Monthly Archives: August 2012

Time goes quickly but there is not a day that I do not think about Elizabeth and she is a long distance away but in a nice peaceful environment.   The only thing wrong of course is that, unfortunately, the “care” under psychiatry wherever you go seems to be all about drug pushing. 

Anyway, I went out mid-week to watch horse racing with work colleagues which was very nice and actually won some money and I was about to return tickets as well, as I noticed that the tickets were not for the right race that I asked for!   I decided to book in a hotel as I work a long distance from where I live and that made a nice change as I did not have to rush in the morning to get ready.

I do not phone Elizabeth every day but it is very upsetting when the phone is not with her and you have to go through the office – you start to imagine that they have confiscated the phone or else perhaps Elizabeth is ill and there have been occasions when she has been very ill recently on these chemicals.  Being kept waiting a long time on a mobile is costly and sometimes you are told you cannot speak to her.   Well on Thursday, after several days of not speaking to her  I decided to phone and Elizabeth was not at all well.  The worst thing about the “care” is lack of information and communication.   I was further upset to hear that other family members had full knowledge of the Tribunal date and had been contacted by a member of the team and when I asked on my visit I was told nothing as though it was secret and I feel as though I am being excluded and that the team do not like me as in the past I have been outspoken but I have not been outspoken under this hospital apart from matters to do with the family not being able to get through on the telephone.   When you hear information third party especially about things as important as the Tribunal that makes you think in light of the last time, what is going on?  Last time they tried to replace me as Nearest Relative but the father of Elizabeth has recently told me that he has no desire to be the “Nearest Relative”.  He has enough of his own caring responsibilities but the one thing we agree on is she should not be sectioned.    A section should only be necessary when someone is at risk to the public or at risk to themselves.    Elizabeth should be allowed time to spend with her family alone and I as nearest relative should have the right to some information but it is as though noone wants to communicate with me at all.   Her father saw the psychiatrist who I thought was on holiday and has been given a lot of information unlike me.  I have got to hear all of this information third party.


So we both agree she should not be on a section and also that a visit should be allowed without a member of staff sitting in a small visiting room listening to every single word of conversation.   I think this is very very wrong.  Unless you as a parent are suspected of terrible abuse then no visits should be monitored.  Even in the prison camp environment of the last hospital you were allowed to see someone and at least have a conversation with the person you care for without a member of staff standing practically next to you all the time.  It is as though they do not trust you and I think it is against someone’s human rights and unnecessary completely especially when relatives have to travel from a long distance away.

Yesterday I went to a meeting with new friends –  the new friends have formed a group who wish to campaign for improvements in mental health care.  They are known as “Speak Out Against Psychiatry”.  This group is mainly patients and some carers who have all suffered tremendously under current psychiatric care.   They are not into violence but are a caring group.  This group are currently concerned and worried for one of the members in hospital and the meeting discussed how best members could help that person who is now in hospital.    The group engage in peaceful protests to draw the public’s attention to a subject that is not highlighted enough in the press and acted upon by Government.   The fact is the “care” is failing so many people and it is very sad to listen to what others have suffered and I think it is extremely brave of those people who have been under psychiatric care to  speak out about it and try and get things improved in a positive way.  Many of the members who have suffered so much try their best to get on with life and think of others which to me is very admirable – these are caring people, people who want to help others yet many of them work/do things in the community in a caring capacity and are highly intelligent.  I would not wish to associate myself with anything that was endangering other people’s lives or causing trouble but this is a worthwhile group who should be highly recognised. 

I get to hear more and more that care in the community does not work for so many and I have seen patients beg to come back  into hospital where they feel safe.  There is simply not enough support given and many people under the mental health when discharged from hospital become isolated and extremely lonely.  There is no encouragement to integrate patients into society and for those who have been in hospital a long time like Elizabeth they need more one to one support in order to get back into life and work for instance.  Elizabeth lost all her confidence and I tried to help by taking  her to college and trying to get her away from mental health activities but her social worker patronisingly said “she would feel more comfortable with her own kind” –  this is terrible –  I saw Elizabeth get on and mix well with other people at college and the psychiatrist was furious that I had gone over their heads.  However before a class started Elizabeth suffered panic attacks like never before but at the end of the class she was so happy and it was a floristry class and the teacher was full of praise.  The care is dreadful because they do not encourage a patient to do things they hold them down and control and do not help them in restoring their confidence or give any encouragement. It is disgusting what is going on.    Elizabeth was eventually placed in a flat but in the evenings there was nothing to do and not enough going on during the day and not enough support.  She was not happy there but noone listened.  The placement was entirely wrong but noone would put their hands up and say they made a mistake.   This is where care is failing. Being in London is a busy and  hectic place to live and stressful.  People are rushing around all the time.    I think therefore Elizabeth is in the right environment because I do believe environment plays a part but disagree that it is just down to home and family like so often is blamed.  Elizabeth had previously taken on too much for herself and I told her to cut things down and she did but life just got on top of her but there was much more than that which I cannot mention. 

