What Does This Psychiatrist Do to Earn $179,000 a Year? (Apparently Not Much)

On August 5, 2009, New York psychiatrist Royle Miralles was suspended with pay from his $179,000 a year position as staff psychiatrist for Wayne County Behavioral Health Network after his superiors discovered (courtesy of a local television news investigation) that he had been disciplined by the state medical licensing board for numerous instances of negligence, incompetence and recordkeeping failures.  Miralles never reported the disciplinary action to his employer.

Miralles is noted as being the highest-paid employee in Wayne County.

What does a county psychiatrist do to make that kind of money?

Perhaps only Miralles and his patients know the answer to that question for sure.  What is known is what Miralles doesn’t do.  According to disciplinary documents acquired by Citizens Commission on Human Rights International (CCHR) from the New York Board for Professional Medical Conduct, Miralles did not do the following standard (and sometimes critical) tests or examinations and/or other medically-required tasks with regard to seven patients:

  • Failed to obtain and/or document patients’ informed consent (patient’s cognizant understanding of the benefits and liabilities of the suggested method of treatment, applicable alternative treatments as well as no treatment) for the drugs he prescribed

  • Failed to adequately monitor lithium levels (failure to do this can result in liver damage and/or failure)

  • Failed to conduct adequate assessments and/or document adequate assessments for tardive dyskinesia (a serious potential side effect of antipsychotic drugs, resulting in abnormal involuntary movements of the face, tongue, limbs and trunk)

  • Neglected to obtain neurologic consultations for patients risking tardive dyskinesia

  • Failed to adequately monitor blood sugar levels, lipid profiles, weight and/or girth during treatment with atypical antipsychotic drugs (which carry known dangerous side effects of abnormal weight gain, blood sugar abnormalities and diabetes)

  • Failed to monitor kidney function and coagulation status prior to and during treatment with a particular drug (the use of which requires such tests)

  • Failed to maintain accurate medical records

This is just a partial list of Miralles’ failures to uphold the standard of care, for which his license was placed on probation for five years with terms and conditions.

$179,000 is a lot of county money to pay someone to neglect basic patient health and safety requirements.

So what do psychiatrists do to earn their pay?

A 2007 review by CCHR of U.S. Department of Justice inspections of public psychiatric facilities revealed that six out of seven of the institutions investigated engaged in some degree in the use of seclusion and/or restraint as a first line of treatment (which it is not) and/or the strikingly high use of pro re nata (Latin for “as needed”) medications as a “chemical restraint” for the convenience of the hospital staff.

What else do psychiatrists do to earn those big paychecks?  A 1997 study revealed that 10% of all psychiatrists admitted to sexually abusing their patients; 80% admitted to being repeat offenders.

If our counties and states really want to balance their budgets and have money available for constructive and community-desirable programs, they need to look at how they might be throwing their citizens’ money away on psychiatrists like Miralles, who take the money but neglect the patients, often to the point of sickness, disfigurement and death.

For more information about psychiatric crime, fraud and more, please contact Steve Wagner, Director of Litigation, CCHR International, 800-869-2247 or swagner@cchr.org


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