talking about the mental health of Dr. Delev. I have the feeling that if the case will be presented without sharp distinction between the obligation of the hospitals and the doctors to keep strict records, the question, did Dr. Delev need psychiatric treatment or not, cannot be won.

Accidentally, I have spoken to Mr. Miho Rusko²²⁰, who was together with Dr. Divic and your client, in Quebec City and he, I trust was sincerely concerned to help your client, told me that your client has suddenly made a few statements which have raised the doubt that he might have been justifiably hospitalized. This must be as far as I am concerned, absolutely clarified.²²¹

If I am right that the hospitals have to prove the absolute necessity of the patients treatment, only then, as the second line of defense, comes the question of the mental health of the patient. The letters of Dr. Littmann and Dr. Divic, testify almost only as to the present state of the mental health of Dr. Delev and are of doubtful value as to the happenings in 1971. Are they willing to make statements antedating their examinations and stating clearly that they are convinced that in 1971, the patient was quite alright.

After this rather lengthy introduction, I don't know of what help I could be to you. I have had a long letter and several calls from Dr. Delev and one call from Dr. G.F.D. Heseltine from London, Ontario, regarding this case of yours and I have declined to participate in it. In a letter from November the 5th, 1974, to Dr. Delev, I expressed my doubts as to bringing this case before the courts. However, this is a case that can be very fashionable and almost "hit", at this moment : in spite of that, I must still say, that I am reluctant to get involved in it.

I would gladly speak to you again and rediscuss the whole matter once more, if you find it necessary.

Sincerely Yours,

Dimitrije Pivnicki, M.D.