Preview:

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS _______________________________________ RANDALL B. VAUTOUR, Plaintiff, v. MICHAEL J. ASTRUE, Commissioner, Social Security Administration, Defendant. _______________________________________ ) ) ) ) ) ) ) ) ) ) ) )

Civil Action No. 10-12171-FDS

MEMORANDUM AND ORDER ON DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE COMMISSIONER SAYLOR, J. This is an appeal from the final decision of the Commissioner of the Social Security Administration denying the application of plaintiff Randall B. Vautour for Social Security Disability Benefits ("SSDI"). The Administrative Law Judge ("ALJ") essentially determined that when plaintiff was abusing drugs, his anxiety disorder rendered him disabled, but that if he stopped abusing drugs, his disorder would not prevent him from working. Plaintiff, who is proceeding pro se, appears to dispute the denial of his claim on the ground that evidence regarding his upper neck, shoulder, and lower back problems was improperly omitted during his administrative appeal, and should have been considered along with the evidence regarding his mental health disorders. Defendant has moved for an order affirming the decision of the ALJ. For the reasons set forth below, the motion will be granted.

I.

Background A. Educational and Occupational History

Plaintiff Randall Vautour was born on July 26, 1953. (A.R.. at 12). He attended high school but did not complete the twelfth grade. (Id. at 37). He earned his General Educational Development (GED) credential in 1987. (Id. at 37, 222). He has received training in smallengine repair for one year, machine-shop skills for five years, quality-control inspection for six months, and research and development for two to three years. (Id. at 37-38). From 1989 to 1991, Vautour worked in shipping and receiving. (Id. at 147). From 1991 to 1994, he worked as a quality-control inspector. (Id.). From 1994 to 1998, he worked in research and development. (Id.). From 1998 to 2000, he worked as a printer technician. (Id., 171).1 From 2000 to November 2005, he worked as a copier service technician. (Id. at 147). In that capacity, he visited businesses to repair copier machines, explained the machines' problems to the businesses' employees, and ordered replacement parts for those machines. (Id. at 148). At some point, Vautour became addicted to Oxycontin. He entered a detoxification program at Bournewood Hospital on November 8, 2005. His employment as a copier service technician was terminated as of that date. (Id. at 39, 40, 163). B. Mental Health and Substance Abuse

On November 8, 2005, Vautour went to Bournewood Hospital for detoxification from Oxycontin dependence. (Id. at 202). He had begun using opiates three years earlier, and had been using Oxycontin almost daily for the last two years. (Id.) He felt that his drug use had

The record does not provide specific information as to Vautour's responsibilities when he worked in those positions.

1

2

gotten out of hand, and that the drug was controlling him. (Id.). He claimed that his Oxycontin use had not affected his job as a copier technician, although he admitted to using it in the mornings before work. (Id.). Mark Brudniak, M.D., performed a mental status examination and found Vautour to be "alert and oriented, well-groomed with good eye contact." (Id. at 203). He described his thought process as logical, without flight of ideas, tangentiality, loosening of associations, or paranoid ideations. (Id.). He observed his mood as anxious, but noted that his insight and judgment appeared to be fair. (Id.). Vautour denied any history of depression or medical problems, although he reported a history of a painful stiff neck, for which he had been taking Oxycontin. (Id. at 202, 203). He stated that although he had consumed alcohol in the past, he had never undergone alcohol abuse treatment. (Id. at 202) Upon his admission to Bournewood, Vautour was detoxified with methadone. (Id. at 203). He informed the doctors that he was not receiving enough methadone, and was notably irritable. (Id.). As the detoxification progressed, his withdrawal symptoms lessened considerably; he became less irritable and more compliant with treatment. (Id.). Prior to discharge, Vautour requested anxiety medication, hoping to be prescribed Valium. (Id.). His condition upon discharge was listed as "improved" and he was prescribed a daily dosage of 50 milligrams of trazodone. (Id.).2 He claimed that he intended to attend Alcoholics Anonymous ("AA") and Narcotics Anonymous ("NA") meetings, and find a sponsor to help him maintain his

Trazodone is prescribed for the treatment of major depressive disorder in adults. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=1684119 (last visited Mar. 28, 2012).

