You Can’t Blame the Patient

Physicians generally know when patients try to manipulate them. Juries may also discern a patient’s attempt to manipulate. But it would be a mistake for a physician to rely upon proving a patient’s manipulation as a defense in a medical liability lawsuit.

A 50-year-old woman was a long-standing patient of Dr. IM, an internist. Over a ten-year period, Dr. IM saw the patient for various routine complaints: coughs, back pain, and minor ailments. Unknown to Dr. IM, the woman had a documented history of recreational drug abuse, including cocaine and once, LSD. Other doctors’ records revealed the woman’s use of Fiorinal some 15 years before the events in question.

The treatment in dispute began with the patient’s complaints to Dr. IM of excruciating headaches. Over the next two years, Dr. IM wrote over two dozen prescriptions for Valium, Fiorinal, and Tylenol #3. During one of those years, the patient received numerous new prescriptions from Dr. IM without undergoing another examination.

Finally, Dr. IM wrote a prescription for Fiorinal and specified “No Refills.” Less than a month later, the patient obtained a prescription for Fiorinal and Valium from another physician. Four months later, the patient filled a similar prescription from yet another physician.

Some three years after Dr. IM’s treatment of the patient’s “headaches” she was finally admitted to a drug rehabilitation facility. The attending physician noted that the patient was taking 10-20 pills of Fiorinal per day, her “drug of choice.” The patient and her husband sued Dr. IM for negligence and blamed him for her drug addiction. The suit claimed emotional distress and $60,000 in lost income.

Upon review, it was clear that the patient had acquired her addiction to Fiorinal even before Dr. IM began treating her “headaches.” Nevertheless, inadequate charting for the extraordinary number of prescriptions, the absence of any referral to a neurologist, and too few examinations presented challenges to defense counsel. Even if all the prescriptions and dosages were justified, Dr. IM would still be susceptible to a charge that he failed to warn the patient of the dangers of addiction to the medications.

Of course, patients must bear responsibility for their own health care choices. Cases such as this, however, show that patients who undermine the physician’s role in their treatment are only too quick to place the blame for the result on anyone but themselves.

Gordon Ownby, CAP-MPT’s general counsel, can be reached at gownby@cap-mpt.com.