Good Ketamine Doctor Bad Matthew Perry Doctors
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Hey everybody, this is Tina again with Good Nurse, Bad Nurse. Welcome back to another episode of this podcast where we use stories from the news to talk about issues in healthcare. Today, before we get into our stories, I want to introduce my co-host.

co-host for this week. Joel, my son, my middle son, has been on the show many times before. I don't even know how many. It's been several. I think it's like twice. No, I feel like you've been on here once. I think it's... I don't know. That's what I remember. So...

You've been on here before, and I always enjoy having my family members on here because, for one thing, they have a little different perspective. I have the nurse's perspective. But for the story that we're doing today, you're a pretty big Friends fan. I binge-watched the first six seasons. Yeah. And...

And then just stopped because I knew I needed to stop binge watching. So we're going to be talking today. This is a very tragic story. It's in the news right now because there's been arrests made, two of which are doctors. And so I wanted to talk about this story about Matthew Perry and

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So just to give you a little bit, for those of you who don't know who Matthew Perry is, he's definitely a little bit back in the day as far as like the Friends show. Yeah, I wouldn't have known his name. Right. Because I'm not an actor guy. Yeah. I knew Chandler, but I didn't know his name.

Well, he started acting as a teenager. He had an early career with Little Parts, did some pilots for some shows, and then he rocketed to fame in the mid-1990s with the Emmy-nominated role of Chandler being on the smash sitcom Friends.

He went on to star in movies like Fool's Rush In and The Whole Nine Yards. Off screen, he struggled openly. I mean, he talked about this in his book with addiction for many years. And

He at one point attempted to replicate his sitcom success with Studio 60 on the Sunset Strip and go on, eventually finding some ratings hits with a revival of The Odd Couple. He never got married. He never became a father. And he died unexpectedly at the age of 54 in October of 2023.

So that was very shocking when that happened. He was very open about his addiction struggle. In fact, I remember him talking about how when he looks back on his time during Friends, those are not fond memories. Mm-hmm.

Which is sad that when he looks at himself, if he sees himself at that time, he sees an addict. Those are his words. And I've said this before. When I use words like addict, I understand that that is not true terminology that we should be using medically. It's true.

We typically will say they are someone who suffers from substance use disorder. And that is appropriate. But also it's difficult when you have a conversational podcast like this and you're using someone else's words and people do refer to themselves sometimes. What's the difference?

Well, the difference is sort of semantics, really. I mean, when you talk about an addict, it sort of objectifies the person. You're taking the responsibility away from them and making it they're suffering this disease. Yes, because it is a disease. And rather than looking at it like it puts a label on them. Like they're addicted to something. Like they're a bad person because of it. Yeah. As opposed to...

They, like many people do, they tried drugs at one point and their body physiologically responded to them, to the drugs, the way most people don't. It's something that...

I think that we can't understand because we don't, we don't suffer from, you know, the addiction like that, or, or I've never tried drugs like that. So I guess I don't know, but that's, that's something that I think that sometimes language can be so powerful, you know, and using the right words, I think it is the right thing to do to try to use the right words when, when describing something like this. So I just wanted to say that because I,

you know, when, at the end of the day, it is addiction that, and there are all sorts of addictions, but that does not dehumanize the person that's going through it. What, no matter what words you use, they're a person, they're struggling with something. We all have things we struggle with. And so just to let you know, there are,

I in no way blame people who struggle with substance use disorder. I definitely do not. I have so many family members that suffer from that.

I have so much empathy for people. And when we get into the story, it's as someone who does have family members who suffer from substance use disorder, who've died from, from the effects of substance use disorder. I am furious at this story really upsets me. It makes me so angry at that people who the people who take advantage of those people. So, um,

We know that, as we said, he died unexpectedly in October of 2023. And I think everyone knew he was in a hot tub. He was found in a hot tub. And most people thought that he was in...

recovery, that he had been sober for, I think, something like 19 months. And that doesn't mean that you're not struggling. That doesn't mean that you're not trying to, and that doesn't mean that you're not going to have chemicals in your body. Because oftentimes, when someone's in recovery, they're going to see a doctor, see a provider, and they're taking medications to try to help them deal with the physical effects and the psychological effects.

