Sunday, December 11, 2016

Death penalty in the United States of America revisited

In 2006 the Puerto Rico Psychiatric Society, with the support of Abraham Halpern, MD made a statement againist the death penalty. The American Psychiatric Asssociation has not done that yet.

The following is an opinion dated December 10, 2016  in edition.cnn.com by a US physician on this torture modality.


We can no longer mask the barbarity of the death penalty

Updated 0151 GMT (0951 HKT) December 10, 2016 



Witness: Inmate struggled during execution 02:28
Story highlights
·       Ford Vox: United States is bumbling its way towards the bitter end of the death penalty
·       It's time for America to take a cue from the rest of the world, Vox writes
Ford Vox is a physician specializing in rehabilitation medicine and a journalist. He is a medical analyst for NPR station WABE-FM 90.1 in Atlanta. He writes frequently for CNN Opinion. Follow him on Twitter @FordVox. The opinions expressed in this commentary are his.
(CNN)The United States is bumbling its way toward the bitter end of the death penalty. As the numbers of executions fall every year, the state-ordered deaths that we do commit become that much more unusual, freakish and unfair applications of the law. As states scramble to implement arbitrary new lethal injection protocols, the cruelty of the procedure only worsens. The way Alabama killed the convicted murderer Ronald B. Smith on Thursday is only the latest example.
According to Birmingham News reporter Kent Faulk, Smith moved his lips after receiving an injection of midazolam, the third-choice sedative that most death penalty states are using in the absence of stronger barbiturate drugs. Besides moving his lips, Faulk reported the man was gasping for breath, heaving and coughing, for 13 minutes, stating that Smith "clenched his left fist after apparently being administered the first drug in the three-drug combination."
Faulk also said Smith's left eye appeared slightly open at times during the procedure and said Smith moved his right arm and hand after a prison official poked and prodded him a second time to check whether he was still conscious.

After the midazolam, which is the same twilight-inducing benzodiazepine that many people experience in lower doses for common procedures like a colonoscopy, prison staff next injected Smith with the paralytic pancuronium bromide and finally potassium chloride (which causes the lethal cardiac arrest).

The medicalization of capital punishment began in 1982 with the first lethal injection in Texas, and for most of the time we've relied on this method, states first injected the condemned with sodium thiopental, a strong barbiturate sedative (in general, barbiturates are stronger than benzodiazepines like midazolam).

But death penalty states lost their access to sodium thiopental when the pharmaceutical company Hospira stopped making it following European pressure. The European Union even specifically blocks the export of drugs that could potentially be used in executions to the United States.

Executioners next turned to pentobarbital, another barbiturate that can induce a deep medical coma, but its Danish manufacturer Lundbeck then cut off our supply of that drug, too. Now, prison officials are relegated to partnering with local compounding pharmacies whose skills in drug synthesis aren't ready for prime time. Or, they can get creative and use a drug so common its supply can't be cut off by the EU or a single manufacturer -- a drug like midazolam.
The only problem with that is that midazolam's a lousy drug for lethal injection. Besides the fact that there are stronger sedatives that it makes more sense to use, we know it's not very soluble, meaning it can easily become a solid in the vial or IV tubing, especially the higher the dose gets. Moreover, potassium chloride only makes its solubility worse, precipitating more of the drug out of solution, enough that trying to force in the injection through the precipitate can break the vein, spilling the drugs out into the arm tissue where they're not going to have their intended effects.
We know that consciousness is a continuum, and from the descriptions of Smith's execution, he was likely in a semi-conscious state for some of his execution. He could have been more fully conscious, but we'd be unaware because the paralytic he got would have prevented him from speaking.

We can't run experiments determining what prisoners really experience with any of the cocktails. After all, the experimental subject would be dead, one way or another, following the procedure. But the evidence we've got -- a number of botched executions using midazolam with subjects moving and attempting to speak after they're supposed to have been rendered unconscious, makes it clear this method is unacceptable.