2

3

sobriety. (Id.). On November 22, 2005, Vautour began seeing Dr. Robert Hopkins for outpatient treatment. (Id. at 222). He told Dr. Hopkins that he had experienced severe anxiety symptoms for years. (Id. at 223). He had had trouble finding a drug that effectively treated his anxiety, and had begun buying Oxycontin on the street. (Id.). He stated that the trazodone prescribed by the doctors at Bournewood had given him a headache, but wondered if the headache had been alcohol-induced because he had been drinking the previous evening. (Id.). He reported that he had a history of drinking, and that he would drink alcohol if he did not have Oxycontin. (Id.). Dr. Hopkins found that "[r]ight-sided headache precipitated by trazodone was suspicious for the diagnosis but his history was not really consistent." (Id.). Dr. Hopkins prescribed Valium. (Id. at 223). He advised Vautour of the risks of sedation, but told him that if the prescribed dosage was insufficient, he should try a larger dose. (Id.). The Valium was effective in relieving Vautour's anxiety. (Id.). On November 28, 2005, Vautour telephoned Dr. Hopkins to say that the prescribed Valium was no longer effective in relieving his symptoms. (Id.). Dr. Hopkins wrote him an a prescription for Risperdal in addition to the Valium. (Id.).3 On December 2, 2005, Vautour told Dr. Hopkins that he had spilled his bottle of Valium into the kitchen sink and lost most of the remaining pills. (Id.). Since that time, he had been taking two Risperdal a day, along with two or three Valium. (Id.). Dr. Hopkins increased his prescribed dosage of Valium, and instructed him to continue taking the Risperdal. (Id. at 224).

Risperdal is prescribed for the treatment of schizophrenia and bipolar disorder. It is a brand name of risperidone. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx? concise=606 (last visited Mar. 28, 2012).

3

4

On December 13, 2005, Vautour informed Dr. Hopkins that he had nearly exhausted his medication. (Id.). Dr. Hopkins surmised that he had been taking his medication at two or three times the rate at which it had been prescribed. (Id.). In addition, Vautour had since visited another physician and had obtained a week's supply of tramadol, which he had exhausted in four days. (Id.).4 Dr. Hopkins felt that Vautour was intoxicated, and noted that his thinking appeared slowed, his memory was impaired, his speech was slowed and slightly slurred, and his pupils were shrunken to pinpoints. (Id.). Dr. Hopkins told Vautour that he did not think he could treat him as an outpatient because he needed to be admitted for detoxification. (Id.). He also advised Vautour of the risk of withdrawal seizures. (Id.). Vautour refused to return to the hospital voluntarily. (Id.). On December 14, 2005, Vautour presented at the emergency room at Emerson Hospital for detoxification from benzodiazepines, alcohol, and Oxycontin, and for treatment for chronic pain and anxiety. (Id. at 206, 209, 215).5 He was admitted to North 5, a locked psychiatric unit, and treated by an interdisciplinary team comprised of internal medicine, social services, and addiction personnel. (Id. at 206, 209). Maureen Malin, M.D., noted that he abused Oxycontin, Valium, Ultram, and risperidone, and that "he [was] actually unable to appreciate the fact that he was severely addicted to his Valium." (Id. at 206). She further noted that although he began the detoxification process, he later asked to be discharged because he thought he would do as well

Tramadol is a prescribed for the management of moderate to severe chronic pain. Its brand names include Ryzolt and Ultram. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=1013 (last visited Mar. 28, 2012). Benzodiazepines are parent compounds for the synthesis of a number of psychoactive compounds, such as the anti-anxiety agents diazepam and chlordiazepoxide. STEDMAN'S MEDICAL DICTIONARY 198 (27th ed. 2000).
5

