I'm not sure if documenting is the larger issue in this case. I just re-read the article to see what you all meant about not documenting the Xanax. Unless you have cameras in the office, I don't see how these paper records hold much weight.
I have looked at my medical records in the past, and the documentation can be wildly inaccurate. For example, I saw a therapist recently who wrote that I began seeing a psychiatrist when I was 5 years old for OCD. In fact, I developed OCD at 5 years old, but I didn't see a psychiatrist until I was 14. Also when I had surgery for my appendix, the radiologist's report of my CT scan said I had metastasized cancer in my pelvis. Neither the ER doctor nor the surgeon noticed this—only my PCP noticed it when he finally got the report. It turned out to be a speech-to-text software issue that caused the error. And if I look back at the ICD-10 codes used to justify some of the blood work I've had done, they're just all over the map. I don't even think a doctor picks them. I think maybe a medical assistant picks one and sees if it will work because they're fairly haphazard, often not even in the same area as the test being ordered.
If I were making a case in this instance, it would have been over the specific medications and whether he was qualified to accept and treat the patient for the presenting situation. If people were practicing rational medicine, you would have to argue it's quite an edge case that a person would need two GABA agonists and to add them both in such short order. He might as well have prescribed a scotch on top of it to make sure every last receptor was saturated. Because what is the real change in this situation (with the limited info we have)? It's not this doctor. The patient was already receiving care, apparently for cholesterol and presumably other such everyday issues, and was an acquaintance and former co-worker of the doctor. No change in relationship. The only real change that we know about was the sudden introduction of three psychiatric drugs.
Also, he was prescribed Ambien by having left a message with the office. There was no evaluation. No checking for why he wasn't sleeping well. And that was AFTER he had prescribed Xanax. If you had prescribed a patient Xanax, they called your office saying they couldn't sleep, would you prescribe Ambien without seeing the patient? And would you not be concerned that after giving them Xanax and Ambien they still come in to see you just two days later?
Probably the most damning piece of evidence is that he referred his patient to a psychologist and not a psychiatrist, meaning that the doctor was going to continue assuming the role of medication provider in spite of none of his interventions having worked to that point. In fact, he didn't stop the Xanax when his symptoms worsened. He added Ambien, then re-prescribed Xanax and Lexapro. Why would you re-prescribe a drug that wasn't working? His actions indicate he thought he had a handle on this from the pharmaceutical side of things.
Perhaps it was inappropriate for him to be treating someone who was essentially a family friend.
But none of this on paper adds up to a case where it was obvious that the patient would die by suicide.
Except: The big piece of the puzzle we don't have is the patient's presentation in the appointment.
I think the surrounding circumstances of the patient continually escalating the requested level of care paint a plausible presentation of him being in dire straits.
Escalation:
Xanax prescription (unknown reasons)->Call to office regarding insomnia->Ambien prescription without evaluation->Appointment required (only two days later after Ambien script)->Xanax re-prescribed and Lexapro added, need for psychologist as decided by doctor
Who has an appointment just two days after getting a new psych drug? A desperate person.
Of note from the article:
"But Belair, the defense lawyer, contended the Shouldises were “hopeful” after the June 6 office visit and “looking forward to” the anti-depression medicine and psychological consultation, both of which Strange had prescribed.
He said the couple went about their day normal afterward, shopping and watching a TV movie at home. Mrs. Shouldis testified she had no inkling her husband might commit suicide, Belair said."
It blew my mind that this wasn't emphasized more heavily and that the jury found him guilty after this statement was made.
We don't know if that statement was made. That's what the DEFENSE attorney said that she said. It's a quotation from the lawyer, not the wife. This is what the accuser's lawyer said she said: "
Charlene Shouldis testified at trial she was concerned her husband would kill himself, and he should have been admitted to the hospital right away, Cannavo said."
The article is giving each lawyer's account of what his wife said about his suicidality, and they're saying opposite things. Given that he was given a new drug to try on June 4 and still went into the office on June 6 and was then given two more drugs that day, I would say she and he probably realized he was in an urgent situation.
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