Dan Ryan and Christine N. Dantonio recently obtained a defense verdict in favor of an internal medicine physician in the Court of Common Pleas of Chester County, Pennsylvania, in a case involving claims under the Wrongful Death and Survival Acts following the suicide death of the plaintiff’s wife. 

The decedent, a Certified Registered Nurse Practitioner, knew the defendant physician from working with him in the past.  In January, 2010, she sustained multiple fractures to her pelvis from a fall in her home.  Following admission to the hospital, the decedent was transferred to a skilled nursing facility where she requested that the defendant physician treat her.  She made good progress and was discharged from the skilled nursing facility in early March.  Thereafter, the decedent began to experience incapacitating pain in her left buttock and groin areas.  She was subsequently diagnosed by her gynecologist as having pudendal neuralgia, a painful neuropathic condition that is caused by inflammation of the pudendal nerve.  When she returned to the defendant physician in April, the medication Neurontin was prescribed to help with the decedent’s pain, and this medication was slowly titrated up.  In early May, the decedent complained of some depression secondary to her pain, in response to which the defendant physician prescribed the anti-depressant Lexapro.  Subsequently, another physician recommended that the Lexapro be increased and that the pain medication Ultram be added.  The defendant physician agreed and made the necessary adjustment to the decedent’s medications.  However, the decedent developed the side effect of hand tremors, and therefore, the doses of Lexapro and Ultram were decreased.  Plaintiff’s pain continued, eventually requiring the Ultram to be discontinued in favor of a narcotic pain medication.  During this time period, the decedent had no obvious signs or symptoms of severe depression or suicidal thoughts.  Tragically, she took her own life on May 27, 2010.

It was alleged that the defendant physician negligently increased the risk of harm to the decedent by failing to warn her and her husband of the potential side effects of Neurontin; significantly, its association with an increased risk of suicidal ideation and behavior.  Plaintiff further alleged that the defendant physician deviated from the standard of care when he failed to discontinue Neurontin following the decedent’s complaints of depression and hand tremors, failed to send the decedent for a psychiatric evaluation, failed to refer the decedent to a pain management specialist, and by prescribing a “dangerous mix” of medications. 

Defendants presented expert testimony that the use of Neurontin was appropriate, as was its combined use with Lexapro, Ultram, and Vicodin to treat the incapacitating nerve condition suffered by the decedent.  The jury was also presented with evidence that the decedent was proactive in her own care and was seeking out specialists all over the country for treatment of her condition.  However, the decedent quickly learned that even with aggressive therapy and/or surgery, there was no guarantee of a cure.  Given the lack of severe depression or suicidal thoughts by the decedent, it was argued that the decedent’s tragic demise was the result of her realization that she would never be able to return to her prior life as a Certified Registered Nurse Practitioner, wife, and mother. 

The jury deliberated for approximately two hours and returned an 11-1 verdict in defendant’s favor, finding that the defendant physician’s treatment of the decedent did not deviate from the standard of care, and therefore, he was not negligent.