4

5

with outpatient treatment, and he was worried about his job. (Id.). Robert P. Collins, M.D., observed that Vautour lacked homicidal or suicidal ideation and denied alcohol abuse. (Id. at 208). However, Vautour reported to Dr. Malin that he had increased his alcohol consumption on weekends, stating that he consumed half a case of beer and two drinks. (Id.). Dr. Malin made differential diagnoses that included benzodiazepine abuse and dependence history, polysubstance use history, and alcohol abuse. (Id. at 207). On December 20, 2005, Vautour was discharged from Emerson. (Id. at 207). Dr. Malin observed that Vautour was in the process of completing his Valium taper and was much less depressed, although he was still "somewhat anxious and angry, and quite fixed in how he wanted to pursue his medication." (Id. at 207). She diagnosed polysubstance abuse, anxiety disorder NOS, chronic neck pain, and an inability to recognize his serious dependence on addiction drugs. (Id.). Dr. Malin scheduled outpatient treatment, and suggested that he attend two to three AA meetings per week. (Id.). Vautour refused to attend an accelerated recovery program. (Id.). Vautour continued to see Dr. Hopkins following his discharge from Emerson. (Id. at 224). On December 22, 2005, Vautour reported that he was "feeling great" and that he had slept in the day before until almost noon. (Id.). Dr. Hopkins felt that Vautour was oversedated, and noted "his speech was slowed but he denied all this and said he was fine." (Id.). On December 28, 2005, Vautour told Dr. Hopkins that although he was not suffering from significant anxiety or pain, he felt that he was sleeping too much. (Id. at 225). Dr. Hopkins recommended that Vautour discontinue his daytime Seroquel, which he believed induced

6

drowsiness, and suggested that he take Tylenol or Excedrin for his pain. (Id.).6 The next day, Vautour called Dr. Hopkins to complain that "his stomach was in knots." (Id.). Dr. Hopkins believed he was experiencing tramadol withdrawal. He suggested to Vautour that the symptoms would abate once Vautour had spent more time off of opiates, and noted that he was "quite insistent that I should think of another pill that he could take to relieve his anxiety." (Id.). On January 10, 2006, Dr. Hopkins noted that while Vautour seemed to have improved, he stated that he still felt "too wound up . . . to return to work." (Id. at 226). He observed that "[V]autour seemed to have little in the way of intellectual resources to deal with his discomfort, and spent too much time watching television and focusing on how he feels." He believed that Vautour's anxiety would improve if he returned to work and stayed active. (Id.). Dr. Hopkins converted Vautour's prescription for Inderal to one for the long acting-version, Inderal LA. On January 18, 2006, Vautour told Dr. Hopkins that he was not feeling much better, and that he was disappointed that the Inderal that Dr. Hopkins had recently prescribed had not been more effective. (Id.).7 Although Dr. Hopkins had switched Vautour from the short-acting version of Inderal to the long-acting Inderal LA at an increased dose, he realized that Vautour had been taking both versions of the drug. (Id.). Dr. Hopkins found that Vautour's symptoms were more typical of agoraphobia than a panic disorder. (Id.). Dr. Hopkins suggested that Vautour try Celexa, but thought that he instead

Seroquel is prescribed for the treatment of schizophrenia and bipolar disorder. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=124 (last visited Mar. 28, 2012). Inderal is prescribed for the management of hypertension. It is the brand name of propranolol. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=1968 (last visited Mar. 28, 2012).
7

6

7

wanted "[s]omething that would give him instant relief when he started to feel bad." (Id.).8 Dr. Hopkins noted that this was typical of patients who had a history of alcohol problems, because they were used to drinking to relieve their discomfort quickly. (Id.). Vautour began taking Celexa. (Id.). On February 1, 2006, Dr. Hopkins told Vautour that he had spoken to his internist and had subsequently received a fax request from the pharmacy for Valium, which he refused to fill. (Id.). Dr. Hopkins noted that "[V]autour then went into an impassioned plea for Valium" and promised that he would control his Valium use. (Id.). Dr. Hopkins told him that he would not prescribe the Valium without a corroborating second opinion. (Id.). Vautour told Dr. Hopkins that he would take his suggestion of taking extra clonidine instead, and Dr. Hopkins doubled his dose. (Id.).9 On February 15, 2006, Vautour informed Dr. Hopkins that his wife had left him earlier that week after he lost his temper and broke her cell phone. (Id. at 228). He admitted to drinking three beers. (Id.). He also refused to take his Seroquel during the day, as he believed he had seen a television advertisement containing a warning regarding the drug's safety, but Dr. Hopkins thought he was "mixed up" and had instead seen a warning for a different drug. (Id.). Dr. Hopkins refused to give him Valium, instead prescribing Zyprexa, an anti-depressant. (Id.). Dr. Hopkins concluded that "he seems really totally unable to deal with things and it is the wife who does deal with things." (Id.).
Celexa is prescribed for the treatment of depression. It is the brand name of citalopram hydrobromide. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=447 (last visited Mar. 28, 2012). Clonidine is prescribed for the treatment of hypertension. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=263 (last visited Mar. 28, 2012).
9
8

