Defense experts fully supported the actions of the family physicians in this case. The patient suffered from physiologic pain brought on by injuries to her cervical and lumbar nerves and her spinal cord. When faced with a patient with clear-cut MRI evidence of a lesion that is capable of causing severe pain, it was appropriate for the family physicians to rely on what the patient said would relieve her pain. The patient required strong pain medication, such as Oxycontin, because other medications failed to relieve her pain. The physicians made a good faith effort to treat the patient and did meet the standard of care in trying to manage a difficult situation.
Regarding causation, the defense argued that the patient took a huge dose of medication, well in excess of that prescribed by the defendants. If she had taken the drugs as prescribed, she would not have died.
During the investigation of this case, it was discovered that the patient had a history of prescription drug misuse dating back more than five years. Her medical records clearly showed that she would manipulate physicians into giving her pain medication and when they finally refused, she would go to another physician. About one month before the patient came to the defendants’ clinic, she was dismissed by a neurosurgeon for lying about medications and abusing her medications. Unfortunately, the family physician defendants did not know about the patient’s history because she purposefully failed to disclose her previous three treating physicians. She also told her psychiatrist that he could not disclose anything to other medical professionals.
The plaintiffs retained an expert in pain management who supported their allegations. He argued that the family physician defendants should have diagnosed the patient as an addict and initiated an involuntary commitment. However, he could not explain why involuntary commitment was warranted or point to any evidence that the family physicians should have been aware of her addiction. This expert also stated that the results from the MRI mandated an emergency referral to a neurosurgeon. Defense counsel pointed out that the radiologist who read the study did not describe her condition as an emergency or note spinal cord involvement.
The plaintiff’s pharmacology expert testified that his primary concern was not with the prescriptions that were given, but with the number of pills that the patient was allowed to receive. He stated that she should not have been permitted to obtain a 30-day supply of Oxycontin. This expert agreed that the patient’s early refill requests could easily be explained by “misuse” of the medication and not “abuse.” He conceded that the family physicians appropriately used the “carrot and stick” approach by denying the patient refills when she did not obtain the MRI and making sure refills were on time and not early. Further, he agreed that the patient’s conduct was noncompliant, unreasonable, and a component that caused her death.
Another weakness in the plaintiff’s case involved the actions of the patient’s husband (a plaintiff in the case) when he found the patient passed out in the garage. He did not take her to the emergency
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department or notify any of her treating physicians. The plaintiff’s own expert described this as negligence on the part of the husband and agreed that health care professionals would likely have intervened had this episode been brought to their attention.
Disposition
At the conclusion of the plaintiff’s presentation of evidence during the trial, the defense attorney made a motion for directed verdict. The judge granted the motion, concluding that the plaintiffs did not meet their burden of proof that malpractice occurred in this case. (A directed verdict is an order from the judge that one side or the other wins the case. After a directed verdict, there is no longer any need for the jury to decide the case. Motions for a directed verdict are rarely granted as judges tend to let the jury make the decision on whether or not the standard of care was violated.)
At the end of trial, defense counsel interviewed jury members. Those interviewed indicated that they felt the patient’s death was an unpredictable suicide and was not due to any fault of the defendants.
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Originally Posted by Preacher