To compound matters, decent physicians aren't willing to participate. Relevant specialties like anesthesiology will kick out a member who facilitates executions. The resulting procedure is archaic. Medics are fumbling around in the middle of the night trying to place peripheral IV lines right before the execution, having difficulty finding veins, when larger central or PICC lines could have been placed beforehand with imaging guidance.
We certainly can't trust the neurological examination skills of these executioners, so they'd be better off using a more objective EEG monitoring protocol to assess the how deeply unconscious their subjects are. But setting up one of the commercially available systems would require the help of companies and vendors that probably have ethical standards that wouldn't allow them to participate in executions.

We've just elected a new president who has embraced torture in the fight against terrorism. So perhaps quibbles about how humane lethal injection procedures may or may not be as means of exiting condemned murders seem a little quaint.

But the Constitution hasn't changed. The Eighth Amendment still prohibits cruel and unusual punishment. Yet lethal injection is only becoming more cruel and unusual. If we want to efficiently dispatch these murderous criminals into a deep coma and then stop their hearts, we've got a lot of work to do devising a better protocol.

However, no good medical professionals want to do that work. No modern, well-run company that wants any kind of international standing for itself will assist. That suggests that it's time for America to take a cue from the rest of the world. Our options just ran out. We can no longer mask the barbarity of what we are doing.



Bridge to the PRPS opinion on the death penalty.


Monday, November 14, 2016

Our President Obama shows civility mixed with assertiveness as a response to a loss.

I had never felt proudly black until now.

Sunday, June 26, 2016

Directiva renovada del Distrito de San Juan del CMCPR



Posición Nombre
1 Presidente Miguel Echenique Gaztambide
2 Vicepresidenta Norma Cruz Mendieta
3 Secretario Ignacio Echenique Gaztambide
4 Subsecretaria Loida Campos
5 Tesorero Angel González Carrasquillo
6 Subtesorera Elsa Arias Ríos
7 Senadora (1) Edmee Soltero Venegas
8 Senador (2) José M. Negrón Pérez
9 Senadora (3) Rosa E. Vega Rodríguez
10 Senadora Alterno (1) Vanessa Marcial Vega
11 Senador Alterno (2) Luis Cotto Ibarra
12 Senador Alterno (3) José L. Romany Rodríguez
13 Instituto Educación Continua Michel Woodbury Fariña
14 Instituto de Investigación Wilfredo De Jesús Monge
15 Fundación Felix Rolón Martínez





Sunday, June 5, 2016

un paso al 2013 en el Colegio de Medicos Cirujanos de Puerto Rico - Homenaje a la Dra Sarah Huertas


www.youtube.com/watch?v=xMQpN98gEOk

Durante la pasada administracion el Distrito de San Juan del Colegio de Medicos Cirujanos apoyo la permanencia del Comite de Salud Mental

Esto es lo que dice el nuevo reglamento enmendado:


Artículo 14.15: Comité de Salud Mental 

1. Será el recurso del Colegio Médico para toda solicitud de intervención al Colegio en materia de salud mental, que no esté referida al Capítulo de Psiquiatría del Senado Médico del Colegio. 

2. Tendrá un sub-comité que se denominará Sub-Comité de Violencia, Abuso de Substancias y Criminalidad que estará compuesto por personas relacionadas a la salud mental. 

Los miembros que componen este sub-comité serán nombrados por el presidente del Comité de Salud Mental.


Directiva pasada del Distrito de San Juan  2014-2016


Thursday, May 26, 2016

inductive reasoning into an interpretation of women

Following is an example of inductive reasoning about women and widowhood by a female, married psychoanalyst. This is not light reading, so bear with me.
First you could read on the scientific method

Saturday, May 21, 2016

inventario del 2015....una de cal y otra de arena

Enfermedad en la familia durante todo un año (downer)
vs
reconocimientos en mi trabajo de parte de
lEl consejo de pacientes de salud mental ^
Los psiquiatras  y ejecutoria en la comunidad^
La oficina de etica profesional ^


referencia:
https://ar.answers.yahoo.com/question/index?qid=20060925093855AAUXWSw

