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hi lucy i'm sure you will receive a lot of good advice in re your father's health care i couldn't possibly venture an opinion about the secrets of the american health care system one thing jumps out at me from your post: what a 'roller-coaster ride' of medications your father has been on! the more i learn about our amazing brains and our amazing brain chemistry the more i lean towards extreme caution call me a coward but i harbour a lot of concern and procrastination about making any change to my 'chemical stew'; i'm still mulling about the hormone issue i've been taking sinemet and eldepryl for nine years and an anti-depressant for six years the ingredients haven't changed at all the quantities have been adjusted occasionally maybe i've been unusually lucky the progression of pd in me has been slow and steady no unwelcome surprises nothing unexpected i consciously and actively decided not to add one of the 'old' dopamine agonists to my regimen due to the complications involved in fine tuning two meds in conjunction with each other rather than just one and also due to the potential for side effects i also was aware that there were three 'new' ones in the pipeline and felt comfortable about waiting another year or two until the 'dust settles' around them your dad's situation reminds me of the old story of the wobbly table with four legs being adjusted and adjusted and adjusted ... at the moment, and from my non-medico, lay-parkie point of view, it sounds to me like his pd is being critically undertreated: >His on-time is next to none; he literally falls >on the floor and can't get up. in re the hallucination/psychotic aspects, whew!! sinemet eldepryl permax elavil risperidol gabapentin amantadine what a barrage of chemicals his brain has been subjected to in a relatively short period of time! looking at his situation from the point of view of "when was he in the best shape, and what was he taking then?" if he was relatively stable and mobile for two years on his original schedule would it not be worth trying resuming that 'recipe' to see if his condition reverts to what it was? if, on the original schedule, he was starting to develop >some mild hallucinations and paranoia over the past 6-8 months >but nothing extreme, and usually only at night [which may have been a not unexpected long term reaction to levodopa therapy especially in more elderly people] then possibly the stress of your mother's illness as well as the inadvertant increase in sinemet were enough to 'put him over the top' chemically speaking in re "the neurologist vs the psychiatrist game" that seems to be being played at your father's expense, i have to echo camilla's comment re being assertive if someone's health is on the line [and there but for grace, ...] i think the old confrontational stance might be apropos: "my way, or the highway!" with love to my parkie bro and to you janet