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A Death on the Subway and Many Deaths in Washington, D.C.

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(Article changed on December 18, 2012 at 08:42)

by Alen J. Salerian, MD

December 17, 2012


   R. Umar Abbasi, the New York Post freelance photographer who took the dreadful photos of a man about to be crushed by a subway train sent chills around the world: not attempting to help but taking pictures.

Man on NYC Subway Tracks Killed
Man on NYC Subway Tracks Killed
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   Of course what happened was horrific. For yet unknown reasons a human was pushed onto the pathway of an upcoming subway train while many watched passively. Also, it has been equally unnerving to observe the eerie silence in Washington, D.C., in response to the deaths of six people triggered by the abrupt cessation of their treatment.   

   "Avoidance of predictable stress" seems to be a common human trait rooted in survival instincts. It was two years ago in Bethesda, MD, when a young woman was bludgeoned to death inside of a clothing store on a weeknight, later it would become obvious that her frantic screams had been heard by dozens.

   It is easy to blame passive bystanders in Bethesda or in New York City for not acting heroic and taking a risk to make a difference. The truth is there are people who occasionally surprise the rest of us through their heroic acts whereas 99% of the time the great majority of us would imitate Mr. Abbasi.

   It is not about right or wrong. It's about what we have evolved to, what we are today.    Were the Washington, D.C. deaths preventable? I say yes. I should know for I was their doctor and have been familiar with the groundbreaking research of Dr. Bridgett Grant and her colleagues who warned of the dangers associated with failure to treat people with pain and addiction. The article published in August 2004 in The General Archives of Psychiatry had an ominous warning: Depriving patients with psychiatric and drug use problems can be fatal as observed by the deaths of former addicts by suicide.

   The assault on our center, The Salerian Neuroscience and Pain, began on 04/05/2012 by two actions: the emergency orders of Mayor Vincent Gray suspending my DEA class II prescription privileges, and the DC Licensing Board launching an inquiry "to determine possible endangerment of public health by substandard care". The dual actions paralyzed the medical operations. This was April 5, 2012. Since then a lot of time has passed. Most of it can be summed up as prolonged inaction packaged nicely as judicial process: several mini hearings, one trial and one mega=administrative hearing. As my children said in public, "If it was an emergency on April 5, 2012, the same urgency should apply to its conclusion. But who is listening?" The reaction from the Health Department, the mayor and the licensing board, or the judicial system, have not been any different than the response from the bystanders as we witnessed 6 deaths (2 suicides and 4 deaths from complications), 1 coma, 2 hospitalizations and 69 victims with serious injuries.

   Should we be surprised by the magnitude of death and misery? I suppose it was a simple oversight that the mayor of the world's most important city overlooked the impact on thousands of patients at The Salerian Center. For many disabled victims their pain medications are their lifesavers. This is precisely where the mayor's blindness triggered catastrophe. Emergency action - without a backup plan for possible adverse outcomes - can make big headlines, but can also kill. And it did.

   What happened in New York City was grotesque. What is happening in Washington D.C. is equally painful. The good news is common sense, reason, and our willingness to learn from past errors can prevent future unnecessary deaths.

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Alen J. Salerian, MD is a Washington, DC based physician, author, and historian who has been practicing psychiatry and psychopharmacology for 35 years. He is the former chief psychiatrist of the FBI's mobile psychiatric unit. He has authored (more...)
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