When the results came out, they did say that he had ketamine in his system and

So then there was all, everyone was just like, oh, did he relapse? To give someone the benefit of the doubt, the thing is that ketamine is a legitimate treatment for depression. Well, the thing is, if you're in a hot tub, I don't know how you could do that legitimately and have that happen because it's out of your system in four hours. Yes. And clearly it was not administered under...

Observation of a doctor.

Coronary artery disease and the effects of buprenorphine, which is a medication that is used to treat opioid use disorder, were noted as factors that contributed to his death, but they were not the primary cause, according to the autopsy results. The death was ruled an accident, but they're saying that autopsy report said that ketamine, acute effects of ketamine,

were the cause for his death. You can actually overdose on ketamine, right? Yes, you absolutely can. But in this case, you have to kind of deduce that it was him being unconscious as a result of ketamine in the hot tub. Exactly. And I think that's exactly right. You would deduce that the fact that the examiner indicated all of those things...

That the ketamine led him down a path, being in the water, causing some sort of issues with his heart and passing out and then drowning. But ultimately, had he not had the ketamine in his system, then all of the other things would not have precipitated afterwards. Yeah.

The report says that he had been receiving ketamine infusion therapy for depression and anxiety. His most recent infusion occurred about one and a half weeks before his death. The problem is ketamine being in his system at the time, as you said,

there's no way that that could be from the infusion therapy because the ketamine's half-life is like two to four hours or less, according to the medical examiner. And so there's no way that a legitimate infusion of ketamine that was administered for depression. So at that point, it's like, well, who gave it to him? Exactly. Yeah. How'd he get it? Mm-hmm.

So a licensed physician and an alleged drug dealer from the San Fernando Valley have been arrested in connection with the death. And a total of five defendants, including two doctors, are facing charges. Jasveen Sangha, who is 41, also known as the Ketamine Queen of North Hollywood, and Dr. Salvador Placentia, who's 42, also known as Dr. P of Santa Monica,

The U.S. prosecutor, right? Yeah.

So, Senga and Placentia have been charged with conspiracy to distribute ketamine, with Senga facing additional charges for maintaining a drug-involved premises, possessing methamphetamine and ketamine with intent to distribute, and multiple counts of ketamine distribution. It also said there was cocaine in there. Oh, really? Yeah. Oh, okay. Yeah. Report it.

So the indictment claims that Senga's ketamine distribution on October 24th, 2023 led to Perry's death. Placentia faces charges for distributing ketamine and falsifying documents related to the federal investigation. Both are expected to be arraigned in the United States District Court in Los Angeles on

And then three others have also been charged. Eric Fleming, who's 54, of Hawthorne, pleaded guilty to conspiracy to distribute ketamine and ketamine distribution resulting in death, admitting he supplied the ketamine that caused Perry's death. Kenneth Iwamasa, 59, of Toluca Lake, who conspired with Zenga, Fleming,

and placentia to illegally obtain and distribute ketamine to Perry. Real quick, Eric Fleming gave the doctors the ketamine or was like a delivery guy? I'm not totally clear on that. Yeah, I'm not sure. I'm not sure either. He distributed it somehow. I don't know. To me, the really important thing here is Kenneth Iwamasa,

Was the 59 year old who they said conspired with Senga Fleming and Placentia to illegally obtain and distribute ketamine to Perry. He was his assistant, like live in assistant. Okay. And he apparently admitted to repeatedly injecting Perry with ketamine, including on the day of Perry's death, despite having no medical training. I cannot believe the nerve of someone. Yeah.

I was an ICU nurse. I've worked in an ICU. I took care of ECMO patients. I remember I have hung ketamine and given ketamine to people. And you don't just give patients ketamine, fentanyl, and these kinds of medications without

being very diligent about assessing them constantly, watching them, watching their respirations. I can't imagine the audacity of someone with no medical training to just administer a medication like this. For me, it's more on the doctors who know the danger of it. I mean, if you're not trained at all, then you don't even know what you're doing. You don't even know the depth and the repercussions of what you're

potentially doing to someone. But look, this needs to be shouted from the rooftops. If you are not a medical professional, you have no business sticking a needle in someone's body anywhere. It's insane. It'd be good if everyone knew that. You'd think it's common sense, but...

