Gitlow Report — USA v. Jittaphol (Dkt. 34.6)

Summary

A report letter by Stuart Gitlow MD MPH dated January 27, 2022, Document 34-6, filed 01/28/22 in Case 1:21-cr-10270-MLW, United States v. Jittaphol, in the United States District Court, District of Massachusetts. The letter gives Keith Halpern Esq. as the referral source and states the reason for referral as a general description of criteria and standard of care regarding inpatient residential treatment. It states that the standard of care relies on two criteria sets, InterQual and ASAM, and that level-of-care determinations are made on a daily basis from clinical findings, so that deciding in advance that a level of care is warranted is inappropriate. It concludes that, in view of the most recent treatment notes regarding Aticha Jittaphol, neither set would support a current treatment plan at the level of inpatient residential care.

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Record facts

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Stuart Gitlow MD MPH 
 
General, Forensic, & Addiction Psychiatry 
153 Gaskill Street 
Woonsocket, RI 02895 
Office:(401) 338-0493; Fax: (775) 429-6295 
Email:  drgitlow@gmail.com 
 
 
        
Diplomate in General, Forensic, and Addiction Psychiatry 
        
American Board of Psychiatry & Neurology 
 
 
January 27, 2022 
 
RE:  Aticha Jittaphol 
 
 
 
 
 
REFERRAL SOURCE: Keith Halpern Esq.   
REASON FOR REFERRAL 
 
General description of criteria and standard of care re inpatient residential treatment. 
SOURCES OF INFORMATION 
 
1) Carlson Recovery Center records, 12/6/21-12/13/21 
2) Hope Center records, 12/13/21-12/27/21 
3) Letter, Debi Dennis, Clinical Supervisor, Carlson Recovery Center, 1/15/22 
4) Letter, Erin Hall, Hope Center, 1/26/22 
 
SUMMARY 
 
Aticha Jittaphol is a 32-year-old transgender female with the primary diagnosis of stimulant use disorder, most 
recently treated at the Hope Center. She is on federal probation and in ongoing communication with her probation 
officer while simultaneously being engaged in recovery-oriented treatment for her addictive illness. Recent records 
detail that she has acknowledged her illness, rents her own apartment, owns her business, and is making progress in 
recovery.  
 
Recent records clarify the absence of any withdrawal symptoms, the absence of dangerous symptoms such as 
suicidality or psychosis, and the absence of any functional impairment. There have been no acute medical or 
psychiatric findings, and all cognitive function has been documented as being intact, both at the Carlson Recovery 
Center and the Hope Center. Ms Jittaphol completed her detox on 12/13/21. 
 
Records from Carlson Recovery Center do not document withdrawal symptoms from admitted methamphetamine 
addiction. At discharge, Ms. Jittaphol denied withdrawal symptoms. She denied ever having suicidal ideation or 
making any suicide attempt. The record and letter from Ms. Denis, Clinical Supervisor, establish that Ms. Jittaphol 
was functionally intact without cognitive dysfunction, and without any acute medical or psychiatric findings. 
 
Records from the Hope Center similarly indicate that Ms. Jittaphol did not suffer withdrawal symptoms, denied 
suicidal ideation or attempts, and was functionally intact without cognitive dysfunction, and without any acute 
medical or psychiatric findings. 
 
The applicable standard of care in the evaluation of appropriate drug treatment placement relies upon two major 
criteria sets: InterQual and ASAM. These criteria similarly provide that determinations as to the proper level of care 
are to be made on a daily basis, based on clinical findings. While certainly it is reasonable to estimate in advance 
Case 1:21-cr-10270-MLW     Document 34-6     Filed 01/28/22     Page 1 of 2

Re: Aticha Jittaphol 
January 27, 2022 
 
2 
 
 
 
 
2 
what level of care might be needed, or to have such care made available should it be needed, it is inappropriate, and 
a breach of the standard of care, to determine that a level of care (e.g., inpatient residential vs. ambulatory) is 
actually warranted in advance, and without consideration of the patient’s individualized progress and needs. 
 
Both InterQual and ASAM consider essential criteria for the assessment of the need for inpatient treatment to 
include: medical and/or psychiatric acuity; presence of or potential for withdrawal symptoms; whether the patient is 
functionally intact; whether the patient is a suicide or homicide risk; whether the patient suffers from cognitive 
dysfunction; whether the patient acknowledges addiction; whether the patient acknowledges a desire to achieve and 
maintain sobriety; whether the patient has the availability of a safe recovery environment; whether there is evidence 
establishing a significant risk of relapse in the absence of inpatient treatment. 
 
In the absence of a combination of a number of these criteria, and in view of the most recent treatment notes 
regarding Aticha Jittaphol, neither InterQual or ASAM would support a current treatment plan at the level of 
inpatient residential care.    
 
 
Sincerely, 
 
 
Stuart Gitlow MD MPH MBA, DFAPA, DFASAM 
ABPN Board Certified General, Forensic, & Addiction Psychiatry 
Licensed: NY, RI, FL, NJ, MA 
Case 1:21-cr-10270-MLW     Document 34-6     Filed 01/28/22     Page 2 of 2

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