The Los Angeles Times from Los Angeles, California • 3

QosAnflclce Slimes Sunday, May 3, 1981 Part I 3 Doctor's Death Linked to Medical Board Actions Sufferingfrom Manic Depression and Facing Loss of License, Physician Accepted Post at State Mental Hospital revoked, but the revocation was stayed, and he was placed on probation for 10 years. He was required to get approval from two BMQA psychiatrists before resuming practice. In August, Hadsall wrote Gould to say how well he was doing. By October, at least one of the Merced hospitals was considering restoring his privileges. A state-ordered psychiatrist gave Hadsall Haldol, an anti-depressant which produced Parkinsonian (tremors and rigidity) symptoms.

He was given Cogenitin to reduce the effects of the Haldol. As months passed, Hadsall was less consistent in taking the Haldol or lithium. His family said the drugs gave him considerable stomach trouble. Both doctors and family agree Hadsall was never a drug abuser. In November, 1978, he began acting strangely again, discussing suicide.

He was hospitalized. Gould, who had opposed the use of Haldol, said he was never notified. "I just think his treatment was ever so slightly in- lithium, describes manic depression as "a genetic illness. It runs in families." "But if you treat them chemically," Gould said, "they get better, regardless of whatever dynamic issues are going on in their lives. Now this is often misunderstood, even by psychiatrists, because the precipitating stresses that can bring on an acute episode will involve ordinary life conflicts." In Hadsall's case the life conflict was his bitter divorce and his inability to get along with other members of the medical profession.

Family members say Hadsall was critical of the "country club" mentality of some doctors and what he considered the materialistic drive of many physicians. The BMQA entered the case in October, 1977, after Hadsall broke into his ex-wife's house and tried to set it on fire because he thought "evil spirits" were threatening his four children. He was hospitalized for mania. In February, 1978, he tried to commit suicide by drinking liquid cocaine The state's attitude 'was as if (Dr. Hadsall) had done something wrong and had to be taught a lesson.

I hadn't seen where he had done anything wrong except follow his doctors' advice. He was a pussycat and did anything you asked. I have a very pronounced bias against blaming patients for their symptoms.lt just doesn 't seem fair. Psychiatrist Brian Gould By LLOYD G. CARTER, United Press International PORTERVILLE, killed Dr.

Franklin Job Hadsall? A brilliant ear-nose-throat physician tormented by an organically caused manic-depressive illness during the last years of his life, Hadsall died unexpectedly at 40 while making a last attempt to salvage his shattered career by working at a state hospital for the severely mentally retarded. His death certificate listed respiratory failure and emphysema as the cause of death, but a psychiatrist contends Hadsall was "hounded to death" by a medical-legal system intent upon punishing him for "delinquent behavior" rather than viewing him as sick. His family, 18 months after his death, says he had no history of emphysema and thinks his fate was sealed by tortured travels through the world of psychiatry and its powerful drugs, the code of silence practiced in the medical profession and his "banishment" to Porterville State Hospital by the California Board of Medical Quality Assurance (BMQA). The events leading to his demise, and the fact that he lay dead for nearly a week before he was found, were brought to public attention only recently at a BMQA hearing for Dr. Charles Harman, another Porterville physician, who claims administrators there accused him of mental illness after he raised questions about Hadsall's case.

Hadsall was not the first doctor on probation to die while working at Porterville. Harman says there were four in recent years: At least two were suicides. What happens to probationary physicians at the other 10 state hospitals is unclear because the state does not keep such statistics. BMQA Draws From Fool What is clear is that the BMQA, faced with a chronic manpower shortage in state hospitals, will draw from the steady pool of doctors who find themselves in trouble, for whatever reason, with medical authorities. There are currently about 300 doctors in California on BMQA probation.

While the state cannot force a doctor to work at a state hospital, where working conditions are often unpleasant and the pay is relatively low, the agency can lift his license to practice if the doctor refuses. Hadsall was faced with such a choice. Three months of conversations with Hadsall's family, friends and physicians show how a sick and depressed doctor was pressured into taking a position on the staff of a state mental hospital where he did not want to be, and wound up a dead man. During his last years, Hadsall saw at least 10 psychiatrists, who diagnosed different problems and prescribed different treatments with such powerful drugs as lithium and Haldol. There was little coordination in these efforts, and in some instances doctors withheld information on Hadsall from medical authorities.

