Posted on 06/19/2002 5:20:51 PM PDT by marshmallow
AN anaesthetist helped lace an abortion doctor's coffee with sedatives because she wanted to keep his temper tantrums under control.
Anaesthetist Dawn Cullen confirmed that in one of his temper tantrums, Dr Peter Bayliss had left a patient tied to a bed with a sanitary pad stuffed in her mouth.
Cullen, Bayliss's former colleague at the Greenslopes Fertility Clinic in Brisbane, was giving evidence at an inquest into the doctor's death.
The inquest reopened this week after Bayliss's housekeeper told the Brisbane coroner's office that the doctor's de facto wife, Claudia McEwan, was rumoured to have spiked his coffee with drugs.
Cullen told the court yesterday that she provided valium to McEwan in a bid to calm the doctor's temper tantrums. "The patients were terrified of him when he got into that state," Cullen said.
Under cross-examination by McEwan's lawyer, Cullen was asked if Bayliss had ever tied patients to beds and put sanitary pads in their mouths to "shut them up".
"I think that happened once," she said.
Cullen said she knew McEwan was putting Prozac in Bayliss's coffee, and remembered giving McEwan an ampoule of valium to use.
"I only agreed when she suggested that he should have it," she said.
Cullen admitted she was concerned about the practise, but said it was necessary to stop Bayliss acting "like a pork chop in a synagogue".
"It was a matter of running the clinic . . . .it would run properly providing he was reasonably calm," she said.
Retired doctor John Ogden said he had known Bayliss for 20 years and occasionally filled in for him at the fertility clinic.
He agreed Bayliss and McEwan slept in separate bedrooms, had separate bathrooms, and led separate lives while sharing a home at New Farm. "In a way, it was an apartheid life to the observer," he said.
Ogden said he had seen Bayliss inject McEwan with pethidine, but had refused to give her injections at Bayliss's request.
"I thought maybe it was becoming a habit," he said.
Ogden said he was "amazed" at the levels of drugs that had been found in Bayliss's body.
"All these are sedatives of considerable magnitude and I can't imagine Peter functioning on this level of drug," he said. "This is a cocktail."
Ogden said Bayliss often walked around the house with a cat draped around his shoulders like a stole, and laced his coffee with HP sauce.
Mary Williams-Howard, who cleaned the couple's house for 10 years, told the inquest how she contacted the coroner's office after an inquest in 1999 found Bayliss's death was accidental.
That inquest found the death was due to a heart condition as a consequence of sleeping pill toxicity, but Williams-Howard said she didn't even know about the inquest until it was over.
"The morning after his death, there wasn't one of us who didn't think something was amiss," she said.
The inquest, before Coroner Michael Halliday, continues today
What in the world would a pork chop do in a synagogue?
geez, I can see why that one never caught on.
Some evidence suggests that meperidine may produce less smooth muscle spasm, constipation, and depression of the cough reflex than equivalent analgesic doses of morphine. Meperidine parenteral doses of 80 to 100 mg is approximately equivalent in analgesic effect to 10 mg of morphine. Its onset of action is slightly more rapid than with morphine, and there is a slightly shorter duration of action. Meperidine is significantly less effective by the oral rather than parenteral route. However, the exact ratio of oral to parenteral effectiveness is unknown.
Indications And Clinical Uses: The relief of moderate to severe pain involved in many medical, surgical, obstetrical and dental situations.
Contra-Indications: Hypersensitivity to meperidine. Contraindicated in patients who are currently receiving or who have been receiving MAO inhibitors within 14 days. The mechanism of these reactions is unclear, but may be related to a pre-existing hyperphenylalaninemia. Some have resembled the syndrome of acute narcotic overdose characterized by coma, severe respiratory depression, cyanosis and hypotension. In other reactions, hyperexcitability, convulsions, tachycardia, hyperpyrexia and hypertension have been the predominant manifestations. Although it is unknown if other narcotics are exempt from the risk of such reactions, virtually all the reported reactions have occurred with meperidine. A sensitivity test should be performed if a narcotic is needed in such patients. The sensitivity test should involve repeated, small, incremental doses of morphine administered over the course of several hours. The patient's condition and vital signs should be under careful observation throughout the test. Severe reactions have been treated with i.v. hydrocortisone or prednisolone with the addition of i.v. chlorpromazine in those cases exhibiting hypertension and hyperpyrexia. The usefulness and safety of narcotic antagonists in the treatment of these reactions is unknown. There is a chemical incompatibility between solutions of meperidine and barbiturates.