Getting back to the group, everyone wants reforms in mental  health care and I cannot wait until one day when hopefully the law is changed to allow a patient choice and to stop the current abuse that is allowed to go on.     Elizabeth is now in what she describes as like “four star hotel” – Cambian Four Star Wards and the food is supposed to be lovely.   Every ward should be like a four star hotel with nice food etc and although she is a long way away I am pleased she is there rather than on the awful acute wards locally.   On a local acute ward things are far from good.  The food is awful, the wards are noisy and sometimes unsafe.  The care is all about drugs and more drugs.   I have seen the same patients return time and time again so this says care is not working under the NHS.  The so called “flagship” of the NHS under SLAM – the Maudsley was the worst place on earth for Elizabeth to go and I was shocked the minute saw what has been known as “BEDLAM”.  Well it was like prison –  the grounds were beautiful.

Anyway, I am still waiting for a satisfactory response to my letter and it is taking a long time.  I am going along to their meeting soon and am looking forward to this very much because I will get to meet the very people who I have written to face to face.

Meanwhile I spoke to Elizabeth – finally they returned her phone which apparently was in the office charging for days on end.  I spoke to her Friday and Saturday and was relieved she seemed OK after on Thurs medical staff were with her and I could not speak to her.  She said she was happy there but commented on the Clozapine that she wants to come off it – her words not mine.   Ihave been told this is one of the worst drugs to come off and no doubt it will make her very ill but if she is suffering on it now then it is for the best.   Meanwhile because of  my concerns of the huge lack of communication and information on the part of the Cambian Group I have appointed independent advocates for myself and Elizabeth and also, I have solicitors on standby.  It is a shame you  have to go to these lengths but the lack of communication is so awful and it affects you so very badly and it is law that the Nearest Relative gets given  some information and that is why I am determined to get something sorted out as this has been going on far too long.   All I want is for Elizabeth to be happy and she is happy where she is so she tells me but there are faults.   The awful drug Clozapine for one is terrible and should not have been given to Elizabeth. 

I am looking at some literature now about NICE praising this drug.  I am horrified that NICE do not speak out about what is going on under the Maudsley and how they are using this terrible drug against patient’s wishes and ignoring FDA advice.  How can NICE sit back and allow the kind of experimentation that Dr James MacCabe is doing and other doctors. 

The next thing I want to do is to go down to the Royal College of Psychiatry and confront some of these people myself.  I have seen the most horrifying research papers and I would also like to go to the offices of NICE and meet with them too.  They should not be praising the drugs like they are doing when I have papers that I am sure the hospital would not wish the patients to read as I have seen  the sheet of paper they give up to highly drugged up patients who are too weak to even know what they are agreeing to like my daughter who was blissfully unaware but suffering terribly and still is on a chemical that makes her feel disorientated and dizzy and so she says has put a “strain on my heart”.   These chemicals shorten a patient’s life by 10 years if not more and I am very keen for Elizabeth to have hollistic care and if I knew of anywhere I could send her I would do anything to get that care for my daughter as it is cruel and abusive to push drugs at someone in the circumstances where the promised drug free assessment was NEVER given as you cannot take someone off as much as 150mg of Seroquel and not expect that person to go downhill and the next thing they slap on a section then by law they can experiment to their hearts consent and get their money from the drugs manufacturing companies in doing so.  The information the Maudsley give the patients is very little but I have done huge research on these drugs and when I brought the true facts onto the ward and wonderful alternatives this was not appreciated by the staff but I was treated like a criminal and I cannot wait to see the heads of this organisation at the forthcoming meeting.      

