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SSRI Stories Summary – Ismail Dogan comes from Turkey to England as a 12-yr-old. He has language difficulties and suffers several racially motivated attacks at school. His trouble fitting in is probably why he leaves school, becomes withdrawn, uses soft drugs (cannabis and khat), and is a loner, overly concerned with his physical health. He first comes to the attention of the NHS at 15. When he is 22, he is accused of assault. Two years later he comes to the NHS with a list of physical complaints, despair, and hearing voices. From this point forward, the NHS makes it their mission to get and keep him on psychiatric drugs, and tells his family he must take them. At various times, they give him olanzapine, Cipramil (Citalopram), thioridazine, Prozac (Fluoxetine), Lustral (sertraline), risperidone, haloperidol, and procylidine. After the Prozac he is not seen by anyone for 5 months until he is arrested for damaging headstones in a cemetery. He does not react well to the medications, reporting unpleasant physical side effects and becoming paranoid. He clearly does not want the medication but he is sectioned and coerced to take it. When his sertraline dose is doubled he becomes aggressive and disoriented, perhaps even psychotic. He is diagnosed with schizophrenia. This leads to the prescription of more neuroleptics. In the autumn of 2004 he is out of hospital, does not attend appointments and has stopped taking the medications. His father contacts the NHS 4 times, concerned about his son’s behaviour. In Nov there is a meeting at which housing is discussed. In Dec Ismail Dogan stabs five people, killing one. In sentencing Dogan to be locked up in Broadmoor indefinitely, the judge blames the tragedy on his decision to stop taking his medication. The BBS reports that Dogan is a paranoid schizophrenic and makes no mention of prescription medications.
Last Updated: Thursday, 2 March 2006, 17:10 GMT
Ismail Dogan attacked six people, killing one of them
A paranoid schizophrenic has been found guilty of attempting to kill five people during a stabbing rampage.
Ismail Dogan, 30, of Tottenham, north London, had already admitted the manslaughter of Ernest Meads on the grounds of diminished responsibility.
He denied five attempted murder charges because his lawyers claimed his ill health meant he could not form intent.
An Old Bailey judge committed Dogan to Broadmoor Special Hospital indefinitely over the attacks in December 2004.
Passing sentence, the Common Serjeant of London Brian Barker told Dogan: “I am not in a position to apportion blame, but it is the greatest sadness you stopped taking your medication and the warnings were not quickly heeded.”
The court heard during the trial that Dogan’s mother had asked for her family doctor to visit their home.
This court has illustrated that there are a number of outstanding questions regarding the level of care and treatment that Mr Dogan received
Victoria Cann, Victim
The defendant had stopped taking his medication and in the run-up to the attacks had begun talking to himself and behaving oddly.
But the doctor refused, saying Dogan should visit the surgery.
At an earlier hearing Dogan admitted stabbing Mr Meads, 58, a father-of two, seven times, in Meridian Way, Edmonton.
The other five attacks took place within a six-mile radius between 0800 GMT and 0900 GMT on 23 December 2004.
After the verdict, two of Dogan’s victims, Roger Levy, 49, and Victoria Cann, 30, said they felt no resentment towards their attacker.
They and another victim David Symes, 31, said in statements that their thoughts were with the families of Mr Meads and the defendant.
Ms Cann and Mr Symes called for an inquiry into how the attacks were able to take place.
Ms Cann said: “What happened to me and five other people on 23rd December 2004 was very shocking and it has certainly changed my life forever.
“What I think this court has illustrated is that there are a number of outstanding questions regarding the level of care and treatment that Mr Dogan and his family received in the run-up to these events.”
Dogan also attacked Raymond Day, 76, and Jeffrey Arthur, 50.
The local mental health trust said it would carry out a review of the case.
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Independent Investigation into the Care and Treatment Provided to Mr. D by the Barnet, Enfield and Haringey Mental Health Trust and the Haringey Teaching Primary Care Trust
A report for NHS London March 2009
(Page 38) 1990: Mr. D’s first contact with health services was when he registered as a new patient with a General Practice on 7 March 1990.