Sunday, April 3, 2016

Directiva electa del Distrito de San Juan. Colegio de Medicos Cirujanos de Puerto Rico


Posición
Nombre
1
Presidente
Miguel Echenique Gaztambide
2
Vicepresidenta
Norma Cruz Mendieta
3
Secretario
Ignacio Echenique Gaztambide
4
Subsecretaria
Loida Campos
5
Tesorero
Angel González Carrasquillo
6
Subtesorera
Elsa Arias Ríos
7
Senadora (1)
Edmee Soltero Venegas
8
Senador (2)
José M. Negrón Pérez
9
Senadora (3)
Rosa E. Vega Rodríguez
10
Senadora Alterno (1)
Vanessa Marcial Vega
11
Senador Alterno (2)
Luis Cotto Ibarra
12
Senador Alterno (3)
José L. Romany Rodríguez
13
Instituto Educación Continua
Michel Woodbury Fariña
14
Instituto de Investigación
Wilfredo De Jesús Monge
15
Fundación
Felix Rolón Martínez


Friday, February 19, 2016

Educacion continuada y Renovacion de la Directiva del Distrito de San Juan


 Es tiempo de  renovación para  la Directiva del Distrito de San Juan del Colegio de Medicos Cirujanos.

Si eres colegiado del Distrito de San Juan, puedes aprender mas sobre Zika en la manana este sabado 27 de febrero en el Hotel Sheraton del Distrito de Convenciones en San Juan. Al mediodia tendremos una corta Asamble de elecciones. Vean el plan de trabajo del Dr Echenique en www.colegiomedicopr.org.
Les indico parte del resume de nuestro candidato a la Presidencia y quien es su grupo ganador.

El Dr. Miguel Echenique es egresado de la Escuela de Medicina de la UPR donde obtuvo su doctorado en Medicina en el 1976. Hizo residencia en Cirugía General y pasó exitosamente sus “Boards”. Ha sido Director de Cirugía del Hospital Auxilio Mutuo, pasado presidente del capítulo de cirujanos de PR, pasado presidente de la Sociedad Americana del Cáncer, y pasado director de cirugía del Hospital Municipal de San Juan. El Dr. Echenique fue Vicepresidente del Distrito de San Juan del CMCPR del 2008 al 2010 y senador por el Distrito de San Juan del CMCPR del 2006 al 2008. En los últimos años se ha dedicado mayormente al tratamiento del cáncer de mama y la investigación. El ha realizado varias publicaciones y colaborado con la educación de residentes como catedrático auxiliar de cirugía.
Actualmente el Dr. Miguel Echenique ha sometido su candidatura a la Presidencia del Distrito de San Juan del Colegio de Médicos Cirujanos. 

Necesitamos su apoyo y voto durante la Asamblea de Elecciones a realizarse en el Hotel Sheraton del Centro de Convenciones el sábado, 27 de febrero del 2016 a la 1:00 PM.
¡Contamos con su apoyo!
El equipo de trabajo que se propone es el siguiente
Posición Nombre
1 Presidente Miguel Echenique Gaztambide
2 Vicepresidenta Norma Cruz Mendieta
3 Secretario Ignacio Echenique Gaztambide
4 Subsecretaria Zoé Ortiz Pedraza
5 Tesorero Angel González Carrasquillo
6 Subtesorera Elsa Arias Ríos
7 Senadora (1) Edmee Soltero Venegas
8 Senador (2) José M. Negrón Pérez
9 Senadora (3) Rosa E. Vega Rodríguez
10 Senadora Alterno (1) Vanessa Marcial Vega
11 Senador Alterno (2) Luis Cotto Ibarra
12 Senador Alterno (3) Jorge Mejía Valle
13 Instituto Educación Continua Michel Woodbury Fariña
14 Instituto de Investigación Wilfredo De Jesús Monge
15 Fundación José L. Romany Rodríguez