The nearest relative is determined by age out of parents and I happen to be the eldest but the team have tried to replace me before now.    As the nearest relative you have rights.  You have the right for a written assessment and to be kept informed to a certain extent on matters regarding the care.  Certainly I should have been told about the forthcoming Tribunal.  However increasingly I am finding that the team are blocking me out.   Today once again, the same problem in not being able to contact my daughter and three phone calls later to Cambian Four Star Wards, each time NOTHING had been sorted out.  It is a few days now since I last spoke to Elizabeth and the last I want is for her to think I am not caring any longer as I cannot get over there so quickly as she has been placed so far away.   I am not unhappy about the placement a long distance away.  It is a much nicer environment however I am extremely worried as I know right now Elizabeth is not feeling too good.  Apparently Clozapine is one of the worse drugs to be reduced and come off and I do not know what is going on – this drug causes worse psychosis than any other so I have heard.  It was against her wish and Bethlem Royal Hospital ignored the fact there are heart problems in the family and Elizabeth has already told me it is putting a strain on her heart.  She feels weak and constantly dizzy and I am bitter what they did to her as they knew full well it was against her wish.   I have not met the manager of Cambian Four Star Wards yet but saw another senior member of staff.  None of these staff have given me any information whatsoever.  It is as though they just want to push me out as mother and nearest relative. I went out and bought a new phone and Elizabeth is not allowed this new phone because it is a camera phone even though the camera cannot be used as the memory card has been taken out.  She is NOT allowed this phone and there is nothing but trouble with all the family trying to get through and constantly this is being ignored by the team.  I have to say that the guy who sat with me all the time during my visit to Elizabeth and would not leave us alone for 1 minute appeared to be helpful but none of the other staff have looked into the phone and got back to me and I understand it could well be because they are instructed not to contact me or maybe they do not want my daughter to speak to me and that is exactly how it appears.  When you telephone 3 times and do not get so much as a call back HOW DOES THIS LOOK.   A couple of times two members of staff have refused to put my daughter on the phone and when they do it is on the public phone and I asked for her mobile which WAS being kept in the office charging for days on end to be given back to her.   So, if she has the phone why is the phone not working as this is TOTALLY OUT OF CHARACTER OF ELIZABETH WHO WAS FOREVER TEXTING THE FAMILY PERHAPS NOW SHE IS BEING DISCOURAGED TO KEEP IN CONTACT AND WHAT IS MORE I HAVE FOUND OUT SOME VERY DISTURBING INFORMATION TONIGHT AND THAT IS ALL I AM GOING TO SAY AT THIS STAGE.  I WILL KEEP YOU INFORMED AS TIME GOES ON AND AM KEEPING A FIRM RECORD OF WHAT IS GOING ON RIGHT NOW.


Under NICE guidelines familiies should be included and there is no excuse because neither the manager or doctor have met me and yet it would seem that I am not being communicated with at all.  I will report the rest later on but for  now I am watching with great interest what is going on here.



Since my last visit to Elizabeth which was a disaster on the first day I came, the next day I visited again and this was a Monday so of course there were management on duty – not THE manager as she was away on holiday.  I was told to ring back at 7.30 the next morning as I was turfed out of the meeting room because someone came late to visit their relative.  The only thing I would say is that someone was there ALL the time with my daughter and insisted on staying throughout the meeting. This may be their rules but in my opinion it is like an infringement of human rights because if for instance the parents were to blame for abuse or harming their relative that person is less likely to want to see them but Elizabeth was looking forward.  It is not every day I can come and we could not talk or go out or do anything and I thought that was bad.  There is no way that I would have taken Elizabeth away or anything else she is on a Section right now and I respect that even though I think it is APALLING.    She has been put on a section because of the way the previous psychiatrist dealt with her taking her off a huge amount of drugs and mixing it with another.   This is enough to make anyone go off balance.


Anyway from what I gather the food is very very  nice at Cambian and that is something.    Why the NHS cannot provide decent food and facilities is amazing when they can sit there having so many of their meetings and no end of staff who get good benefits from their job.   I am so pleased she is not in that place of horror Bethlem Royal Hospital but the one good thing is that my blog came to the attention of more than one patient who attended this hospital who have suffered alongside my daughter because of the shocking treatment.  