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So Dr. Mark Chavez, who's 54, of San Diego, apparently agreed to plead guilty to conspiracy to distribute ketamine. Chavez admitted to selling ketamine to Placentia, which he had diverted from his former clinic and acquiring additional ketamine through fraudulent means.

The indictment details how Placentia, after learning of Perry's interest in ketamine, conspired with Chavez to obtain and sell the drug to Perry. Throughout September and October of 2023, Placentia provided ketamine to Perry and Iwamasa without medical justification, even teaching Iwamasa how to inject Perry with the drug.

And you would think that if you're going to teach, if you're going to take it upon yourself to teach someone how to inject the drug, teach them how to assess them to teach them the importance of watching them, of not just administering that and then just leaving. Yeah. I mean, if that obviously someone administered it. Yeah. It was probably him. Right. It's just kind of context. That's what it seems like. Allegedly. Yeah.

So if he had known how to properly just watch someone. Not to inject them and then leave them. In a body of water. Yeah, in a hot tub. And this medical doctor knew, apparently, that Perry's ketamine addiction was worsening. Placentia continued to supply the drug, leading to Perry's death on October 28th in 2023. So following his death,

Federal agents found evidence of drug trafficking at Sango's residence, including vials of ketamine, methamphetamine, other drugs. Placentia also submitted falsified medical records to obstruct the federal investigation. And I always find that interesting because

You know, they start stacking these charges on people because of the things that they did to try to hide their crime. And I always find that like, well, what else? If you're going to commit a crime, of course you're going to try to cover it up. But that's just how it works. It also works that if you are committing these crimes, then you're not the kind of person who knows how to actually get away with it. Yeah, apparently. Yeah.

Well, if convicted, Sangha could face a minimum of 10 years in prison with a maximum of life imprisonment, while Placentia could face up to 10 years per ketamine-related charge and up to 20 years for falsifying records. All the defendants are presumed innocent until proven guilty in court, of course, as we said. So here's the thing. As we said at the beginning, ketamine is a legitimate drug.

treatment for depression. It's been proven. It's actually an incredible treatment for depression, probably better than any known other treatment that's actually approved for use legally. Yes. And the thing is, because of its psychedelic side effects and properties, I think a lot of people are afraid of it. Yeah, I'm afraid of it. Yeah, it's scary. It is scary.

But there are legitimate clinics. There are actual providers who legitimately, and they were seeing, Matthew Perry was seeing a legitimate provider. They're good, they're responsible. Yes. And they said no when he wanted more. Yes. And he did try to go to the people that were treating him and he asked for more. And they basically said, we've reached the maximum amount that we can give for this.

justification of treating depression. So those, those doctors, those providers are not being indicted. They are not being arrested because they were just doing their job and treating him. But it was because someone, you know, just struggling with, with addiction issues, with substance use disorder, uh,

Trying to get more and then having access, you know, having the money, having the contacts, having people that are willing to just go and, you know, find people to it. It's got to be really difficult for somebody like that. For Matthew or the doctors? Well, for for a anyone who is in Matthew Perry, who would be in his position to have the resources to be able to. Well, whereas, you know, they have the resources for doctors.

treatment, but they also have pretty much unlimited resources for obtaining whatever it is that they want. And unfortunately, and I wonder if there's any research that shows whether people who have it, it's one thing to have depression and go to a ketamine clinic and get ketamine injection infusions for treating depression. If somebody does struggle with substance use disorder though,

Is that a good idea? I think it's a legitimate treatment, especially for substance use disorder. Psychedelics generally do have a, like there's been a lot of research done and that psychedelics have a really good effect on substance abuse and actual addictions, like physiological addictions. They just go away after psychedelic experiences under proper treatment.

It's a known thing. So I definitely think it's not a bad, it wasn't a bad idea for him to be doing it. But clearly there was something else going on that was not, that was deeper that he just never found. He just never found the answer to. And that's really sad. I've read several articles of people that were close to him, other actors that were in the show, friends.