Mr. D had completed his education in Turkey aged 12; however on arriving in England his schooling resumed, he had difficulty in settling in because of language difficulties. In 1990 Mr. D was hurt in the school playground in what appears to have been a racially motivated attack. As a result he was found a place in another school and recommenced his education there in September 1990.
Mr. D developed a history of truancy at his new school.
1992: When Mr. D was 17 years of age and in the sixth form he was once again assaulted at school. In this assault Mr. D sustained a broken nose. The police were not involved with this incident. As a result Mr. D left school and enrolled in computer classes at his local college. Mr. D left this course after a few months.
Mr. D visited his GP on four occasions with minor physical ailments.
1993-1996 [Mr D / Ismail Dogan] visits the GP a couple of times for physical ailments and starts to smoke cannabis.
1996 20th February 1996. Mr. D’s GP received a letter from the A&E Department at the North Middlesex Hospital regarding an intervention. Clinical records show that Mr. D missed an appointment with his GP on 2nd April 1996.
1997 Mr. D used his father’s car to work as a mini-cab driver… His parents noticed that he was drinking alcohol, taking home bottles of whisky, which he drank on his own in his bedroom. He spent more and more time on his own and hardly ate meals with the family. The mini-cab business was owned by a group of Somalian men and it was at this time that Mr. D started using Khat.
1998 18 December. Whilst Mr. D was driving along the road, he allegedly drove over the foot of a 37 year old male pedestrian. This pedestrian removed one of the car’s wing mirrors. Mr. D stopped his car and chased the man. When he caught up with him, Mr. D assaulted him by hitting his head against a brick wall causing a cut to his forehead. He was charged with Actual Bodily harm (ABH) and was remanded in custody at HMP Pentonville for six weeks18.
1 April 1999. The Police cautioned Mr. D after he had been seen acting in a strange manner and was found to be in possession of a small amount of cannabis. When his car was searched the Police found ‘rice flails” and so he was also cautioned with being in possession of an offensive weapon. (A rice flail constitutes two pieces of wood each joined by a length of metal chain).
9 November 1999. Mr. D attended the GP surgery with his father “to discuss his condition”21.
2000 27 January 2000. Following the incident of 18 December 1998 Mr. D attended Wood Green Crown Court and pleaded guilty to Actual Bodily Harm (ABH), following which Mr. D was subject to a one year Combination Order consisting of a one year Probation Order and 40 hours of community service. He was also expected to attend the ‘Break Free’ project. The Pre-Sentence Report stated that Mr. D did not “accept full culpability” and at one time denied that he had run over the victim’s foot, saying that the victim had stolen the mirror. The Probation Officer, completing the PreSentence Report, recommended the Combination Order as this would enable Mr. D to work with a Probation Officer to explore the events of the offence and any underlying reasons for his aggressive behaviour…
3 February 2000. Mr. D attended his General Practice, complaining of abdominal pain. He was given a prescription and given advice about taking more fluids.
28 March 2000. Mr. D attended his General Practice complaining of a painful shoulder and was given a prescription for Diclofenac 50mgs. He was referred to have an x-ray of his left shoulder and cervical vertebrae.
(Page 42) First Admission
4 June 2000. At 4pm Mr. D attended the A&E department at the North Middlesex Hospital. He was complaining of headaches and a slow heartbeat. Mr. D was referred for a psychiatric opinion and admitted to Downhills Ward, St. Ann’s Hospital for the first time. Mr. D felt that that there was something wrong with his blood. He said that his ‘blood was like water’ and that his ‘body does not feel normal’ and ‘I am dying’. During the interview he confided that he felt that his skin was changing colour and he was hearing voices. An electrocardiograph (ECG) was completed and a letter sent to his GP25.