Manufacturers' Warnings In Clinical States: Drug Dependence: Meperidine can produce drug dependence similar to that of morphine and therefore has the potential for being abused. Psychic and physical dependence, as well as tolerance may develop upon repeated administration of meperidine. Meperidine should therefore be prescribed and administered with the same degree of caution appropriate to the use of morphine. As with other narcotics, meperidine is subject to the provisions of the Narcotic Control Act.
Drug Interactions: Interaction With Other CNS Depressants: In the case of patients who are concurrently receiving other narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers (see Dosage), sedative-hypnotics (including barbiturates), tricyclic antidepressants, and other CNS depressants (including alcohol), meperidine should be used with great caution and in reduced dosage. The following conditions may result: respiratory depression, hypotension, and profound sedation or coma.
Head Injury and Increased Intracranial Pressure: Head injury, other intracranial lesions, or a pre-existing increase of intracranial pressure may markedly exaggerate the respiratory depressant effects of meperidine and its capacity to elevate cerebrospinal fluid pressure. Furthermore, adverse reactions produced by narcotics may obscure the clinical course of patients with head injuries. Meperidine must be used with extreme caution and only if its use is deemed essential in such patients.
I.V.: If necessary, meperidine may be given i.v., but the injection should be given very slowly, preferably in the form of diluted solution. Increased incidence of adverse reaction such as severe respiratory depression, apnea, hypotension, peripheral circulatory collapse, and cardiac arrest have occurred with rapid i.v. injection of narcotic analgesics, including meperidine. Meperidine should not be administered i.v. without the immediate availability of a narcotic antagonist and the facilities for assisted or controlled respiration. The patients should be lying down when meperidine is given parenterally, especially i.v.
Asthma and Other Respiratory Conditions: Meperidine should be used with extreme caution in the following patients who are: having an acute asthmatic attack, have chronic obstructive pulmonary disease or cor pulmonale, have a substantially decreased respiratory reserve, and have pre-existing respiratory depression, hypoxia, or hypercapnia. Even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea in such patients.
Hypotensive Effect: Severe hypotension in the postoperative patient or any individual whose ability to maintain blood pressure has already been compromised by a depleted blood volume or the administration of drugs such as the phenothiazines or certain anesthetics may result from the administration of meperidine.
Occupational Hazards: Ambulatory Patients: The mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery may be impaired by meperidine. The patient should be cautioned accordingly. Like other narcotics, meperidine may produce orthostatic hypotension in ambulatory patients.
Pregnancy: Meperidine should not be used in pregnant women prior to the labor period, unless the potential benefits outweigh the possible hazards. Safe use in pregnancy prior to labor has not been established relative to possible adverse effects on fetal development. Therefore when meperidine is used as an obstetrical analgesic, it crosses the placental barrier and respiratory depression or psychophysiologic functions can be produced in the newborn; resuscitation may be required (see Overdose: Symptoms and Treatment).
Lactation: Meperidine appears in the milk of nursing mothers given the drug.
Precautions: Supraventricular Tachycardias: Meperidine should be used with caution in patients with atrial flutter and other supraventricular tachycardias due to possible vagolytic action. This action may produce a significant increase in the ventricular response rate.
Convulsions: Meperidine may aggravate pre-existing convulsions in patients with convulsive disorders. Convulsions may occur in individuals without a history of convulsive disorders if dosage is escalated substantially above recommended levels because of tolerance development.
Acute Abdominal Conditions: In the case of patients with acute abdominal conditions, the administration of meperidine or other narcotics may obscure the diagnosis or clinical course.
Special Risk Patients: Elderly or debilitated patients, and those with severe impairment of hepatic or renal function, hypothyroidism, Addison's disease and prostatic hypertrophy or urethral stricture should be given meperidine with caution and the initial dose should be reduced.
Incompatibilities: Solutions of meperidine are chemically incompatible with aminophylline, barbiturates, heparin, iodines, methiallin, phenytoin, sodium bicarbonate, sulfadiazine and sulfisoxazole.
Adverse Reactions: As with other narcotic analgesics, the major hazards of meperidine are respiratory depression and, to a lesser degree, circulatory depression; respiratory arrest, shock, and cardiac arrest have occurred. Lightheadedness, dizziness, sedation, nausea, vomiting, and sweating are among the most frequently observed adverse reactions. These effects seem to be more prominent in ambulatory patients and in those who are not experiencing severe pain. Lower doses are advisable in such individuals. Some adverse reactions in ambulatory patients may be alleviated if the patient lies down.
