Learn more below why the court was responsible for Dr. Shepard becoming so delirious from Lithium Toxicity it caused a manic episode where Dr. Shepard was unable to tell right from wrong.


BEFORE TAKING LITHIUM DR. JACK SHEPARD NEVER HAD ONE PROBLEM AND THE LAST 35 YEAR WITHOUT TAKING LITHIUM

DR. JACK SHEPARD HAS NEVER HAD ANY PROBLEMS,

DR. SHEPARD ONLY HAD PROBLEMS WHEN HE WAS TAKING LITHIUM, WHICH DUE TO THE BAD REACTIONS TO IT,

PROFESSOR RITTBERG RECOMMENDS THAT HE NEVER USES IT AGAIN "BELOW"PRACTICED DENTISTRY,

AS A SINGLE FATHER RAISED 2 TEENAGERS AND TRAVELED THE MIDDLE EAST - as an "observer"

WHY DR. JACK SHEPARD 35 YEAR OLD NO MOTIVE ARSON CHARGE SHOULD BE IMMEDIATELY DISMISSED DUE TO COURT NEGLIGENCE ACCORDING TO PROFESSOR RITTBERG TESTIMONY BELOW:

TO:              Whom it may concern 
 
FROM:           Barry Rittberg, M.D.
 
RE:                 Jack Shepard, DDS
 
DATE:            August 19, 2015

I have been asked to clarify something I had written about in a previous letter to the court system regarding Jack Shepard.  In the previous letter I made a statement that was “If the court did not order psychiatric follow up along with lithium therapy, then that was clearly an error.”  From my discussions with Dr. Shepherd he was under court order to take lithium but was not ordered to follow up with a psychiatrist for lithium monitoring.  There was apparently a psychiatrist that was prescribing lithium to Dr. Shepherd without having ever seen him.  Psychiatric monitoring of lithium is and was the standard of care This is quite dangerous as lithium as a narrow therapeutic window meaning that doses too low are ineffective and doses too high can cause toxicity including an acute delirium. 


As a routine when I prescribe lithium I will monitor patient’s lithium level at least quarterly and when they are first starting on it every one to two weeks.  Apparently Dr. Shepherd never had any lithium levels drawn.  There was nobody monitoring the medication and there was no ancillary labs that were drawn.  Someone on lithium needs to have a regular check of their electrolytes, their creatinine and their thyroid hormones.  Lithium can affect all of these three things in an adverse manner thereby causing toxicity to the kidneys and toxicity to the thyroid gland.  It can also lead to alterations in serum sodium which can result in either excessive sodium causing sedation and acute mental status changes or low sodium which can result in seizures.  This would have been especially important in Dr. Shepard’s case as he was a distance runner and would run around the Minneapolis lakes in the hot summer weather.  This may have been enough to make him toxic, as he would have lost fluids but not lithium, thereby raising his serum lithium level.

 
My understanding is that he was charged with arson related to a fire in his home or office.  Dr. Shepard has little recollection of what transpired during that period of time and it’s certainly possible that he was either manic or toxic on lithium at that point in time.  He even points out that he reported his vehicle stolen although he had just parked it down the street.  He was that confused over the situation.  It seems to me that much if not all of his aberrant behavior can be attributed to mania resulting from not being monitored properly.

 
It would be considered malpractice for a psychiatrist or other physician to prescribe medications to a patient without examining them and then monitoring them periodically for benefits and side effects.  It appears that the court system has been negligent in their ordering lithium for Dr. Shepard without adequate supervision being arranged.


I find it significant that Dr Shepard has had no recurrence of behavioral disturbance for the past 34 years despite not being on lithium. Given his negative experience with lithium in the past, I would not recommend it as a treatment now.


 

 

 

 

 
 

 

 

 

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2 additonal letters from Professor Rittberg concerning Dr. Jack Shepard, " I find it significant that Dr Shepard has had no recurrence of behavioral disturbance for the past 34 years despite not being on lithium. Given his negative experience with lithium in the past, I would not recommend it as a treatment now."  Professor Rittberg M.D.

TO:                Whom it may concern

FROM:           Barry Rittberg, M.D.