On admission Mr. D was appropriately dressed, had good eye contact and fairly good rapport during the nursing assessment. The nurse gained the impression that he was preoccupied with vague hypochrondriasis and presented with somatic symptoms… During the medical assessment he said he had smoked cannabis for four years and had started chewing Somalian Grass (Khat) in 1999… He denied having any paranoid feelings but felt that he could no longer live with this ‘sickness’ and said he had had thoughts of killing himself but would not do so out of respect for his parents. Mr. D had worked for two years but was working no longer because of these symptoms. The medical notes stated that Mr. D was probably suffering from a psychotic illness precipitated by Khat. It was noted that Mr. D was distressed by his illness and that he had occasional thoughts of suicide…
Later that evening Mr. D’s sister telephoned the ward to say that her parents wanted to take Mr. D home. His illness was explained to them and that he needed to stay in hospital because he had a mental health problem…
13 June 2000. Mr. D was seen at the ward round. The plan was
- “to stay in hospital during the day and have leave
- to have soluble olanzepine 5mg. at 5.30pm and then could go home”
Mr. D agreed to take the medication but left the ward and did not return as planned.
29 June 2000. The CPN visited Mr. D at home… [unspecified] Psychotic symptoms, denies hearing voices and visual hallucinations
19 July 2000. …Mr. D spoke to the CPN on the telephone and told her he was fine and that he did not want to see her anymore. He reassured her that he was no longer taking drugs but just wanted to live his life. She told him that as he had an appointment to see the Consultant Psychiatrist, Dr. 2, she would telephone him again in three weeks time.
19 July 2000. Mr. D was seen in the outpatients department. He was no longer taking the medication… as he said it gave him headaches and made him feel worse. “…..he denied deliberate self harm ideation, expressed no intent or plans but said he was dying anyway. He experienced persecutory delusions…He has depressive symptoms… He also suffers with paranoid delusions… I have decided to start Mr. D on an anti-depressant and have given him two weeks supply of Cipramil 20mg… I have arranged a follow-up appointment for in September 2000, at which stage we would give consideration to increasing the dose of his Cipramil, or the addition of another antipsychotic.
|24 October 2000||A private doctor wrote to the Consultant Psychiatrist, Dr. 2, thanking him for copying him into the GP’s letter. He refuted that he told Mr. D to throw the Cipramil (Citalopram) in the dustbin. He explained that he started Mr. D on Melleril (Thioridazine) because it was so much cheaper to buy than Olanzepine, which he would have preferred but Mr. D could not afford the cost. This doctor also saw Mr. D’s mother who would not accept his illness. He told her that Mr. D must take his medication. He asked that copies of Mr. D’s medical notes be sent to him as he intended to continue seeing Mr. D.|
|24 November 2000.||The Consultant Psychiatrist, Dr. 2, wrote to Mr. D’s GP and was pleased to say that Mr. D seemed to be extremely well. Mr. D informed him that he was taking his medication and although preoccupied with his breathing, it had improved since he had taken up sport. Mr. D was to continue taking Prozac (Fluoxetine) 20mg daily and would be seen in a further three months.|
|7 February 2001||Mr. D did not attend outpatients for an appointment.|
|16 February 2001||The Care Coordinator made a home visit… [but] he only wanted to see the Consultant in the outpatient clinic and did not want her to visit him. He agreed to attend outpatient’s appointment.|
|28 February 2001||The Care Coordinator visited Mr. D at home and discharged him from her caseload, as he did not want her involvement…..|
|2 March 2001||Mr. D’s Consultant, Dr. 2, wrote to him, as he had not kept the appointment on the 20 February 2001 at 2.40pm|
|23 March 2001||Mr. D failed to keep his appointment on the 20 February 2001 and 10 March 2001. The Consultant, Dr. 2, wrote to Mr. D’s GP and explained that as he had failed two appointments, unless he was re-referred he would receive no further appointments.|
|20 May 2001||Mr. D was arrested for criminal damage to some head stones in Tottenham cemetery. The police helicopter was called out and video footage was taken. Mr. D thought the police helicopter was ‘after’ him. When Mr. D was arrested he was muttering incoherently and told the Police that “God told him to do it” A police doctor, (forensic medical examiner-FME), saw Mr. D and advised that a MHA (1983) Assessment be carried out. He was found to be in need of detention. Mr. D admitted to chewing Khat again and said that it had made him unwell in the past. He had stopped taking his medication possibly two to six months earlier.|
|3 Jan 2001
|Letter from neurologist to Dr. 2 explaining that previous referral did not arrive and agrees to a scan under sedation.|
|16 Feb 2001||Care Coordinator’s notes state that a home visit was made after having been informed that Mr. D had been admitted to St. Ann’s. Mr. D said that he did not want to have visits from Care Coordinator preferring to meet Dr. 2 at OPA. Mr. D also declined the opportunity to attend the day hospital. Care Coordinator stated in the clinical record that Dr. 2 was informed. There is no record of this|
|19 Feb 2001||Letter from Care Coordinator explaining to Mr. D that she was on leave from the 19 – 26 Feb 2001.|
|27 Feb 2001
|28 Feb 2001||Care Coordinator visited Mr. D at his home. She wrote that Mr. D felt alright and didn’t want any involvement in his plan. Plan: letter to Dr. 2, give Mr. D her contact number, brief mental health assessment completed, Mr. D to agree to see Dr. 2 at OPA.