And really everybody that was close to him that knew him well said that he was a very kind person, just a good person through and through. He was just the sort of person that you just love to be around and

He was the funny one on the show. He was just so much joy and wit and just his character was incredible. The sad thing is that now watching that show,

Yeah. Just knowing that he couldn't even watch the show. Yeah. That for me really. It changes it. Changes it. Because now we have that. Now we have his perspective. Yeah. On that. To know that that person that's on that show who is coming across so jolly and so just witty, as you said, and that is suffering so much on the inside. It's that you can't see it. I mean, and I know he's acting, but.

There's just an element of acting that is as personal. It's like him. He's there being the actor and he is expressing himself there. It's, it is a removed thing and it's not. Yeah. But just to think that, you know, you're sitting there watching that show and that person who is acting that out is, is,

Saying a few lines and then leaving the set and just completely falling apart and struggling. They're in a very, very dark place over years. So that definitely changed it for me when I heard him say that in an interview. It was just kind of it hit kind of hard. Like, wow, I don't know if I can.

watch the show at the same time. It just puts it in a new perspective. I wouldn't mind watching it for sure. It just kind of adds depth to what I'm seeing and the reality of it. Well, the fact is that those, any show that you're watching, they are, they're obviously actors and each one of those people, they have their own things going on in their lives. But when something like this happens, it's just, it's, it's incredibly sad. Um,

It infuriates me to think that there were... And one of the things that is really, really infuriating that we haven't even said about this is that there were text messages that went back and forth. Yeah, that is awful. Yeah. And one of the things that was said in a text message, and I don't know that they actually specified who, but they read a text message where...

One of the doctors was reaching out to someone else, I guess, to try to... They were just talking about it, right? Yeah. They were saying, hey, this guy is wanting ketamine.

And according to the U.S. attorney, that doctor said, I want to be his supplier. I want to be his supplier. His go-to guy. His go-to guy for drugs. And he reached out to his person who had the supply from apparently a previous clinic that he ran. And he said, how much can I charge this guy for?

You said, I wonder how much I can save. It's really hard. Did you use the word moron? He did. Yeah. How much can I charge this moron? Yeah. It's so hard. When I heard that, I felt no more empathy for these people. I know. Yeah. Like there's just none. Put them under the prison. Right. Just to literally dehumanize someone like that. They just have no empathy whatsoever for the person struggling with that person.

And they charged them. He ended up spending something like $55,000 for like 20 vials of ketamine, something like that. And one report that I saw said that like maybe this doctor would have spent like $12 on a vial and they were charging him thousands. They knew he had a lot of money and they knew he had a problem with substance use disorder. So the two of those together,

They just saw dollar signs. He did not care about his life at all. Also, what's really sad to me is to think that he had a live-in assistant, someone who lived there. He had to have trusted this person immensely. It's hard to imagine where the state of mind he must have been in. When I put myself in that guy's shoes, it's like, you're not going to say no. Matthew wanted him to do it.

And I, he's a paid person to do whatever he says pretty much. So I understand like if he felt the pressure and like, it's an, it's a difficult situation to be in. It's not necessarily, they didn't care about him and like, didn't, you know, wasn't worried about him. We don't really know. But in that situation, when you work for someone and they ask you to do something, you're,

I could totally see someone going along with it. Well, here's the problem with that. And that I, I agree with you. I can see somebody just getting in so far in over their heads. They don't want to lose their job, especially where you're working, making good money and you live in a mansion with, with, uh, an actor, an A-list actor. I mean, he, he hadn't been, you know, active in a while, but everyone knows him. And yeah, so definitely a prestigious job to have.

So I could see it, but it's no different than, you know, you're working in a hospital and a doctor asks you to do something and you don't want to say no. And that happens a lot to nurses where the doctor's prescribing something and the nurse doesn't want to say no. There was the doctor in Ohio who in the ICU and would put in orders to extubate patients and

And then order all this fentanyl right after. And these patients who they decided to put on comfort care. In other words, the patients were kind of at end of life. And they said, you know, the family said, yes, take them off life support. And they would take them off life support and then immediately dose them with this crazy amounts of fentanyl. And they did indict him. He was found not guilty. But there was a question, I think, at some point of why the nurses were going like, why would the nurses go along with this? Yeah.

