According to a report by the Detroit Free Press, 60% of the patients who committed suicide with Kevorkian's help were not terminally ill, and at least 13 had not complained of pain. The report further asserted that Kevorkian's counseling was too brief (with at least 19 patients dying less than 24 hours after first meeting Kevorkian) and lacked a psychiatric exam in at least 19 cases, 5 of which involved people with histories of depression, though Kevorkian was sometimes alerted that the patient was unhappy for reasons other than their medical condition. (In 1992, Kevorkian himself wrote that it is always necessary to consult a psychiatrist when performing assisted suicides because a person's "mental state is ... of paramount importance."[22]) The report also stated that Kevorkian failed to refer at least 17 patients to a pain specialist after they complained of chronic pain, and sometimes failed to obtain a complete medical record for his patients, with at least three autopsies of suicides Kevorkian had assisted with showing the person who committed suicide to have no physical sign of disease. Rebecca Badger, a patient of Kevorkian's and a mentally troubled drug abuser, had been mistakenly diagnosed with multiple sclerosis. The report also stated that Janet Adkins, Kevorkian's first patient, had been chosen without Kevorkian ever speaking to her, only with her husband, and that when Kevorkian first met Adkins two days before her assisted suicide he "made no real effort to discover whether Ms. Adkins wished to end her life," as the Michigan Court of Appeals put it in a 1995 ruling upholding an order against Kevorkian's activity.[22] According to The Economist: "Studies of those who sought out Dr. Kevorkian, however, suggest that though many had a worsening illness ... it was not usually terminal. Autopsies showed five people had no disease at all. ... Little over a third were in pain. Some presumably suffered from no more than hypochondria or depression."[23]