Decision to have no further involvement with Mr. D unless requested to by him or the team
|20 March 2001||DNA OPA. Mr. D discharged. Dr. 2 states that as he had missed two appointments no further ones would be made.|
|20 May 2001||Admitted under section 2 from the police station for criminal damage and agitated behaviour. He had been arrested by police two months previously but had been released. Required restraint and had pressured speech, he was also thought disordered. Paranoid ideation, non compliant with medication for the last four months. Mr. D was admitted to K2 ward.
Issue: was the contact that Care Coordinator had made with him two months previously anything to do with the police involvement in February. It is not recorded anywhere
|21 May 2001||The diagnosis was a possible schizo affective disorder, drug induced psychosis, hypomania. Plan: Haloperidol PRN, drug screen, routine obs., section 2 application completed
Mr. D presented with many somatic symptoms and appeared to be paranoid and thought disordered. He was restless on the ward, but took medication with encouragement. His drug screen was negative.
|22 May 2001
|Mr. D’s medication was reviewed. Haloperidol 5mgs BD, Olanzapine 10 mgs. Lorazepam 1 mg|
|23 May 2001||Took Medication. Stayed on Ward
|24 May 2001||W/R. Not recorded who attended. Mr. D appeared to be relaxed and appeared to be improving mentally.
|25 May 2001||Mr. D appeared to be getting ‘brighter’, took PRN
|26 May 2001||W/R not recorded who attended. Mr. D judged to still have poor compliance with medication|
|27 May 2001||Spent most of the day in bed. Took meds|
|28 May 2001||Pleasant and compliant|
|29 May 2001||W/R. Dr. 4, Interpreter and mother present. Mr. D due in court 16/7/01. Dr. 2 suggested the use of a depot, mother refused consent. Decided on Haloperidol in divided doses. W/R informed that Mr. D would be going to Turkey. Section 23 completed and Mr. D discharged from section 2
Mr. D given 1 weeks leave
|30 May 2001||Mr. D attended A&E with chest pains and depression.
|31 May 2001||W/R. Dr. 4. Pt and mother left without being seen. Medication reviewed. Mr. D contacted at home and informed that his meds had been changed. Haloperidol 5mg nocte, Risperidone 1 mg nocte, procylidine 5 mg BD. To be reviewed on Tuesday.|
|2 June 2001||W/R: not recorded who attended. Mr. D appeared a little better, no paranoid thoughts. Discharged on Risperidone 2mg for 3/7 increasing to 3mgs 4/7 and then 6mgs daily. Care Coordinator to follow up. Diagnosis schizophrenia|
|11 June 2001||Difficulties breathing|
|27 June 2001||DNA OPA.