Assemblyman William Filante (R-Sonoma), the only physician in the state Legislature, says the Hadsall case is an example of what may be "criminal negligence" occurring in the staffing of state hosp-tals. Hadsall suffered from manic-depressive illness, showing the first symptoms as early in 1972 and getting progressively worse after his divorce in 1975. Such manic illnesses can bring on acute episodes if sparked by conflicts, such as divorce. Dr. Brian Gould, a San Francisco psychiatrist who treated Hadsall in 1978 and again in 1979, says Hadsall's manic-depressive or "bipolar" illness had been incorrectly identified as schizophrenia.

Gould, who has treated thousands of patients with You know, this is a chronic recurring illness. I have many patients who go through one or two or more relapses before we find exactly the right formula for them. In Dr. Hadsall's case, however, the authorities responded as if he were disobeying the treatment plan that was outlined. He wasn't." Because of the May outburst, the BMQA scheduled another hearing, again to determine if his license should be lifted.

An agreement was worked out under which he could continue to practice medicine in a "structured, supervised" environment. The only structured, supervised environment available turned out to be the state hospitals, which are chronically short of manpower. Gould said, "These men (BMQA) officials felt they had a responsibility to protect the public from an erratic and potentially dangerous physician, and in that mission I was on their side. "But I thought they were being overly punitive to Dr. Hadsall because he had done nothing wrong.

We should have had an opportunity to just treat him medically before we brought in the police powers of the state to put him out of business. I'm confident that we could have done it." Was Hadsall dangerous? Aside from the hostility directed toward his ex-wife, Sally, he had never harmed anyone, although he had been verbally abusive. Strange Operating Room Behavior His demeanor in the operating room had been strange at times, including poetry recitations and relativity dissertations, and he once made a menacing gesture toward a nurse with a pair of scissors. But no one ever accused him of malpractice, and he would always stop practicing when he felt the onset of a manic episode. His office receptionist, Lena Mendoza, said Hadsall loved and was loved by his patients who often praised his surgical skills and remained faithful to him.

Hadsall was not to get another chance at working out his problem medically while continuing in private practice. The BMQA suggested he look for work in a state institution where he could be watched closely. He also learned he was about to lose his malpractice insurance. When he learned he might lose his license to practice, he told a BMQA official he might as well kill himself. He began looking for a job in a state facility near Merced.

No one wanted to hire him. On July 2, 1979, a BMQA hearing was held in Modesto, north of Merced. It was determined he was unfit for private practice at that time. He was ordered to continue psychiatric treatment. He applied at Porterville State Hospital, an institution for the severely mentally retarded 125 miles south of Merced, and was accepted.

His girlfriend and children had a birthday dinner for him on July 30 (his birthday was Aug. 2), and the next day he glumly left for Porterville. Died 5 Weeks Later After five weeks of working at Porterville, he died unexpectedly in his lonely apartment. He failed to show up for work two days and missed a psychiatric appointment, butibeyond a telephone call to his residence by Porterville chief of staff Dr. Alfred Carney, hospital officials took no other action to determine his whereabouts or condition.

Why didn't Carney do more? "Why should he?" responded Dr. James T. Shel-ton, executive director of Porterville. Please see DOCTOR, Page 29 adequate, and it allowed him to fall into a recrudescence of the illness and then instead of bringing the man back for prompt restabilization, too many people were covering for him. So he was allowed to go on destroying his reputation," Gould said.

He said the BMQA attitude at the time "was as if he had done something wrong and had to be taught a lesson. I hadn't seen where he had done anything wrong except follow his doctors' advice. He was a pussycat and did anything you asked. I have a very pronounced bias against blaming patients for their symptoms. It just doesn't seem fair." State psychiatrists were ready by January to recommend full restoration of medical privileges, provided that Hadsall's behavior was monitored.

