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Qualified Immunity Denied to Prison Psychiatrist who Prescribed Lethal Drug Combination; $450,000 Settlement

The Sixth Circuit Court of Appeals has affirmed the denial of qualified immunity to a psychiatrist in a lawsuit brought by a prisoner’s estate. The appellate court found the evidence could establish that the psychiatrist had “consciously exposed” the prisoner “to a substantial risk of death through his medical treatment without so much as a warning.” The case settled for $450,000 following remand.

When Scott Quigley, Jr., 23, was transferred from a Michigan Department of Corrections (MDOC) facility to the Charles Egeler Reception and Guidance Center in February 2008, he came under the medical supervision and care of Correctional Medical Services, the MDOC’s private contractor.

The day after Quigley arrived at the guidance center, physician’s assistant Steven Garver conducted a physical exam and prescribed 50mg of Amitriptyline (brand name Elavil) once a day, which was double Quigley’s previous prescription. A few weeks later, on March 7, 2008, Dr. Tuong V. Thai, a psychiatrist, completed a comprehensive psychiatric assessment; Quigley’s current prescription was discussed, as was adding the medication Trazodone (brand name Desyrel).

Dr. Thai prescribed 100mg of Trazodone once a day for four weeks. Three days later, Quigley was found dead in his cell. Prison charts confirmed that he had received both Amitriptyline and Trazodone during the previous three days; the cause of his death was not clearly established. In a “battle of experts,” Quigley’s estate submitted expert testimony that he had suffered a fatal drug interaction resulting in serotonin syndrome, while Thai’s experts claimed Quigley’s death was due to an epileptic seizure.

The district court denied Dr. Thai’s motion for summary judgment, in which he argued he was entitled to qualified immunity. The court found there was sufficient evidence to conclude that Quigley likely died as a result of the treatment he received for depression, and that treatment which kills an otherwise healthy 23-year-old constitutes a “substantial risk of harm warranting constitutional protection.”

The Sixth Circuit agreed, holding that Quigley’s estate had satisfied the objective component of an Eighth Amendment deliberate indifference claim by demonstrating his medical need was “sufficiently serious.” Turning to the subjective component – that Dr. Thai could infer a substantial risk to Quigley and had disregarded that risk – the appellate court held a reasonable fact finder could find for the estate on that point.

The record showed that “it is well known in the psychiatric profession that a tetracyclic like Trazodone should not be administered in conjunction with a tricyclic like Amitriptyline because the drugs exponentially increase the potency of one another, ‘lead to toxic levels and are deadly.’” Thai’s notes indicated he had discussed with Quigley his Amitriptyline prescription and explained the side effects of Trazodone, but did not advise him to not take both simultaneously or inform medical staff to not dispense both drugs.

Finally, the Court of Appeals found the right at issue was clearly established. “Obviously, if a doctor knows that his actions could kill a prisoner and takes those actions anyway without even advising of the risk, that amounts to more than a reasonable mistake in medical judgment,” the Court wrote. In sum, a doctor may not consciously expose a patient “to an excessive risk of serious harm.”

The Sixth Circuit affirmed the district court’s denial of qualified immunity. It also affirmed a state law gross negligence claim, as it was similar to the subjective component of the Eighth Amendment claim. See: Quigley v. Thai, 707 F.3d 675 (6th Cir. 2013).

Following remand, the case settled in October 2013 for a total of $450,000. Of that amount, $171,705.94 went towards attorneys’ fees and costs, and the balance of $278,294.06 went to Quigley’s mother and the personal representative of his estate.

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