I have requested the file under Data Protection and I am entitled to the bulk of it only I have just been given a proportion and where are the minutes.  If you attend a meeting you should be en titled to a copy of the minutes.   The Consultant psychiatrist on Fitzmary II said he preferred to concentrate on the care.   I nearly choked with  laughter when I hear this “care!”  WHAT CARE –  the care is all about drug pushing in my opinion and this hospital were not at all grateful to the contribution I made when I brought so many interesting ideas to the ward and was even prepared to pay for entertainment for the patients at the weekend.  Patients who hardly have any visitors and virtually have nothing to do at weekends.  What good is this!   



Anyway the good thing is this bad exprience brought me into contact with a wonderful group called Speak Out AGainst Psychiatry and I am in huge admiration of this group of people who have helped themselves – mainly ex-patients all of whom have suffered apalling care and gave me support like I have never had before.  I am truly grateful.  I now have the most wonderful advocate through this group who I would not hesitate in recommending to anyone as this is a person who has experience of what it is like to be on a dreadful ward under the care of professionals who do not care to listen.   He has written so many wonderful emails to SLAM and has come to a meeting to support me.   If I feel such a meeting daunting with a team how does that make a patient feel.  I commend his braveness and unselfishness in helping me in such a wonderful way and now my daughter is miles away.  A wonderful organisation called Hafal can help me as regards advocacy but I still would like this person to be the advocate for my daughter as this person would know exactly everything about the previous care and would be truly independent.   I see some good changes coming about in Wales and Ireland as regards the law.  Now a patient can have an independent advocate and this is so important.  I am trying to find out more about these changes as I have heard that a patient can have choice of care in Wales and holistic care is the way forward without a doubt.   I am hoping to go to a conference soon through Chy-Sawel in Cornwall where a Dr William Walsh along with other professionals will be talking about his research and I believe that every care provider should attend such a conference and adapt these changes.  The conference is aimed at educating professionals to bring about much needed change.


Anyway, I spoke to Elizabeth at the weekend.   She is OK and when I visited she looked better.  God knows what dosage of chemicals she is on and if it is Cambian’s policy to ply thse drugs like the Maudsley then this is not the right care and I am looking in to other things right now as hollistic care would be the answer and that is not to say I would ever tell my daughter to stop taking these chemicals as I know that is not possible unless you have a doctor to help you.  THIS IS NOT ENCOURAGED AND THERE IS NO FACILITY IN THE WHOLE OF THIS COUNTRY TO PROVIDE SUCH CARE.  I stand by what I say that Clozapine is the worse drug of all but they are all very harmful.   I would like to see Elizabeth on the minimal of chemicals but with a dietician and nicer living accommodation and decent care and encouragement to eat the correct foods.  I believe that Wales is better for her to get well than the stressful environment of London.   I still miss her though and still worry but hope that she makes a decent life for herself.  I cannot be around forever but so far none of these professionals I have come across previously have given me much confidence.  It is hard to trust anyone now.  Hafal though are supposed to have patient involvement and this is what I like.  FAIRNESS. If Eliazbeth  is treated fairly then what more can I ask for. 

Travelled from Cornwall to Wales today – could not tell Cambian an exact time because did not know how long it would take.  However was told room book between 2 and 4 so arrange between 4pm and 5 pm and told it was OK.  On arrival brought in things Elizabeth had requested sat down – they made me a coffee but all the time a member of staff was standing there listening to every single word of  conversation and it was like she was stood next to me all the time.  When I asked if I could spend some time with my daughter on my own I was told firmly “no”.   So I tried to sort out the problem with her phone which has been ongoing and has caused no end of distress to the whole family as we have been unable to get through to her and still after all this time nothing has been sorted out.  Anyway the mailbox was full so cleared that. Elizabeth went to get my Birthday cake and I had brought no end of cup cakes which Cambian said that they would not accept however no sooner had Elizabeth brought my Birthday cake out to me in a container and I could only have stayed about 10 minutes the people who were supposed to have arrived at 3pm turned up and I was told to leave and Elizabeth was told to get back to her room.