Ultimately, that didn't turn into anything. I mean, I think some people lost their jobs and certainly went through a lot over that. So there was some gray area for sure. There is some responsibility, but it's a very different situation between the assistant and the doctors. Yeah. My assistant had no idea what he was doing. No, but I mean, you can't just be injecting people. Yes, absolutely. Weigh in over his head.

It's hard for me to imagine how you don't understand that you could kill someone. And I don't know. Well, I mean, I'm sure Matthew knew that. I'm sure he knew the risks. And it's like...

Well, I think that when you're... It's hard to put so much blame on the assistant when... Yeah, but if someone is struggling from substance use disorder, you can't allow that. You can't... That's going to cloud their judgment. They're not... They're never going to admit to themselves that their life is in danger. They are never... They can't... That thing in your brain that is causing you to want more, more, more, it's so powerful. It just lies.

It lies to you. You're literally lying to yourself. And it's so powerful. I've just seen it. I'd say that lie can easily spread to the people around you. To where you're convincing them. Yeah. And yeah, I guess I can see that. I guess I can see that. And then the more you do it, they just get more and more comfortable with it. Yeah. It's a normal thing. Yeah. People just don't know.

The doctors knew. The doctors are very... Yeah. Knew a lot. Yeah. They knew exactly what they were doing. Well, it's exactly why two of them have been indicted. Now, they are innocent until proven guilty. I keep saying that because I always get nervous whenever I do these stories of ones that don't have an outcome yet. Because...

The fact is that we do live in a country where we are innocent until proven guilty, and we want it that way. It does appear as though there's a lot of evidence, you know, and I think that I don't know if they're going to end up, you know, having some sort of a deal. I feel like... I really hope not. Well, I feel like a lot of these people, yeah, it seems like these people who put like guilty...

are probably going to have some sort of a deal where they're going to testify against, you know, someone else is what it typically, you know, they typically will, they'll arrest five people and three of them are going to get deals and two of them are going to go down because the three who got deals and admitted, you know, admitted, you know, guilt for lesser charges are going to testify. And that usually is what happens. Yeah.

So I have to tell you guys about an experience I had with a nursing student. So you know, I've been doing travel nursing. Well, this hospital where I'm at has a lot of LPN students doing their clinicals there. So one of them was following me around one day, and she noticed my stethoscope. And of course, y'all know the Echo Technology Company that sponsors our podcast, they teamed up with Littman to make the stethoscopes to beat all stethoscopes, the 3M Littman Core Digital Stethoscope. And this is the one that I use now. So she said, Oh my gosh, I've been wanting to try one of those. So of

So of course I let her use it and she just could not stop talking about it for the rest of the shift. It was so cute. She was like, you know, I can't hear anything with my normal stethoscope because I have tinnitus. And so she was so excited because she could actually hear what heart sounds were supposed to sound like. She said, I'm going to ask for one of these for graduation. And I was like, yeah, you definitely should. So just so you know,

The Echo technology that makes Testescope so amazing. You can enable it with a flip of a switch. You can turn it on and off. It has active noise cancellation up to 40 times amplification, wireless auscultation using Bluetooth technology. It connects with Echo's free app and software.

so that you can visualize, record, share, live stream, analyze heart sounds, lung sounds, and whatever body sounds you want to listen to. So you can go to echohealth.com and use the promo code GNBN to get $50 off your order. And that's echo is spelled E-K-O, by the way. So it's echohealth.com and use the GNBN promo code to get $50 off your order. I wanted to do the good doctor story first.

To sort of highlight the use of ketamine because I think that it can get a bad rap, you know, and I think it's helped a lot of people. So I found this article on. Yeah, and it came out, it looks like right after. Right after it. Yeah. Because people obviously are going to react toward ketamine in this way. I am sure. Demonizing it. This is October the 27th of 2023. And this is from NIH.gov.

