The Case of the Forgetful Psychiatrist

Sometimes psychiatrists forget they are medical doctors.

I was consulted by a family whose daughter, aged 19, had been a short-term psychiatric patient. She was suffering from a bout of depression, possibly brought on by diabetes. At the time I was consulted, this young woman was in what turned out to be a persistent vegetative state. Tragically, this young woman had gone from a vibrant teenager with her whole life ahead of her to being totally helpless and requiring round-the-clock care.

The girl was somewhat overweight but didn’t appear unhealthy, per se. I only ever saw her lying down. She would move very little, occasionally turning her head from side to side and making quiet noises. Her sleep cycle was normal, but when she was awake, her eyes had a blank look to them. She wouldn’t turn to look when someone spoke to her, but if her mother squeezed her hand, she had the sense the girl was squeezing back.

The parents demanded answers! What had happened to cause this horrible, tragic outcome for a psychiatric patient, their young daughter.

The mother was animated and impassioned, but clearly deep in her grief. The father was less expressive, showing far more subdued emotions and speaking in a dry, distant manner that was likely driven by the tragedy.

Albany is blessed with what is often called the “country club” of psychiatric institutions: the Capital District Psychiatric Center, which is where this young woman was being treated. Well regarded for its care in most cases, the CDPC was housed in a modern but austere building. All concrete and glass, it had a strong institutional appearance that did not convey warmth.

The CDPC is located on New Scotland Ave., adjacent to a tertiary-level hospital, the Albany Medical Center Hospital. It’s a neighbor of a variety of institutions. Nearby, is the Albany School of Pharmacy, Albany Law School, the Veterans’ Hospital, and a large office building dedicated to the New York State Office of Mental Health. Given its location, patients at the CDPC receive medical and sometimes psychiatric staff services from Albany Medical Center when necessary.

Yet, unfortunately, this young woman, who suffered from diabetes, did not receive even a minimum standard of care as a diabetic patient.

In the usual way with this kind of situation, I asked the parents to obtain her medical records from both her personal physician and the CDPC. I do this sometimes bearing in mind that, if I as an attorney ask for those records, it can stir up unwanted curiosity on the part of the staff. This can lead to an extraordinarily defensive attitude from the institution, which impedes my investigation.

I told them I would review all the records and try to give them an answer. I submitted them to an internist who lives in the Albany area. He could find no explanation for the outcome of this patient. He certainly couldn’t tell me if the patient’s care was improper.

The parents were frustrated and disappointed to hear that. They urged me to persist and to try to discover whether their daughter’s fate was sealed by some innate genetic factor that caused this outcome or whether there was some other missing piece.

I agreed. This was still a puzzle to be solved.

At that point, I upped the ante and consulted with a diabetes specialist in New York City. This doctor had worked with someone who is considered to have written the book, if you will, on diabetes. He examined the records and tentatively came to the conclusion that this patient should not have fallen into this comatose state. But again, there seemed to be a missing piece.
Unlike the first doctor, he did believe there was malpractice but didn’t have the information that could lead us to a successful court case.

This young woman had been a patient in a state institution, which meant if there was going to be a lawsuit it was against the New York State and would be heard in the New York State Court of Claims. When you sue New York State, you don’t get a jury; there is no sympathy factor involved. You get a judge hired and paid for by New York State, with no community input whatsoever. You have to bring these lawsuits only when you have all the evidence.

I decided to do some extra sleuthing to try to find out if there was a missing piece that would give my New York City medical expert the ability to give a strong opinion that would hold up in the Court of Claims.

Years earlier, I had consulted with a nurse who had gone to work at one point in her career for the New York State Commission on Quality Care. It was her job to investigate institutions everywhere in the state to make sure that patients were getting the appropriate level of medical care. She had all the appropriate training for this. It was her job, in this role, to investigate complaints from patients and interview medical personnel. She was very well qualified to investigate and come to an initial determination if what might amount to medical malpractice had occurred in state institutions.

Believing that there was some key information missing but not sure where to look, I called her up and we met at my office. She said that she was familiar with the CDPC and had investigated complaints there. After hearing about the case, she asked what turned out to be a very dramatic question:

It appeared on the surface that we did have them all–the doctor’s records, the nursing records, etc. Then she dropped a bombshell. She said that CDPC nurses kept an informal journal of records on patients that did not constitute formal patient records.

I went to the judge and mentioned what I had learned, but not the source.

The judge called for a conference with the Assistant Attorney General. They seemed skeptical that there might be additional, informal notes, but they did not resist. The AAG agreed to look into it. Shortly thereafter an informal set of notes was delivered to our office. Those notes revealed the real reason why the patient had succumbed to this fate.