It is my Birthday today and I am extremely upset at how I have been treated.  I have done nothing but praise this private hospital thinking on reading their description it was a wonderful place that listened to patients and even took on board patient’s ideas who have been on acute wards but this seems now far from accurate in reality.    I have been in tears today on my Birthday as I hardly get to see my daughter and have travelled a long way.  I am not happy now that Elizabeth is in such a place where the psychiatrist has referred to “my behaviour”.  Now I want it in writing from the doctors and teams individually everything in terms of my behaviour and reason why I was treated like a criminal today and not even allowed to have a conversation with my own daughter without a member of staff standing practically next to me.   I see this as an infringement of human rights and shocking treatment.   It is clear that Cambian 4 Star Wards do not care less about the family and there is no guarantee that I will be able to see her tomorrow which will mean a telephone call direct to the CQC to investigate what is going on under the closed doors of this private hospital who I thought was the very best  place from their description as compared to what I have seen on a local acute ward.

When a family do not get to see someone who is ill because they are miles away I just cannot believe what happened today.  I was told because I did not book in advance they had to honour someone who turned up late who did book and I did not want to mess anyone around and so did not want to give a time and then get delayed and hold up anyone else but nevertheless they knew I was coming and I had actually booked between 4 and 5 pm. There has been time to assess her and time to consider even just a couple hours leave to be with her family but the psychiatrist Dr W……………………. referred to what she called “my behaviour from the previous ward and perhaps she would like to come out and say exactly what she thinks of me when she has not even met me and has chosen to go off on holiday refusing flatly to even consider a visit or leave and leaving everything in the hands of the manager who is also on holiday and who had to call meetings to get this visit agreed.    I like Wales as an area as it is peaceful but the drugs of Clozapine and Metformine are causing Elizabeth a lot of pain and she has complained of feeling a strain on her heart.  I am far from happy with what is going on and noone would even show us round.  I can understand they do not want you in their bedrooms but the whole element of control and their behaviour towards the family is disgusting and an infringement of human rights and if my daughter suffers from any problems with her heart as a result of these drugs then they deserve to be investigated in court and I have solicitors lined up.

Going to see Cambian 4 Star Wards for the first time at the weekend.  It is a long time or seems so that I have seen Elizabeth and have only spoken to her on the phone.  The rest of the family and I feel she sounds quite disorientated on the phone and confused and of course there has been plenty of problems getting through as the phone was kept in the office for a while and then appeared to be constantly switched off.  Anyway it will be nice to see her but it would have been even better if I was allowed to take her out.   This is where the doctors control everything –  I asked the ward manager but she said no assessment had been made yet the doctor knew I was coming down and could have done this but her comments were “she would have to see if such a visit would be too distressing to my daughter and the other patients”. 

Both the manager and the doctor are away right now.

I am sure the facilities and the home are very nice as I have had described to me by Elizabeth it is like a 4 star hotel there.  It would be perfect if only they offered care that was not drug pushing of chemicals which Elizabeth was given at the Bethlem Royal Hospital – the worst chemical of all and that is Clozapine which I have read all about.  There are so many people I know who have developed heart problems on this drug and I and the rest of the family are horrified at reading the research papers.   This shows that the Maudsley clearly do not care about the welfare of their patients by giving out this drug based on what I have read.   It is all about raking in the funding from the drugs manufacturing companies and this is probably the reason behind all the high security as I could not blame a patient from running a mile from this prison camp.

Anyway if there are any ill effects to my daughter then it will be down to the prescription of this drug by the Maudsley and I will want some answers to this and proof of her diagnosis as no proper assessment was done and I want to see the proof of what diagnosis she has in light of the way this assessment was carried out.  

I got some of the file but should have received copies of the minutes as I attended several meetings.  I should have also had copies of conversations and the incidents where I was labelled as threatening to the team but got none of these, only select papers which I already  have in any case.

 If there was decent communication none of this would be necessary.


The CQC have powers to investigate complaints but only limited and they are not interested in individual cases but as I pointed out I heard many patients complaining of their rights and not being listened to which could be another factor why I was banned. 

I certainly  have listened to my daughter but the more drugs they dished out there were times when she was confused and mixed up and I felt at times she was being manipulated.  The CQC have a duty to intervene but it looks from the letter that they are passing matters to the PHSO and this is no good in my opinion.  The need to send down their inspectors and interview all the patients and take a look at the advocacy there that is wholly unfair and not independent.

The CQC sent me some of the file but it contains nothing –  I should have had copies of the minuts of every meeting I attended and copies of the report/investigation that led to me being banned.  Surely I am entitled to have some explanation and noone has given me anything.