8

On March 1, 2006, Dr. Hopkins noted that Vautour continued to complain of anxiety but did not appear anxious. (Id.). He informed Vautour that he should stop taking every drug except for clonidine. (Id.). He thought that starting him on Depakote might reduce his irritability and mood shifts, but observed that Vautour seemed displeased by this suggestion, because "[h]e wanted to have what he called a tranquilizer and . . . he wanted to have something that worked very promptly, not any kind of long-acting agent." (Id.).10 On March 6, 2006, Vautour telephoned Dr. Hopkins to tell him that his medication was not working. (Id.). After Dr. Hopkins questioned him, he admitted that he had been experimenting with it, taking different combinations of medications than Dr. Hopkins had prescribed, and adding other medication that had been prescribed by his internist. (Id.). Dr. Hopkins noted that Vautour did not remember accurately what he had or had not taken, and suggested that he continue with his drug regimen as it had been prescribed. (Id. at 229). Vautour expressed dissatisfaction at that suggestion. (Id.). He also told Dr. Hopkins that his wife had left him again the day before, but could not describe why she left. (Id. at 228-29). He denied drinking beer. (Id. at 229). On March 16, 2006, Vautour told Dr. Hopkins that he was still having trouble sleeping and continued to feel very anxious during the day. (Id.). Dr. Hopkins found that in spite of his complaints, he appeared very calm, although he perceived some akathisia. (Id.).11 When Dr. Hopkins suggested that Vautour resume taking Remeron to help him sleep and alleviate his

Depakote is prescribed in the treatment of bipolar disorder. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=11 (last visited Mar. 28, 2012). Akathisia is a syndrome characterized by an inability to remain in a sitting posture, combined with motor restlessness and a feeling of muscular quivering. STEDMAN'S MEDICAL DICTIONARY at 41.
11

10

9

daytime anxiety, he noted that Vautour appeared "disgusted." (Id.). He concluded "[I] think that he, in fact, is not very anxious but wants me to prescribe Valium for him again." (Id.). Dr. Hopkins suggested that Vautour return to work, perhaps at a machine shop, but noted that Vautour became angry at this suggestion and claimed that there was no way he could return to work. (Id.). On April 19, 2006, Vautour said he had been sleeping well, but complained of anxiety. (Id. at 230). Dr. Hopkins continued to discuss with Vautour the possibility of returning to work. (Id.). Vautour indicated that he might be interested in either a shipping-and-receiving job or driving a delivery van, and that when his condition improved, he might go to the unemployment office to learn more about any job training programs it offered. (Id.). He maintained, however, that he was still too anxious to work, that he could not even fill out a job application, and that his hand shook with nervousness in the morning. (Id.). On May 17, 2006, Dr. Hopkins again discussed employment with Vautour. (Id. at 231). Dr. Hopkins asked whether he had considered electrical work or plumbing, but Vautour felt that those jobs would be "too much for him." (Id.). Dr. Hopkins found that he continued to be downcast and to complain of anxiety, but again noted that his symptoms more closely resembled those of agoraphobia. (Id.). He did not detect anxiety. (Id.). On May 31, 2006, Dr. Hopkins found that while Vautour did not sleep as well since discontinuing the Remeron, he had maintained a fairly high level of activity that included mowing the lawn, working on his house, and riding his motorcycle. (Id.). On June 14, 2006, Dr. Hopkins observed that Vautour had put on weight and continued to complain of anxiety, although again he did not find him anxious. (Id.). He suggested that 10

