Dr Stefan Kruszewski, a psychiatrist hired by the Bureau of Program Integrity in the Pennsylvania Department of Public Welfare, filed a law suit on 1 July in a federal court in the Middle District of Pennsylvania, charging that he was fired on 11 July 2003 after he uncovered widespread abuse and fraud in the bureau.

Dr Kruszewski's role at the bureau was to oversee the state's mental health and substance misuse programmes to protect against fraud, waste, and abuse. When he uncovered serious abuses, including deaths of children in the state's custody possibly due to substandard care and the off-label use of potent atypical antipsychotic medications, “they fired the messenger,” Dr Kruszewski told the BMJ.

Dr Kruszewski's efforts to clarify the causes of death in four children and one …