In May, 1979, however, there was a serious relapse, forcing hospitalization. After release, Hadsall was abusive to nurses and his ex-wife and had to cancel surgery when he arrived at the hospital incoherent. Barbara Horta, a real estate saleswoman and Hadsall's girlfriend since the previous January, says they tried to get help from Fresno psychiatrists but were turned down. In desperation, they again turned to Gould. "I received this frantic phone call, and he was readmitted in May of 1979," Gould remembers.

"I then found out that from about the previous November he had been having his ups and downs. They should have contacted me earlier. Everyone was acting in good faith, as far as I can tell, and yet the result was disastrous." Gould said Hadsall had merely fallen off his correct amount of lithium, which, when restored returned him to a normal mental state. "He needed, I think, higher than ordinary lithium levels and careful following," Gould said. "He didn't get it, and he relapsed.

Not surprising. used in his practice. The next month, his family had him hospitalized in San Francisco. "He was extremely depressed at that point, suicidal," said Gould, a psychiatrist who decided previous diagnoses of schizophrenia were incorrect. "I took a full history and disagreed with his standing diagnosis at that time.

I thought that rather than having a schizophrenic disorder with depression, that all his problems were better explained by a bipolar mood disorder, a manic-depressive illness." Gould notes Hadsall had "had a short trial of lithi-. urn previously, but it was an inadequate trial." Hadsall, who by this time had already seen a handful of psychiatrists, had also been given a variety of tranquilizers and anti-depressants. "So basically all I did was make a diagnosis. I put him on the proper regimen of lithium, and he did wonderfully." Hadsall "went back home and began to put his life in order," said Gould. Outbursts as Symptoms of Disease "Many of his behavior outbursts that caused his divorce complicated the actual legal proceedings, like when he kicked his wife's door in, and his problems at the (Merced) hospitals (where he had privileges) were all symptoms of disease, and this is something I've seen many times.

I have one patient who has had four manic episodes and four divorces. "Woe accumulates to the person whose metabolic disorders affect his central nervous system. If it was a diabetic who went into a coma or something, we wouldn't be so punitive. But when your behavior goes off, bad things happen to you. And that's what subsequently happend to Dr.

Hadsall." Hadsall still faced a BMQA hearing. On April 5, 1978, Hadsall, his attorney, Norman Fletcher of Fresno, and the BMQA reached a stipulated agreement in which his license to practice was Ranch School Students Ride, Rope, Read Bible Senior Activist Pushing Union for the Elderly BONSALL, Calif. OW-Clarence Chown's Rawhide Ranch resembles old Dodge City but it's actually a Christian non-denominational school that revolves around horses, cows, goats and rabbits. "It's an experience that every kid loves and he learns while having fun," Chown said of his 47-acre Old West camp. Youngsters here range from second-graders to sophomores in college.

About 200 a week participate in the summer program, while others come for sessions at other times of the year. There is also day school for grades 2 through 12 and a two-year vocational school for college -age students. The boy campers live in dormitories shaped like covered wagons and the girls in log cabins clustered in "Ft. Rawhide." The youngsters spend two hours daily on horseback and in the study of veterinary science, livestock production and rodeoing. Despite its Western motif, Chown insists, "It's not a dude ranch." "We train the horses and children the same way," said Chown, a 53-year-old former livestock dealer who opened the school as a boys' and girls' camp 17 years ago and expanded it eight years ago.

"It's not in their ability to be champions all the time and it's important not to break their spirit." In fact, Chown, whose four sons were junior rodeo champions, believes "the livestock industry is a tremendous opportunity for young people a multimillion-dollar industry." He pointed out that former Rawhide students have found jobs as horse trainers and ranchers and in a wide range of related fields such as camping and recreation. There are from 30 to 50 teachers or paid ranch hands. The student body has included sons of a British diplomat, a Mexican governor and Japanese businessmen. A class in Bible is taught, but Chown's students are from many different religions. Rawhide Ranch has 125 horses and gives 30,000 riding lessons a year.