RE:                 Jack Shepard, DDS

DATE:            May 7, 2015

 I have been asked to clarify something I had written about in a previous letter to the court system regarding Jack Shepard.  In the previous letter I made a statement that was “If the court did not order psychiatric follow up along with lithium therapy, then that was clearly an error.”  From my discussions with Dr. Shepherd he was under court order to take lithium but was not ordered to follow up with a psychiatrist for lithium monitoring.  There was apparently a psychiatrist that was prescribing lithium to Dr. Shepard without having ever seen him.  Psychiatric monitoring of lithium is and was the standard of care This is quite dangerous as lithium as a narrow therapeutic window meaning that doses too low are ineffective and doses too high can cause toxicity including an acute delirium.  As a routine when I prescribe lithium I will monitor patient’s lithium level at least quarterly and when they are first starting on it every one to two weeks.  Apparently Dr. Shepard never had any lithium levels drawn.  There was nobody monitoring the medication and there was no ancillary labs that were drawn.  Someone on lithium needs to have a regular check of their electrolytes, their creatinine and their thyroid hormones.  Lithium can affect all of these three things in an adverse manner thereby causing toxicity to the kidneys and toxicity to the thyroid gland.  It can also lead to alterations in serum sodium which can result in either excessive sodium causing sedation and acute mental status changes or low sodium which can result in seizures.  This would have been especially important in Dr. Shepard’s case as he was a distance runner and would run around the Minneapolis lakes in the hot summer weather.  This may have been enough to make him toxic, as he would have lost fluids but not lithium, thereby raising his serum lithium level.
 

My understanding is that he was charged with arson related to a fire in his home or office.  Dr. Shepard has little recollection of what transpired during that period of time and it’s certainly possible that he was either manic or toxic on lithium at that point in time.  He even points out that he reported his vehicle stolen although he had just parked it down the street.  He was that confused over the situation.  It seems to me that much if not all of his aberrant behavior can be attributed to mania resulting from not being monitored properly.

 
It would be considered malpractice for a psychiatrist or other physician to prescribe medications to a patient without examining them and then monitoring them periodically for benefits and side effects.  It appears that the court system has been negligent in their ordering lithium for Dr. Shepard without adequate supervision being arranged.

 

 

Professor Barry Rittberg 's 1st letter Starts the court by not ordering Medical follow up along with ordering the Lithium thearpy for Dr. Jack Shepard was a clear error of the court, it  is the reason Jack Shepard had protracted manic attacks at this time;  which made him deliriuous placing him in a state where he did not know right from wrong; this is a clear case of complete  court neglience which caused Dr. Shepard's problems which the law over 35 years ago.

Dr. Shepard's night long distance runs around Lake Calhoun and Lake of the Isles would make him more likely to become toxic on Lithium due to, this type of heavy exercise causes the runner to get  rapidly dehydrated, lose of  makes the Court directly responsible for Dr. Shepard becoming delirious from lithium toxicity which made him  have a protracted manic episode, during this protracted manic episode he developed his legal problems “ an arson charge for a fire in his home” which was directly related to his manic episode; because during this manic episode Dr. Shepard was unable to tell right from wrong; Professor Rittberg.


"It would be considered malpractice for a psychiatrist or other physician to prescribe medications to a patient without examining them and then monitoring them periodically for benefits and side effects.  It appears that the court system has been negligent in their ordering lithium for Dr. Shepard without adequate supervision being arranged."


This Letter states  that it was clearly a Court Error which caused Dr. Jack Shepard's legal problems because the court  ordered Dr. Jack Shepard to take Lithium without ordering him to also have ordered him to have Medical or Psychiatric follow-up along with his Lithium Therapy, " testimony of Steven Nelson- Dr. Shepard's parole officer 35 years ago"  that caused Dr. Jack Shepard state of mind at the time that he was charged in his Arson Case of burning himself up alive.

by Professor Rittberg. University of Minnesota Department of Psychiatry























































That was clearly an error by the Court to ordered Dr. Shepard to take lithium; but that the Court did not order Shepard to be placed under a Psychiatrist’s regular care is complete Negligence per se by the Court; because it is meant to protect the public.
 
That was clearly an error by the Court; this type of Court Negligence would be classified as “Negligence per se” this is a type of negligence is not a matter to be decided by a jury, but rather is a legal conclusion derived solely from the violation.
 
No Psychiatrist would ever prescribe Lithium to a patient he had never seen before or after. If a Psychiatrist prescribed lithium to a patient he never saw, he would be guilty of malpractice for prescribing Lithium (a toxic medicine) to Dr. Jack Shepard, a person he never saw before he prescribed Dr. Jack Shepard lithium or after.
 
For the Court to order Dr. Shepard to take lithium without being under a Psychiatrist’s regular care and follow up is “Negligence per se” by the Court.