Other adverse reactions include: CNS: euphoria, dysphoria, weakness, headache, agitation, tremor, severe convulsions, uncoordinated muscle movements, transient hallucinations and disorientation and visual disturbances. Inadvertent injection about a nerve trunk may result in sensory-motor paralysis which is usually, though not always, transitory.
Gastrointestinal: dry mouth, constipation, biliary tract spasm.
Cardiovascular: flushing of the face, tachycardia, bradycardia, palpitation, hypotension (see Warnings), syncope and phlebitis following i.v. injection.
Genitourinary: urinary retention.
Allergic: pruritus, urticaria, other skin rashes, wheal and flare over the vein with i.v. injection.
Others: pain at injection site; local tissue irritation and induration following s.c. injection, particularly when repeated; antidiuretic effect.
Symptoms And Treatment Of Overdose: Symptoms: Serious overdosage with meperidine is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In severe overdosage, particularly by the i.v. route, apnea, circulatory collapse, cardiac arrest, and death may occur.
Treatment: In parenteral overdosage, circulation should be maintained with infusions of plasma or suitable electrolyte solution and assisted respiration may be necessary. If consciousness is impaired and respiratory depressed, an opioid antagonist should be administered. Naloxone, a pure antagonist, is now the treatment of choice. Administer i.v. naloxone (e.g., 0.4 mg) which may be repeated at 2- to 3-minute intervals. For children, the initial dose recommended is 0.01 mg/kg of naloxone. In neonates, a more rapid and improved antagonism was noted after 0.02 mg/kg was administered. A response should be seen after 2 or 3 doses. Note the duration of action of naloxone is usually shorter than that of meperidine and thus the patient should be carefully observed for signs of CNS depression returning.
Note: In a individual physically dependent on opioids, the administration of the usual dose of an opioid antagonist will precipitate an acute withdrawal syndrome. The severity of this syndrome will depend on the degree of physical dependence and the dose of antagonist administered. The use of opioid antagonists in such individuals should be avoided if possible. If an opioid antagonist must be used to treat serious respiratory depression in the physically dependent patient, the antagonist should be administered with extreme care and only 10 to 20% of the usual initial dose administered.
Dosage And Administration: See Table I. Pain Relief: If i.v. administration is required, dosage should be adjusted for the patient and made with repeated slow i.v. injections of fractional doses (e.g., 10 mg/mL) with the use of an infusion pump. When administered concomitantly with phenothiazines and tranquilizers, meperidine dose should be reduced.
Preoperative Medication: Repeated slow i.v. injections of fractional doses (e.g., 10 mg/mL) via an infusion pump.
Support of Anesthesia: Repeated slow i.v. injections of fractional doses (e.g., 10 mg/mL) with the use of an infusion pump or continuous i.v. infusion of a more dilute solution (e.g., 1 mg/mL) should be used and titrated to patient needs and operative procedure.
Availability And Storage: Each mL of sterile solution contains: meperidine HCl 10 mg. Nonmedicinal ingredients: sodium chloride and water for injection. Preservative-free. Rapiject prefilled, single-dose syringes of 50 mL. Store between 15 and 25°C, protected from light.
It's a flavouring sauce, used for cooked meat dishes.
As for the story, how many other Aussie abortionists are spending their worktime in a drug-induced haze? Perhaps, if you have the vestige of a conscience left, it's the only way you can get through the day.
AN anaesthetist helped lace an abortion doctor's coffee with sedatives because she wanted to keep his temper tantrums under control.
Anaesthetist Dawn Cullen confirmed that in one of his temper tantrums, Dr Peter Bayliss had left a patient tied to a bed with a sanitary pad stuffed in her mouth.
Can anyone be surprised by this, really? The image of a woman strapped to a metal gurney and gagged with a maxi-pad may be the most perfect possible description of the relationship of these "doctors" to their patients.
They love women, don't you see? And respect them. Respect their bodies, their independence. Respect and love women so much that they stoop to do the dirty work of sticking tubes up the women's vaginas in order to suck the unwanted life out of them. It's stressful work, made endurable only because of the great service it represents to the women they love and respect so much.
We must be more compassionate toward these noble doctors. Who can blame them if, in an occasional fit of pique, they silence an ungrateful woman by stuffing a maxi-pad up her 2nd most offensive hole?
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