The Fresno Bee
Fresno psychiatrist faces disciplinary action by medical board in second patient death
By Barbara Anderson
February 21, 2015
The medical board this month accused Dr. Latif Ziyar of gross negligence in the April 2012 death of a patient who shot and killed himself one day after the doctor discharged him from Community Behavioral Health Center in northeast Fresno.
Six years ago, Ziyar was accused of negligence in the treatment of a 35-year-old man who stopped breathing and died while at Community Behavioral Health Center in 2005. The medical board said Ziyar improperly prescribed an antipsychotic medication and revoked his license on Aug. 13, 2009. The revocation, however, was stayed and he was placed on three years probation. Ziyar denied the allegations but agreed to the probation.
On Friday, Ziyar’s attorney, Dr. Marvin Firestone of San Mateo, said the doctor was not on probation at the time of the latest accusation or when the events occurred. “We’re going to defend the accusation aggressively,” he said. “Dr. Ziyar evaluated this gentleman before he was discharged and he did not seem suicidal. He denied he was suicidal and wanted to go home and wanted to be discharged.”
According to the medical board’s accusation, Ziyar was negligent in his care of a 65-year-old man with a long history of outpatient treatment for depression. On the day that Ziyar discharged the patient, saying he was feeling better and not suicidal, a nurse had noted in the patient’s chart that his condition had not changed, the board said.
The patient, identified in the accusation only by the initials JH, was first admitted to Community Behavioral Health Center on Feb. 1, 2012, and discharged on Feb. 14. He was admitted a second time on March 28 and was placed on a “5150” safety hold because he posed a potential danger to himself.
He had given away firearms because he was concerned he might use them on himself, the board said. He had stopped taking antidepressant medications and said he wanted to jump off a bridge, and “I want to get rid of the pain inside.” He was described as “hopeless, depressed, and at risk for self harm.”
Ziyar saw the patient on March 30 and noted that this was his fourth episode of depression but the first time he actually had an intent to end his life. Ziyar diagnosed severe recurrent major depression and prescribed medications, the board said.
On April 2, a nurse made an assessment that the patient “still feels helpless and hopeless” and wrote that “no harm to self since on unit, but remains a danger to self as evident by withdrawn and guarded behavior.”
The nurse noted that the patient remained depressed and with minimal change, but according to the accusation, on that same day, Ziyar said in his discharge documentation: “Hospital course remarkable for good improvement.”
Ziyar noted that the patient had been provided with “ward milieu therapy*, medication adjusted” and said he had “made good progress toward the end of hospitalization. His mood improved, suicidal ideation resolved.” And Ziyar said the patient was “discharged today in stable condition,” the board said.
The next day, on April 3, the man told his wife he was going to the pharmacy to fill a prescription but instead went to a neighbor’s farm and took a rifle, drove down the road and shot himself, the board said.
Firestone said Ziyar would not have discharged the patient if he thought he was suicidal. “Dr. Ziyar is a very dedicated psychiatrist who in his work at that hospital took in a lot of very ill patients, including this patient, and did what he could to help him.”
*Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities. Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective punishments. If one patient violates the rules the entire ward is punished to varying extents based upon their cooperation with the staff. (Source: Wikipedia)