Thursday, November 29, 2012

Shame on this Jury

According to this article out of Syracuse, NY, a jury awarded $1,500,000 to the survivors (and their attorneys) after the suicide of teacher/coach Joe Mazella. The plaintiffs argued that Mazella's family doctor prescribed paroxetine for as long as 10 years and that he was negligent in doing so with little or no contact then abandoned the patient who killed himself without even telling his wife of his plan and after hospitalization and change in medication.

Anti-drug "reform" psychiatrist Peter Breggin wrote here about his testimony for the plaintiffs:

  • The family doctor had increased the dose of paroxetine to 40 mg and added olanzapine after a telephone consultation.
  • He criticized the family doctor for not warning Mazella about the "serious risks" associated with the drug (despite that fact that he had been taking the drug for 10 years!)
  • "I also concluded that a hospital psychiatrist was negligent in not recognizing that Mr. Mazella was suffering from adverse drug effects and in discharging him without proper followup two weeks before his death."

In neither article could I find any basis for establishing a causal link to the suicide either with the admittedly negligent prescribing or the drugs themselves. Apparently Dr. Breggin finds it sufficient that one has taken such drugs prior to the suicide: post hoc ergo propter hoc.

Even the widow is quoted as saying, "He’d given no hint that he was suicidal, but he was complaining often about the effects of his medications, Janice Mazella said."

I might have testified for the defense:

  • There is no evidence that any of the medications contributed to the suicide. Mazella's suicide resulted from his own wish to die, and nothing else. We will never know what motivated him to such a tragic choice.
  • Nothing the family physician did or did not do contributed to the suicide. The hospital physicians assumed responsibility for his care after the family doctor discharged him. Even if this discharge somehow constituted abandonment his hospitalization obviated further need for involvement by the family physician. Mazella had apparently stopped the paroxetine prescribed by the family physician prior to killing himself. Perhaps he should have continued the drug.
  • The hospital physicians could not assure that Mazella followed up at the appropriate interval with another physician after discharge. That was the responsibility of Mazella and the physician of his choice.
  • If the drugs made Mazella feel so bad he should have stopped taking them on his own or at least sought consultation with another physician.
  • For anyone to have stopped Mazella from killing himself required that they have contact with him during the time between his first thoughts of suicide but before the act, and that he tell them he intended to kill himself. Perhaps Dr. Breggin could have saved him had he been living with him 24/7!

According to the first article, "Janice Mazella said she hopes the verdict sends a message to patients and their loved ones to be careful about doctors overmedicating." It certainly does. It sends the message that if you kill yourself while taking the right medications, prescribed by a doctor with a good malpractice insurance policy, your survivors may be better off financially than they would have been had you remained alive.

Breggin calls Mazella's death the "tragic outcome" of use of prescribed antidepressant drugs. We may never know how many suicides occur among those who people like Breggin has frightened away from getting the treatment that could have saved them. But if your loved one kills herself after reading Breggin's propaganda and failing to get treatment, I want to be your expert witness.


  1. I do not believe that primary care physicians are qualified to prescribe psychotropic medications, any more than they are qualified to perform othopedic surgery,
    I would say the primary care Dr. was negligent, in his treating a patient for a psychiatric condition for ten years,and for prescribing Olazapine following a phone "consultation".
    But where was the patient's family for the ten years prior to the patient's suicide?
    Why did his wife not take him for a consultation with a psychiatrist?
    For the Dr. to have informed the wife of a change in the patient's medication or anything else about the patient would have been a breach of Dr.-Patient confidentiality and a HIPAA violation. The patient's family was in a far better position to observe that the patient was depressed enough to be suicidal. If they were unable to do so, how can they blame the Dr. ? It seems that they are scapegoating the primary care physician.
    The jury's verdict should be overturned.

  2. The fact is anon, that primary cares prescribe more psychiatric drugs than do psychiatrists, for better or worse, and in my experience the vast majority require follow up visits much less frequently, although 10 years seems extreme. But even if it had been yearly visits there is no evidence it would have changed the outcome.
    As for the olanzapine, why not after phone consultation alone? Would the outcome have been different if the physician had been able to perform an abdominal exam, rectal exam, or listen to his lungs?
    Why did the patient not seek psychiatric consultation himself or at least return on his own to the PCP?
    HIPAA is irrelevant here. If the wife had concerns HIPAA would not have prevented her from communicating them to the doc, and if the doc wanted to talk to her, he could have asked the patient to authorize him to do so.

  3. Well, this all seems a bit vague. As to why he did not seek psych consultation independently, it could be for a variety of reasons. He may have required a referral from the primary care doc, pdocs all booked up in the area, etc.

    I do get the impression that the primary care doc was in over his head and should have more rigorously followed up with the patient...and referred out to a psychotherapist or psychiatrist.

    I actually met a primary care physician who tole me that he prescribes psych meds. When I asked his NP about it, she said they prescribe after a psychiatrist first prescribes them, but they don't do med basically....imo that means you don't prescribe psych meds. I would hate to have something go wrong with my meds, call the prescribing doctor, and then be told...oh we don't do med changes here. See if you can track down that pdoc you saw way back when for a med change...if he is still around and can fit you in after all this time.

    PCPs either need to get out of prescribing psych meds or have special training.

  4. Seems that there is something troubling with this case.
    child psychologist in Denver

    1. I recently went to my pcp looking for a med for "anxiety" he gave me a script for something that gave me a horrible reaction, i went back to him to try again, he referred me to a psych doc, which was a bit of a hassle. But... the psych doc was able to ask the right questions and diagnose my condition correctly as ADHD... which is what had been causing the "anxiety" for many years. It has been a great relief for me, to have a name for it, to be able to research and catch the behaviors. The psych doc also gave me a script for a very mild med, which has helped my "90 mile an hour mind" slow down considerably. My life feels so much better, i wish i were diagnosed years earlier, but still grateful to have a better life now. The idea that someone should know which direction to go, when they are suffering is just wrong. Spin around 90 miles an hour, then stop and go in the right direction...try it... i dare ya. It is sad that this had to happen to this person and his family, and the doc. I don't like the litigious nature of our society, and yet... how does it stop? I am not angry with my pcp, nor had i thought about legalities... i just wanted relief from the extreme anxiety, i could not endure to much more of it. My pcp ended-up doing what he should have done in the first place, he was/is my first line of defense, (he went to medical school, i didn't). Am i really supposed to know better? Really?

  5. Anon, I wish there were enough pdocs around so no PCPs would try to do our work, but we make mistakes too, and it doesn't matter who prescribes the drug. If it's the right one for you it works, and vv. We all need better science.

  6. I had an appt with the pdoc this morning to check on my progress...another appt scheduled next month to make sure meds are working well. This is what needs to be done as a rule.