Vautour seek a consultation concerning his condition, but Vautour was apprehensive about traveling into Boston or Belmont. (Id. at 232). Dr. Hopkins noted that his anxiety appeared to be specifically related to dealing with novel situations, such as traveling to unfamiliar places or interviewing for a job, and continued to adjust his medication. (Id.). On June 27, 2006, Vautour visited Dr. Hopkins with his wife. (Id.). Dr. Hopkins reviewed his diagnoses, which included substance abuse and anxiety. (Id.). Vautour had visited Dr. Jeffrey Speller, who had diagnosed Type 2 bipolar disorder and generalized anxiety. (Id.). Dr. Speller suggested that Vautour completely change his medications, discontinuing the three drugs that Dr. Hopkins had prescribed and adding five others. (Id.). Dr. Hopkins discontinued his clonidine prescription, reduced his Klonopin12 dosage, and substituted an Elavil13 prescription for Effexor.14 (Id.).15 On July 12, 2006, Dr. Hopkins noted that Vautour said that he had not been sleeping well since discontinuing the Elavil. (Id.). He claimed his anxiety and agoraphobia had increased.

Klonopin is is prescribed to treat panic attacks and seizures. It classified as a benzodiazepine. It is a brand name of clonazepam. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=1249 (last visited Mar. 28, 2012). Elavil is prescribed to treat depression. It is a brand name of amitriptyline. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=695 (last visited Mar. 28, 2012). Effexor is prescribed to treat depression. It is a brand name of venlafaxine. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=1559 (last visited Mar. 28, 2012). On July 5, 2006, Dr. Hopkins wrote a letter to the Hartford Insurance Company in which he stated that while Vautour had recovered from his opiate dependence and his neck and shoulder pain, he continued to be disabled by his anxiety disorder, and was totally unable to work. (Id. at 220). Vautour received short-term disability insurance benefits from Hartford in October 2006. (Id. at 233).
15 14 13

12

11

(Id.). Dr. Hopkins, acting at the suggestion of Dr. Speller, added Abilify16 to his regimen. (Id.). On August 9, 2006, Dr. Hopkins found that "[p]atient was uncharacteristically chatting a blue streak, talking about riding his motorcycle and going on at length about how much he likes that and where he had been, and going to the shop and telling stories about other people who ride motorcycles." (Id. at 232-33). Vautour told Dr. Hopkins he had been doing chores around the house, and had been sleeping well since he had started taking amitriptyline (Elavil), even remarking that it was "perfect." (Id. at 233). He had been sleeping for eight hours a night and was active during the day. (Id.). Dr. Hopkins found that he had fewer complaints and was in a better mood than he had ever observed. (Id.). On September 6, 2006, Vautour recounted to Dr. Hopkins a long story about repairing the brakes on his wife's car and fixing the alternator on his truck. (Id.). While he felt that his mental health had improved, he became extremely nervous upon taking his truck to be inspected. (Id.). He had been taking two to three Xanax, and wanted to be able to take this amount daily. (Id.). Dr. Hopkins renewed his prescription for Abilify and increased his prescribed dose of Xanax. (Id.). On October 4, 2006, Dr. Hopkins found that Vautour "was in quite good spirits." (Id.). He had lost several pounds, and his daytime anxiety appeared to have improved. (Id.). Vautour informed Dr. Hopkins that he was actively seeking employment, and Dr. Hopkins noted "I was impressed that he was spontaneously thinking about returning to work." (Id.). On November 1, 2006, Dr. Hopkins reviewed Vautour's medication with him, pointing

Abilify is prescribed to treat schizophrenia and major depressive disorder. It is a brand name of aripiprazole. Physicians' Desk Reference, PDR.net, http://www.pdr.net/drugpages/concisemonograph.aspx?concise=1961 (last visited Mar. 28, 2012)

16

12

out that he had exhausted a four-week supply of an increased dose of Xanax in just over three weeks. (Id.). Vautour denied that he had been taking extra pills, and claimed that he may have put some of them in a container to take with him on a trip to Canada. (Id.). Dr. Hopkins observed "I am not sure I believe him . . . he was very defensive and in denial." (Id.). He also discussed with him that when Vautour called him to request pain medication for a broken rib, he did not disclose that he had been prescribed 40 Vicodin pills by another doctor in addition to 20 pills he had received at the emergency room. (Id. at 233-34).17 Dr. Hopkins told Vautour that he felt that he had misled him in order to get more drugs, and thought that his drug use was getting out of control despite his improvement over the summer. (Id. at 234). On January 5, 2007, Vautour told Dr. Hopkins he felt that he was benefitting from the Ritalin, but did not think it was long-lasting enough. (Id.). He also told him that he had gone on a job interview for a position in a leather upholstery shop. (Id.). Dr. Hopkins increased his Ritalin dose and discontinued his Abilify. (Id.). On February 7, 2007, Vautour told Dr. Hopkins he felt that he needed an increased dosage of Ritalin, and Dr. Hopkins adjusted his prescription accordingly. (Id. at 235). After Dr. Hopkins suspended his practice in early 2007, Dr. Sten Lofgren, M.D., saw Vautour on several occasions. (Id. at 94, 241). On February 27, 2007, Dr. Lofgren diagnosed a generalized anxiety disorder with "no clear precipitant identified." He described Vautour's mental status as anxious, oriented, and without evidence of psychotic thought patterns. (Id. at 241). Dr. Lofgren listed his prognosis as "fair to good" based on the diagnosis and his previous response.