My expert reviewed them and said, “This completes the picture. It’s now obvious what happened.”

We went over the notes together. For several days, the patient was suffering from incredible thirst. She was drinking so much that at one point she was found bent over the toilet bowl drinking from it.

This was both shocking and disgusting! The young girl must have been so thirsty and was demanding so much water that the nurses simply stopped trying to fulfill her needs.

A raging thirst from a diabetic indicates that the insulin is out of control. Unless it is brought into balance and treated immediately, the patient can end up in a diabetic shock. If this isn’t treated properly and quickly, the patient can then fall into a comatose state.

That’s what had happened here. Not only did the CDPC not recognize what was happening to this patient, but when the patient was sent to Albany Medical Center, the error was compounded by the emergency room staff not being made aware that they had a diabetic patient who was about to crash permanently.

Shortly thereafter we were granted a trial by the state judge. The Assistant Attorney General appointed by the state to defend the state was James King. King would go on to become the judge who presided over a case I brought against the New York State Highway Department, which resulted in the largest personal injury award in history against the state.

We had done all the usual pre-trial procedures. The patient couldn’t be deposed because of her condition. However, the defense had to produce the attending physician in charge of the patient’s care.

This doctor was a psychiatrist. During our deposition, she had a shallow, bureaucratic demeanor. Her answers were nothing short of a disaster for the state. She didn’t seem to have known much about the diabetic condition of the patient. She was unaware of what was happening to the patient, offered no diagnostic opinions of any kind, and seemed to have no recollection of anything she had ever learned about diabetes in medical school. In short, her callous responses indicated that she had forgotten she was a doctor.

At trial, I suggested to my partner that we should call the psychiatrist as a witness to show the level of medical ignorance that led to this unfortunate outcome. But, under oath, an amazing transformation took place. This psychiatrist was no longer ignorant. Apparently, she had taken the time to bone up on diabetes and gave standard answers to the questions we asked. When we asked her about the raging thirst of the patient, she claimed to be ignorant of that and authoritatively stated that if she had known about it, she would have known what to do and done it.

This surprise was going to work against us. My partner and I discussed it and needed someone to fill in the gap in our case. We needed a critical care specialist who could testify on the care required of a diabetic whose insulin was out of control.

We finished with the state’s witness on a Friday. On Sunday, my partner and I drove up to Schenectady to visit Ellis Hospital’s Critical Care Unit.

Normally we would have sought out someone at Albany Medical Center Hospital. However, that was where the patient was treated when she was moved from CDPC. We were worried that CDPC was going to avoid liability by claiming the hospital was at fault. We needed an expert who could testify that by the time Albany Medical Center saw my client, she was already too far gone, which would put the onus entirely on CDPC.

Dr. Yannios was the only critical care physician working that night, and he only had a few minutes to speak with us. We sat together in the cafeteria of the hospital and outlined the case and asked if he could testify on Monday about the level of care required to prevent a bad outcome for a diabetic patient in this condition.

Dr. Yannios was completely taken with the details of our case, and he empathized with the tragedy of our client. As our final witness, he gave dynamic testimony and sealed the case for us. Then it was the state’s turn to put on any defense they had.

The judge took an adjournment and asked that the defense and plaintiff agree on the order of witnesses. Before we could, King, the lead defense attorney, came over to us. He leaned over into my ear and said,

We told the judge, who then asked, “What will it take to satisfy you? What kind of verdict are you looking for?”

Among the evidence we put on was the prospective costs of caring for this young woman if she lived a normal lifetime. King and I sat down and discussed the economics of the case, as well as the pain and suffering the client had endured before falling into her state. We also discussed her ongoing suffering—there was proof, provided through an expert, that even though the patient was in a semi-vegetative state, there was a level of consciousness and awareness that would constitute extraordinary pain and suffering.

We came to the conclusion that a settlement of $5.5 million would be appropriate. This was, at the time, the largest medical malpractice award ever against New York State.

The judge’s decision was on the front page of the New York Law Journal. This publication has a statewide circulation and keeps lawyers up to date on decisions and other issues involving legal matters.

The family was astonished at the verdict and the size of the award. It gave them a small amount of comfort, with the girl’s mother stating, “Now we can give Tara the care she deserves.”

Sadly, the young girl did not live a normal life expectancy. The family took good care of her at home. A specialized environment was set up for her. Yet despite their best loving care and medical attention, she only lived a few years before she passed away.