The spread is three miles east of Associated Press but is actually a Christian non-denominational school that teaches the Bible and livestock skills. A boy twirls a rope at Rawhide Ranch near Bon-sall, Calif. The ranch looks like an Old West town Bonsall, north of Vista on Route 78 in rural northern San Diego County. Farm animals that the youngsters raise are sold to help support the school, where tuition is $750, which covers room and board. That income is supplemented by sales from the ranch's Western store and by livestock stud fees paid by area ranchers.

Both teachers and campers seem to love the program that Chown offers. Teen-age Paul Blais called it a "great school I thank the Lord I'm here." Bob Johnston, who teaches drama, noted a major ingredient in Rawhide's success: "There's something about God's country and the earth that is wholesome." VENTURA (UPI)-At the age of 78, retired engineer Tony Lamb is organizing a union of elderly people which he predicts will have such clout it will put the Teamsters to shame. "We can't strike," says Lamb, "But we sure can vote." One of the first projects of the "Tony Lamb Senior Advocate Union" is a mammoth retirement village in Ventura County for union members. It would cost $50 million and provide housing for 8,000. It would be shaped like a wagon wheel and contain 5,000 "Cape Cod saltbox" prefabricated units.

Younger seniors would live around the outer rim of the wheel and progress inward as they get older and less able to get around. In the middle would be a central mall, the hub of the village, which would include a union -operated cooperative food market, cafeteria, nursing home, health clinic and clubhouses. Start in Two Years Lamb says he hopes to start the project in two years, but that depends on signing up members. He hopes for 300,000 members in California. How many members does the TLSAU have now? "Two hundred and twenty-five," says Lamb.

"But you have to start someplace. The word is just getting around." Lamb is not some kind of geriatric crackpot. He is the senior citizen coordinator for Ventura County, a job, and has been active for years in California and national programs for the retired. But Lamb said he decided that a union was the only way of transferring numbers into power after a recent visit to Sacramento to protest the Legislature's cut of automatic cost-of-living increases from Supplemental Security Income. "In Sacramento, we walked around wearing badges that read 'Senior he said.

"What a laugh. We got no place." Lamb says the union will hire a Please see SCHOOL, Page 29 Pressures in the Workplace Called Major Problem That Aching Back May Be Caused by Stresses of Office Politics By MURIEL DOBBIN, The Baltimore Sun SAN FRANCISCO-It might be a virus that is raising your temperature and making your back ache, but it could be office politics. In the range of what is known as "stress in the work place," office politicking ranks high, according to Dr. Robert Tager, a California neurologist and professor at the University of Southern California, who has become an expert on stress management. Office politics, said Tager, or what people perceive as office politics, can contribute to high blood pressure, tension, heart problems and general illness because one of the side effects is a lowering of physical resistance.

"I have found it to be a major problem, perhaps more of one than overwork," said the neurologist, who has conducted many interviews with employees in the course of giving stress management seminars around the country. He emphasized that the office politics problem has to be seen in terms of the worker's perception. It might be, he noted, that the new typewriter or the promotion that went to someone else was the result not of their having the right connections, but of doing a good job. On the other hand, he acknowledged, the person who became convinced that he was doing better work without similar recognition was likely to become convinced that he was the victim of injustice and would display what he had come to recognize as signs of stress. "Stress as a real difficulty has only become recognized over the past ten years or so, but now employers are beginning to recognize that it has a very real impact on productivity," he explained.

The techniques of dealing with stress as advised by Tager, include improving nutrition habits, learning "deep relaxation" through meditation, and taking more exercise. By exercise, he said, he means jogging, swimming and games like handball. And he suggested cutting down on salt, sugar, cholesterol and fats to help reduce the risk of stress-related diseases such as high blood pressure, heart attacks, strokes, peptic ulcers, arthritis, headaches and chronic backache. "Backache is one of the most common symptoms of stress, which often causes muscles to tighten, and if there is a back problem there, then it is likely to be exacerbated," he reported. Tager acknowledged that it is unlikely that office stress could be eliminated.

What he is recommending, he said, are methods of managing personal reaction to such stress so it does not reduce the efficiency of both the employee and the employer. He added that increasing problems of stress among women workers are coming to light, combined with indications that women are more subject to heart attacks than they had been previously. I.