Vautour presented at the Emerson Hospital emergency room on October 19, 2006, complaining of right-sided rib pain after falling on some rocks. (Id. at 204). He was diagnosed with a chest wall contusion and a rib fracture. (Id.).

17

13

(Id.). On April 25, 2007, Dr. Michael Maliszewski, Ph.D., assessed Vautour's psychiatric condition for a disability determination. (Id. at 255, 271). He determined that Vautour possessed the recall and attention span necessary to perform simple tasks. (Id. at 244, 260). While Vautour was socially withdrawn and would perform better in a more independent role, he would be able to perform concrete tasks in a supportive work setting. (Id.). Dr. Maliszewski concluded that Vautour's anxiety-related disorders and substance addiction disorders did not restrict his daily living activities, only moderately limited his ability to maintain social functioning, and only moderately limited his ability to maintain concentration, persistence, or pace. (Id. at 244, 254). On October 6, 2007, Vautour was brought to the Saints Medical Center Emergency Department after he complained of feeling weak, and then collapsing, while working outdoors. (Id. at 275). Upon arrival, his mental status was acutely altered and his speech was garbled. (Id.). His urine screen for drugs of abuse was positive for benzodiazepines but otherwise negative. (Id. at 280). His hospital workup revealed elevated levels of amitriptyline (Elavil) in his system, and his doctors attributed his symptoms to an overdose. (Id. at 278). Vautour stated that the overdose was accidental. (Id. at 310). He denied current or past drug use, drinking at all during the past year, and any medical problems. (Id. at 281). He also told his doctors that he had been working repairing coffee machines, and refurbishing one of his old automobiles. (Id. at 281, 304). He was discharged on October 9, 2007. (Id. at 281). On June 26, 2008, Vautour was admitted to Emerson Hospital from Lowell General Hospital for evaluation and treatment after the police authorized his hospitalization, believing he

14

posed a serious risk of harm due to mental illness. (Id. at 374).18 Vautour had telephoned "911" repeatedly, claiming that he saw trespassers squatting on his lawn. (Id.). He alleged that they had been camouflaging themselves with tree branches and poinsettias, and informed the police that while he was able to restrain several of them, they had managed to escape when the police arrived. (Id. at 374, 376). Vautour also described seeing little toy babies on a wire. (Id. at 376). He said that he had been having these types of experiences for approximately one year. (Id.). He presented at Lowell with psychosis, visual hallucinations, and paranoia, and was physically and chemically restrained due to his inability to understand why he was sent to the hospital. (Id. at 274, 363). After his transfer to Emerson Hospital, Rosemary Lee, N.P., assessed Vautour's mental status as alert and oriented, with mood and affect euthymic. (Id. at 374). She noted that there was evidence of delusional thought process, and observed that his memory was questionable, his cognition was grossly intact, and that his speech was tangential and rambling. (Id.). An MRI of his brain showed no abnormalities. (Id. at 371) Dr. Robert Stern, M.D., further evaluated Vautour's mental status and observed that he appeared anxious and distracted. (Id. at 376). He found his mood to be angry and irritable. (Id. at 376). Dr. Stern concluded that his insight and judgment were poor, and that he was a poor

The record refers to a "Section XII" issued by police. (A.R. 374). The term appears to refer to a Massachusetts statute that permits the police in an emergency situation to restrain or hospitalize persons posing risk of serious harm by reason of mental illness. See Mass. Gen. Laws. ch. 123,

Download 27888.pdf

Massachusetts Law