The whole system is no unfair and does not go far enough to ensure that patients are not being abused.   Patients should also be listened to and are not fairly represented.    The advocates were far from independent and this needs to be looked at as well.   My daughter has a fabulous new advocate and I am happy that he is the best and fair representative for her as he is not attached to hospitals that dish out the funding for such advocacy. 

Today I tried to speak to my daughter but the phone was again off and despite you telling the staff at Cambian things are right, you just cannot get through.   A letter has been received by my daughter so she told me about the tribunal but I have not heard anything from anyone in the team.   I am still waiting to hear if I can visit her but that involves meetings being held. 

The fact is there is no reason why I should be prevented from seeing or taking out my daughter as I hardly see her now.  She has human rights and I have never seen such treatment before and fail to see how this could benefit my daughter just because they do not like the mother.  When I asked this question previously at the Maudsley the staff were quick to say it is not because they are worried about her safety in my company –  so it would all seem to be personal.  However if Cambian did not have anything to do with the NHS/social services then this hospital would be perfect – I am sure it is much nicer than all the acute wards put together.  As nearest relative surely I should be told about the date of the Tribunal.;201/2/83

Antipscyhotics – time to introduce change

This link to a most interesting article in BJPsych   bjp.rcpsych

Well it is a good thing they are having a forum on this as I would have plenty to say on the subject and I have noted down the dates of their conventions and if at all possible may attend in future.  They need to listen to the patients and carers who witness at first hand what these drugs do.  It is all very well for the doctors who just prescribe them and then are not even based there at the hospital to see what is going on.   In any case how on earth can someone get a clear opinion and base their views on guesswork and especially as it would appear many do not read the files or want to know the family but assume that it is the family at fault or else cannot be bothered and just base their diagnoses on observations.

I have been asked many times about how my daughter did at school.  Well what on earth has this got to do with matters.  I can see that Dr Jame MacCabe is doing some more research.  I personally think he needs to concentrate on the dangers of these drugs and look at the real thing to aid recovery and that is correct care and that extends not just to hospital but in the community.  For this correct care you need the patients to be involved because the experts do not listen to the patients half the time and that is the main problem.  They also do not work with the families and are dismissive in every way.

Yes it is time to introduce change in the form of orthomolecular psychiatry as I could see a huge improvement in my daughter with decent care and a doctor who actually listened.

I have just had a call from Elizabeth to say there is a Tribunal (so her phone must now be with her – that is something!) and solicitors have written to her but the solicitors are not her solicitors so they must have been from the hospital.  It is shocking and disgusting that you have to go through this procedure when someone is of no risk to the public and would not just go out and disobey rules etc – she may well be in a strange area but if told to stay in she would but why keep someone a prisoner.   I am most bitter about this because if it was not for the previous shocking care in a so called worldwide renowned hospital then if they had done things properly and reduced by miniscule amounts on a day to day basis as I showed in a wonderful book and cd by Dr Tracy – things would not have got to this stage and I would have been happy.  As it is I am not at all happy as I blame this hospital for my daughter’s current situation as they are the ones who have not done things properly and plied with even more drugs against my daughter’s human rights.   I also do not like the way they are using the patients for their clinical trials.


Whilst this publication is a start it is action that is needed – action speaks louder than words and whilst the NHS do nothing apart from have endless meetings after meetings – nothing is achieved as there would not be such a mess under the mental health otherwise.

Whilst I can see why so many people are afraid to complain fortunately I am not.  I want to see action and change and I am prepared to go down to a meeting at the Royal College of Psychiatry and speak my mind.  They also need to listen to the many others who feel the same way and do something.


There is a way psychiatry can be involved in helping a patient and that is NOT through these awful chemicals and I have made sure that my daughter will know who is responsible one day and hopefully there may be something like an Alternative Care Centre like Earth House over here.  Patients have a lot to offer and are the most highly intellligent people from what I have seen.  Anyone who thinks otherwise is narrow minded or else ignorant as to what is going on and they should do some proper research and I have certainly done that into these drugs that are so highly damaging and extremely dangerous.  I wish I had done that in the beginning but I know full well you cannot just come off them and if someone is on the minimal of these drugs rather than maximum and has experts involved in looking at nutrition/diet, tests at bio lab – this is what should be done for the patients.

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