Peggy Salters is a woman that has had an incredibly important role in shaping modern day psychiatry.

While her name may not be well-known, Peggy Salters is known for being the first person in history to receive compensation for the after-effects of electroconvulsive therapy (ECT) [1].

Salters lived to tell the tale, and her case has become well-known in the years since her case was decided in 2005.

Background

Peggy Salters was from South Carolina, United States. She was diagnosed with severe depression during the 1980s, and was prescribed medication.

Salters tried various medications, but they failed to alleviate her symptoms. Her doctor, Dr. John Emerick, recommended that she underwent ECT.

What is ECT?

ECT, which is also known as shock treatment, involves an electric current being sent through the brain of a patient, with the aim of triggering an epileptic seizure.

In the modern day, ECT is often used as a “last resort” of treatment, for when various medications and therapies have failed to reduce symptoms.

But in the past, ECT was routinely used, and often seen as being one of the most effective forms of treatment for mental health problems.

ECT Sessions

Salters first underwent ECT in the late 1980s. Dr. Emerick appeared to be impressed by Peggy’s progress, noting that her symptoms were reducing significantly.

Further ECT sessions followed in 1990, with her symptoms continuing to reduce. It appeared to “cure” her mental illness.

Over the next seven years, Salters showed no signs of mental illness. She was able to study and complete a Masters Degree in Science and nursing, before qualifying as a nurse practitioner by 1999.

However, trouble would soon return – with Salters seeing a revival in her symptoms, which appeared to be triggered by the deaths of some family members, most noticeably – her husband in October 1999.

Soon enough, Salters sought help for her mental health, and was once again diagnosed with severe depression, this time while being under the care of Dr. Eric Lewkowiez.

Lewkowiez’s notes on their first meeting showed that Salters was struggling to sleep, reported low energy, significant weight loss, and was tearful.

Salters was once again prescribed antidepressant medication, though she once again found that these didn’t help. She mentioned having suicidal thoughts, and suggested to Dr. Lewkowiez that ECT could be an option.

Dr. Lewkowiez had little experience with ECT, but after referring Peggy to Dr. Robert Schnackenberg, the duo decided that ECT would be an appropriate treatment for Salters.

So Salters was prepared for ECT, and she underwent 13 sessions over an 18 day period. At first, the sessions were given every other day, before an intensive programme involving ECT being administered every day commenced.

After effects

Following this intense period of ECT sessions, Dr. Lewkowiez met with Salters. Notes from the session suggest that Salters had missed a recent ECT appointment and that she was having memory problems.

But Dr. Lewkowiez continued to recommend that she continued with the ECT. He failed to report this complication to Dr. Schnacknberg.

A meeting two weeks later saw Salters report the same memory problems – while she was also unable to complete work, or function properly at home. She was also rapidly losing weight and unable to sleep.

During this period, Salters was given three more ECT sessions in the following month – which were referred to as “maintenance ECT”, with the aim of solidifying the effects of the previous month’s sessions.

At the next meeting – two weeks later – Salters remained “confused and disoriented” according to Dr. Lewkowiez. Salters decided to stop partaking in ECT sessions, due to concerns that she was “unable to function”.

But Salters’ issues remained even following the ceasing of ECT sessions. Dr. Lewkowiez recommended that she stopped her work as a nurse, and instead apply for disability payments, as she appeared to be unable to work appropriately.

Dr. Lewkowiez decided to refer Salters to psychologist Dr. Mary Elizabeth Shea. Dr. Shea conducted an investigation and spoke to Salters, and came to the conclusion that Salters had suffered memory loss as a result of ECT.

Lawsuit

Following this, Peggy Salters launched a legal battle against numerous parties. She filed lawsuits against Dr. Lewkowiez, Dr. Schnackenberg, and another doctor involved in her care – Dr. Kenneth Huggins.

She also filed a lawsuit against the Palmetto Baptist Hospital. She suggested that the Hospital and its employees were liable for her memory loss.

She claimed that her memory loss came as a result of negligent treatment for her diagnosis of severe depression. She testified at her trial. Experts testified that Salters was not informed about the risks of ECT.

The lawsuit against Dr. Schnackenberg and Dr. Huggins was dismissed. However, the jury in the lawsuit against Dr. Lewkowiez agreed that there had been medical negligence.

Salters was subsequently awarded $625,177.00 in damages. Dr. Lewkowiez immediately appealed, but this was dismissed.

Salters reached an out of court settlement with the Palmetto Baptist Hospital. Details of this settlement are unknown.

Salters referred to the court’s decision as a victory for all victims of ECT.

Summary

This case has become well-known, and was seen as a landmark moment for patients that believed they had received negligent care from health professionals.

While many ECT cases had reached the courtroom, time after time, the psychiatric profession has been able to manipulate court proceedings, though this finally ended here.

Salters claimed that she had lost all of her memories from the last 30 years, including those of her husband. This was a tragic outcome to her ECT treatment.

Brain scans confirmed a brain injury, and her cognitive abilities had decreased significantly. She was also diagnosed with dementia.

Salters is now approximately 75 years old, though very little is known of her current whereabouts and mental state, but clearly, damage has been done.

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References

[1] Justia US Law. (2007). Salters v. Palmetto Health Alliance. Available: law.justia.com/cases/south-carolina/court-of-appeals/2007/2007-up-187-1.html Last accessed: 4th May 2021.