St. Louis Psychiatrist Vadim Y. Baram Disciplined for Fraud, Dishonesty: Delivered Unnecessary Shock Treatments

October 26, 2021

On May 13, 2021, the Missouri State Board for Registration for the Healing Arts reprimanded psychiatrist Vadim Baram for misconduct, fraud, misrepresentation, dishonesty, and unethical conduct related to “willfully and continually performing inappropriate or unnecessary treatment.”

This is all related to ECT treatments that he delivered to three patients:

• 143 shocks to Patient 1 from 2009 to 2013
• 97 shocks to Patient 2 from 2011 to 2013
• 70 shocks to Patient 3 from 2010 to 2011

The Board noted that “A physician should decrease or attempt to decrease treatment frequency of maintenance of ECT. The goal is to extend the time between treatments and eventually remove the maintenance treatment. A physician should decrease treatment frequency if cognitive side effects are present.”

The Board noted that Baram did not attempt to reduce the frequency of shocks.

The Board stated that patients should be re-evaluated regularly to determine if treatment should be continued. This must be done “each day, not just over the course of years. Determining whether ECT should continue includes assessing the patient before beginning ECT treatments and after, then again on every visit. The patient assessment should occur within 24 hours after treatment, usually within 10 minutes. The assessment is one that only the physician does and is not something that the physician can have a nurse do on his or her behalf.

Again, the Board noted that Baram did not perform assessments within 24 hours of performing ECT.

The Board stated that the rationale and indications to justify continued use of shock should be entered into the patient’s medical record.

Baram failed to include information sufficient to justify continuing ECT treatment for the three patients. Further, there was no indication of a plan to decrease the frequency of shocks. Also, he did not properly note assessments and did not adequately determine if any cognitive side effects were present after each shock.

The Board noted that in the place of actual assessment data, these patients’ records contain identical, copied and pasted repetitive phrases which lacked relevant information about side effects, physical exams, and cognitive assessments:

• Baram recorded the exact same line in Patient 1 's chart 27 times, repeated another line 19 times, and repeated two subsequent lines 13 and 14 times.
• In Patient 2's chart, he repeated a single line 36 times, repeated another line 26 times, and repeated a later note 14 times, respectively.
• In Patient 3's chart, ne repeated one line 12 times and another 11 times.

There was no evidence in the patients’ records that Baram sufficiently assessed the cognitive side effects and the present condition of the patients.

Source: Findings of Fact, Conclusions of Law and Disciplinary Order, Vadim Y. Baram, M.D., Case Number(s) 2013-003922 and 2014-007312 (AHC Case No. 16-3561), Missouri State Board of Registration for the Healing Arts, May 13, 2021.