The fact that Dr. Jack Shepard became toxic on Lithium the Court was responsible because of their Negligence per se, in ordering Dr. Shepard to take Lithium but not also ordering Dr. Shepard to have regular professional Psychiatrist to follow up which would be medical malpractice, no Psychiatrist would ever prescribe (a toxic medicine) Lithium to a patient; he had never meet; and then never have period visits with Dr. Shepard to see how he was responding to his Lithium therapy and regular follow ups, on Dr. Shepard condition and taking regularly his Lithium Level in his blood on a regular basis. The court while ordering Dr. Shepard to take Lithium without any professional Psychiatrist to follow up with Periodic visits and in Dr. Shepard case take even more lithium blood controls due to his habit of his nightly running around Lake Calhoun and Lake of the Isles every night.

The court by not ordering Dr. Shepard to have regular visits with a Psychiatrist to follow up his Lithium Therapy, was a clear case of court Negligence per se, making the Court 100% responsible for Dr. Shepard becoming delirious from lithium toxicity which made him  have a protracted manic episodes, during one of these protracted manic episode Dr. Shepard developed his legal problems and a Psychiatrist would have taken even more lithium Blood tests do to his habit of running around Lake Calhoun and Lake of the Isles, because of the Court’s Negligence per se by not order Dr. Jack Shepard to see a  Psychiatrist regularly made it possible that Dr. Shepard was never advised of the things that were dangerous to do for all patient who take lithium.

In standard Psychiatric treatment; treating a patient on lithium without regular Psychiatrist visits and regular Lithium blood levels tests would be malpractice and unheard of!

The most important thing after the court ordered Dr. Jack Shepard to take Lithium the Court should have order Dr. Jack Shepard to see a Psychiatrist regularly ( leaving this Psychiatric responsibility to his Parole officer Steve Nelson, who Dr. Shepard said recently retired and had a very good relationship so if the court has any questions Steve Nelson should be easily found to verify any facts the court may wish)  as a Parole Officer obviously he had no medical training let alone  no Psychiatric  training is another major error in Dr. Jack Shepard getting the proper Lithium Blood testing and advise and professional care anyone on Lithium therapy needs) he saw at no set schedule just Steve nelson would cal every few months) ; who would have  advised Dr. Shepard his  night long distance runs around Lake Calhoun and Lake of the Isles would make him more likely to become toxic on Lithium due to, this type of heavy exercise causes the runner to get  rapidly dehydrated, lose of  makes the Court directly responsible for Dr. Shepard becoming delirious from lithium toxicity which made him  have a protracted manic episode, during this protracted manic episode he developed his legal problems “ an arson charge for a fire in his home” which was directly related to his manic episode; because during this manic episode Dr. Shepard was unable to tell right from wrong; also without any Psychiatrist to follow up, he was never advised of the things that were dangerous to do for all patient who take lithium; like he should have been advised his night long distance running would make him more likely to become toxic on Lithium due to, this type of heavy exercise causes the runner to get  rapidly dehydrated , and would cause him to become toxic on Lithium;  The Court was direct responsible that Dr. Jack Shepard got severely toxic on lithium due to habit of running around Lake Calhoun and Lake of the Isles every night; and he would not have reached a point where he was delirious from lithium toxicity.

While the court ordered Dr. Shepard to take Lithium the Court was Negligence per se because it did not also order that Dr. Jack Shepard to regularly be under the professional Psychiatrist care ( which is mandatory) where he would have gotten regular follow up and this clearly makes the Court Error and Negligence per se 100% responsible for Dr. Shepard becoming delirious from lithium toxicity which made him  have a protracted manic episodes, during one of these protracted manic episode Dr. Shepard developed his legal problems which was directly related to his manic episode; because during this manic episode Dr. Shepard was unable to tell right from wrong; also without any Psychiatrist to follow up, he was never advised of the things that were dangerous to do for all patient who take lithium; like he should have been advised his night long distance running would make him more likely to become toxic on Lithium due to, this type of heavy exercise causes the runner to get  rapidly dehydrated , and would cause him to become toxic on Lithium.  Dr. Jack Shepard

 READ 2  LETTERS OF PROFESSOR RITTBERG WHO IS AN INSTRUCTOR  AT THE UNIVERSITY OF MINNESOTA DEPARTMENT OF PSYCHIATRY



STATING THAT IT WAS COURT NEGLIGENCE & ERROR WHICH CAUSED ME TO GET TOXIC ON LITHIUM WHICH HE SAID MADE ME 



"toxic on Lithium due to, this type of heavy exercise causes the runner to get  rapidly dehydrated, lose of  makes the Court directly responsible for Dr. Shepard becoming delirious from lithium toxicity which made him  have a protracted manic episode, during this protracted manic episode he developed his legal problems “ an arson charge for a fire in his home” which was directly related to his manic episode; because during this manic episode Dr. Shepard was unable to tell right from wrong."  Dr. Rittberg