|7 Oct 2001||Letter from Dr. G to Dr. 2 informing him of DNAs at OPA re-MRI
|25 Sept 2001||OPA with Dr. 2. Whilst in Turkey Mr. D had not been well and had seen a doctor with possible side effects from the risperidone. Continued with Lustral 50 mg|
|8 Oct 2001||Self presented to OPD. DR. 2 could not see him and referred him to the ERC.|
|9 Oct 2001||Dr. 2 saw Mr. D where he presented with his somatic symptoms and general anxiety. Dr. 2 increased the Lustral to 100mg daily|
|5 Nov 2001||Fourth admission. Police contacted by the family of Mr. D. Mr. D wanting to slash his wrists and end it all. Mr. D believing that he was the Son of God. Verbally aggressive. The family very scared. Mr. D unable to accept he needed to be in hospital and required rapid tranquillisation. Seclusion and restraint.
Diagnosis depression with a relapsed schizophrenia. Admitted on a Section 4. his rights under section 132 were read to him. 1:1 observation. Diagnosis paranoid schizophrenia not controlled on Risperidone.
|6 Nov. 2001||W/R. It was noted that Mr. D’s key worker was his usual Care Coordinator and that she had not seen him for a while. Dr. C discussed the discharge plan with the Care Coordinator “ who was seeing the patient today”. It was decided that once the section had expired Mr. D was to be discharged. OPA were to be arranged. No CPA papers were completed. Mr. D was felt not to be sectionable.|
|7 Nov 2001||Referred to the day hospital|
|13 Nov 2001||Discharge summaries sent. Care Coordinator was contacted and told to arrange an urgent follow up in the community. The family reluctantly agreed to take Mr. D home|
|22 Nov 2001||ERC notification of attendance at GP due to side effects from his risperidone. OPA follow up arranged
|30 Nov 2001||Urgent referral to Dr. 2 re-adverse reaction to Risperidone. Mr. D attends ERC the following day.|
|10 Dec 2001||OPA with Dr. 2, Mr. D had been placed on Olanzapine 5 mg daily and appeared to have been tolerating it well. Mr. D appeared to be well.|
|20 Feb 2002||OPA with Dr. 2. Mr. D appeared to be much better. Somatic symptoms in abeyance. Dr. 2 suggested a referral to the day centre.|
|8 May 2002||OPA Somatic symptoms returned. Mr. D was due to go to Turkey.|
|18 Sept 2002||OPA with Dr. 2. Mr. D could not work due to physical pain. Dr. 2 was concerned that Mr. D may not have been entirely compliant|
|28 Jan 2003||LETTER SENT BY CARE COORDINATOR TO MR.D TO ARRANGE APPOINTMENT. NO COPY IN NOTES OF THIS OR ANY REASON WHY THE CMHT SHOULD BECOME INVOLVED AGAIN AT THIS TIME. FAMILY CLAIM TO HAVE MET CARE COORDINATOR IN SUPERMARKET CARPARK, REQUESTING HELP AT THIS TIME . NO CLINICAL RECORDS EXIST OF THIS AND CARE COORDINATOR HAS NO MEMORY OF IT. FAMILY HAVE A COPY OF THE LETTER|
|15 Oct 2004||Mother and sister of Mr. D visit ERC and see Mr. C, ASW. They say that Mr. D is withdrawn and not taking his medication. Checked out on PIMS and ASW suggests that they make an appointment with their GP. ASW gives the family his contact details.|
|8 weeks before the incident||Father stated that he went to St. Ann’s asked for help and got turned away.|
|6 weeks before the incident||Father claimed he went to St. Ann’s and asked for Dr. 2 but got sent away
|Four weeks before the incident||Father claims he went back to find Care Coordinator and was told that she was on Leave. He was advised to go to the GP
|Three weeks before the incident||Father claims he went back and asked for the Care Coordinator to be told she was still on leave.
Father went back later the same day with his daughter because Mr. D was aggressive the Trust sent them away and told them to go to the GP
|30 Nov 2004 (last contact)||Family visit GP. Asking for rehousing for Mr. D. Arrangements were set in motion for a home visit that never occurred.|
Dec 23, 2004
|[Mr D was responsible for] the stabbing of five other members of the public. Mr. D was subsequently arrested and convicted as the perpetrator of these offences.|