Paxil 11.9 million dollar award

[Jules A]

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http://www.law360.com/articles/841112/jury-awards-11-9m-over-neglected-pa-jail-inmate-s-suicide

 

[st2205]

Can only see part of it. What's the alleged negligence?

 

[Jules A]

Sorry about that. Try this:
http://www.prweb.com/releases/2016/10/prweb13743675.htm

 

[Armadillos]

Already didn't like Paxil, knowing that this case is out there and that the hired gun experts apparently have Paxil on their bad list is enough reason for me to never prescribe it again.

 

[PikminOC]

Sorry about that. Try this:
http://www.prweb.com/releases/2016/10/prweb13743675.htm

thx

 

[st2205]

Though I don't use Paxil much there's certainly a place for it. I find it unfortunate if we allow fear to drive the way we practice medicine, which is one of the reasons we're in a lot of our legal messes with its beuracracy. If we all stop using Paxil not because of clinical reasoning but because of sensationalized fear, we create an artificial standard of care against which we become judged. It's why we keep admitting people for homicidal ideation and several other things that are not treatable mental illnesses -- because we're afraid of the ramifications, not because we're actually helping anything (in fact in many cases we know we're actually causing further harm). However, because of our fear we continue to create artificial standards of care to which we are then held to. As physicians, we complain a great deal about all the regulatory BS but then we never do anything about it besides bemoan our position. The only way to change is to change the culture and reset the false standards of care. That would take some time and would have a lot of people laying down as a sacrifice but if we're not willing to do that (and actually treat people for hell sake), we're going to continue going deeper down this path where each physician no longer utilizes their clinical judgement in their best efforts to fulfill their duties to their patients.

 

[Shikima]

There is no such thing as a clean pill out there. No matter what you are treating. ALL interventions (medication, medical and surgical) have some risk associated with it.

But then even trial lawyers need to eat. That is why there are so many ambulance chasers out there and they lobby congress heavily not to curb their antics.

 

[nexus73]

4 days off paxil. Restarted at 30mg. Open and shut case?

 

[Blitz2006]

When do you guys prefer to use Paxil? Its the most sedative, so I've been told its good for people who can't sleep/have anxiety. Usually tell patients to take it at night. This true? Is max dose for depression 50 or 60 mg/day?

 

[splik]

never, and there is no evidence to justify going above 40mg, it may actually be less effective above that. really the evidence is fairly damning that the harms outweigh any imagined benefit which don't appear to surpass placebo

 

[Mad Jack]

That article was written by Peter Breggin's wife on behalf of Dr. Breggin, for the record. Here's the website, linked from the article itself: http://breggin.com/

He's pretty avidly against all psychiatric drugs, not just Paxil, and advocates pretty hard against them all.

 

[Jules A]

That article was written by Peter Breggin's wife on behalf of Dr. Breggin, for the record. Here's the website, linked from the article itself: http://breggin.com/

He's pretty avidly against all psychiatric drugs, not just Paxil, and advocates pretty hard against them all.

I didn't even see the author's name until you pointed it out. Here is another one from his website with more case details:

https://www.madinamerica.com/2016/10/11-9-million-paxil-suicide-verdict-inside-story/

I thought I had heard he's been excluded as not an expert in other cases?

 

[Mad Jack]

I didn't even see the author's name until you pointed it out. Here is another one from his website with more case details:

https://www.madinamerica.com/2016/10/11-9-million-paxil-suicide-verdict-inside-story/

I thought I had heard he's been excluded as not an expert in other cases?

He's also carried a few cases as their expert. He lists a few of them on his page I'm pretty sure.

 

[Jules A]

He's also carried a few cases as their expert. He lists a few of them on his page I'm pretty sure.

Right on, his 30 page resume lists many.

 

[Liquid8]

Had to google this Breggin guy, somewhat concerning that the first page of results has links to quackwatch: http://www.quackwatch.org/11Ind/breggin.html

 

[Bartelby]

The award seems quite excessive, and Breggin is a well known critic of psychiatric medications. In his own article he says that the defendant was in jail for vandalizing the property of a competing business and that paxil (which the defendant had been on for years) was the reason the defendant committed that crime (seriously, look at the link posted above!). It sounds like he's willing to testify that paxil is responsible for any bad behavior a person exhibits while taking it. That said, akathisia could have contributed to the suicide. We don't know anything other than medication dosing and that the patient appeared to be in bad shape when a psychologist saw him so who knows?

With that said, I think that this is more of a cautionary tale about doing lazy assessment and management rather than a prohibition on paxil use. It seems the ordering psychiatrist never evaluated the patient at all. The psychologist, who apparently evaluated the patient later, said the patient was "extremely anxious and like a “cornered rat,” spoke very little, made poor eye contact, and looked hunched over and withdrawn." Despite this the psychologist did not evaluate the time course of the patient's symptoms, did not evaluate for suicidal thoughts, and only documented "rule out depression."

I think if we demonstrate that we gathered the relevant data and exercised clinical judgment juries are likely to be kinder in their assessments, even if there is a bad outcome.

 

[Jules A]

It seems the ordering psychiatrist never evaluated the patient at all. .

It is concerning because as often happens we continue OP medications on admissions and don't see them until the next day, in jail it can be several days later, or not at all if another provider takes their case. Would the argument have been the psychiatrist was negligent for not starting the patient on his long term well tolerated OP medication which contributed to his suicide if the initial order had been reduced?

 

[st2205]

It is concerning because as often happens we continue OP medications on admissions and don't see them until the next day, in jail it can be several days later, or not at all if another provider takes their case. Would the argument have been the psychiatrist was negligent for not starting the patient on his long term well tolerated OP medication which contributed to his suicide if the initial order had been reduced?

Exactly.

I don't know about the specifics of this case but here in the real world we're constantly admitting people who have no idea what they're taking, when they last took it, what the dose is or even what they're taking it for.

 

[MLT2MT2DO]

4 days off paxil. Restarted at 30mg. Open and shut case?

Is SI dose dependent?

The guy didn't get sued for causing the patient explosive diarrhea...

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