And it's called Cracking the Ketamine Code. At a glance, it says treatment-resistant depression affects nearly 3 million people in the United States. While monoaminergic antidepressants have been around for years, they don't help everyone. In the early 2000s, researchers began looking at ketamine as a possible treatment. Decades of NIMH-supported research led to the 2019 approval of S-ketamine for treatment-resistant depression.

Otherwise known as TRD. Yeah. So the research shows that it's about the same effectiveness as the monoaminergic drugs as far as success rate. Yeah. But it also...

helps in cases where the monoaminoid quants didn't work. Well, that's the thing. With those monoaminoid, that's a broad umbrella of types of drugs. So you're talking about SSRIs, you're talking about different types of antidepressants. That's a big umbrella that

So think about all the different types of antidepressants. You go to the doctor and you say, I'm just not feeling good. I'm feeling down. I'm, you know, I'm just kind of depressed or whatever. They have a whole list of antidepressants to choose from to try. And they'll start on, you know, one that's been around for a while. And they'll say, let's try this one.

And see how this works. Usually they do that because of insurance. Insurance is like, use the tried and true. They've been around a while. They're cheaper. They're proven effective. Side effects are good. Yeah. Well, at least they've been around long enough to, you know what they are, you know what to expect. But then they go down the line. Well, that one's not working. Let's try this one. That one's, oh, the side effect's too bad. Let's taper off that one. Let's try this one. Well, for some people, by the time they get through

several of those and they just start to feel like there's no hope. Yeah. And this is just worse. Yeah. To the end of the list. And it's like, well, now what? Now what? Yeah. This is something that is not under that umbrella. Completely different. Completely different. It's about the same level of effectiveness. So that's, but so that is huge. Yeah. And the fact that people have not found a drug that helps them and they, and they, they try this and it works. You know,

This study specifically talked about a woman who lost her oldest son and it sent her into this horrible depression that she just could not come out of. No drugs, she could not have had any drug that would help. And she entered into this trial and apparently it really helped to turn her around.

Those sort of success stories are huge. And I wanted to just highlight this doctor in particular, Dr. Carlos Zarate, because he has really been a huge part of discovering this treatment and really doing a lot of research. He's been a part of this since the early 2000s and moving it forward and

So I just, I hesitated, you know, to do the story because I don't want to put this huge negative light on ketamine, on the ketamine treatments. Because ketamine is just like many other drugs. It has good uses, but it can be misused. It absolutely, you know, can be used in the wrong way. Yeah, I mean, if this was a properly administered situation, it'd be different, you know, but it wasn't.

Right. No, and this is an obvious... I think because it's an actor, because it was somebody so popular, it shocked the whole world. Everyone loved him. Everyone loved him. It has really thrown this ketamine into the spotlight. But...

I have to believe that this is... He's not the only person that's died of ketamine. No, no. A related death. No. And I'm not talking about the legitimate infusions. I'm talking about anytime you have these prescribed medications that can have these effects, you're going to have people who are going to sell them on the side to...

try to make money off of people who struggle with, with substance use disorder. So you're not going to get around that. That's just, it's always going to be there no matter what. I think, yeah, it,

Even if you completely made everything legal. I mean, just make it. In this case, yeah. You can get it legally. Well, and no limits. You don't even have to have a prescription. You want ketamine, go to the store and get it off the shelf. Of course you can't do that. I'm just saying people will find something. This is a perfect example of what would happen. Because for him, the money wasn't a problem. Right. And so it pretty much was like that. Yeah.

And this is what you get. Yeah. The rich people. Well, you can see what happens when...

When you mix the problem of substance use disorder with having an endless supply of resources. And it's just really sad. It really is. I guess that wraps it up for this episode. Kind of a short and sweet episode. But I wanted to address this. This has just happened in the news. It's August of 2024. I just thought it was important to talk about. Thanks for coming back on the show. No problem. It was fun.

Well, you guys can reach out to me at Tina at GoodNurseBadNurse.com. I'm on social media at GoodNurseBadNurse. And you can go to our website at GoodNurseBadNurse.com. Look forward to hearing from you guys. And as I always have to remind you, even if you're a bad girl or a bad boy, be a good nurse.