In 2014, psychiatrist Peter R. Breggin, MD was the medical expert in the case of Joseph Mazella vs. William Beals, MD, in Syracuse, New York. Mr. Mazella committed suicide by stabbing himself multiple times in an exceedingly violent death. The jury awarded $1.4 million to the surviving family.
Dr. Breggin testified that the negligent prescription of the antidepressant Paxil (paroxetine) caused Mr. Mazella’s condition to deteriorate, ultimately causing or contributing to his suicide. In addition, Dr. Breggin testified that Dr. Beals abandoned the patient, further causing or contributing to the tragic outcome.
In June 2016, the NYS Court of Appeals overturned the verdict and ordered a new trial. Citing Dr. Breggin’s testimony, the Appeals Court specifically found that the evidence presented was sufficient to support the verdict. However, it also found that the trial court abused its discretion in admitting evidence concerning the defendant doctor’s negligent treatment of twelve other patients. The court found that this information was irrelevant to defendant’s liability in Mr. Mazella’s case and unduly prejudiced the jury against Dr. Beals.
At the start of the new trial on May 8, 2017, the defense raised a Frye challenge, claiming that Dr. Breggin’s opinions concerning Paxil during the original trial lacked scientific evidence. They asked the judge to exclude Dr. Breggin from testifying about any harm caused by Paxil. Frye refers to a standard for admitting scientific evidence at trial. In a Frye hearing, the court must determine if the expert’s scientific technique or method for developing the evidence was consistent with methods generally accepted by experts in the particular field.
Before Dr. Breggin’s rebuttal affidavit, the defense seemed certain they would disqualify his opinions as unscientific and they adamantly refused to settle the case before retrial. The Frye hearing centered on Dr. Breggin’s report, which cited and presented copies of 37 scientific publications to bolster his opinions expressed in his affidavit.
The trial judge found that Dr. Breggin’s report did present sufficient scientific evidence for all of his stated opinions, and the defense settled the case on the following day before Dr. Breggin could take the stand.
Dr. Breggin’s successful response to Frye challenge marshalled the latest science on the following points:
(1) Scientific studies confirm that the SSRI antidepressant Paxil (paroxetine) can cause suicide in adults;
(2) Scientific studies that also confirm that all SSRI antidepressants as a group can cause suicide in adults;
(3) Scientific studies that long-term exposure to SSRIs such as Paxil can cause a worsening of the patient’s condition including sexual dysfunction, apathy, anxiety and worsened depression;
(4) Scientific studies that SSRI-antidepressants can cause especially violent suicides, such as the multiple self-inflicted stabbings in Mr. Mazella’s case;
(5) Scientific studies that Paxil withdrawal can cause or contribute to suicide.
Background of the Case
Mr. Mazella’s primary care doctor referred him to defendant Dr. Beals who is an internist who presents himself as specializing in mental health and addiction issues. Dr. Beals prescribed Paxil for Mr. Mazella for 11 years without seeing with him and without having a telephone conversation or any other meaningful contact. Dr. Beals admitted in retrospect that he had been negligent in not seeing his patient for so many years; but he denied that Paxil could cause or contribute to suicide in adults or that he had been negligent in prescribing the drug to Mr. Mazella.
After 11 years on Paxil, Mr. Mazella experienced the abrupt onset of new psychiatric symptoms, and he phoned Dr. Beals who was on vacation. Without seeing Mr. Mazella or referring him elsewhere, and without having access to his medical records, Dr. Beals on the phone doubled Mr. Mazella’s Paxil from 20 mg to 40 mg. He also added the potent antipsychotic drugs Zyprexa 2.5 mg and doubled it, again by telephone, on the following day.
Immediately after these dose changes, Mr. Mazella experienced severe worsening of his anxiety and depression, with fears of having a heart attack, and he sought treatment at an emergency room. After clearing him physically, the emergency room sent him to the city’s short-term emergency psychiatry facility called CPEP. Doctors at CPEP changed Dr. Beals’ treatment regimen by reducing Mr. Mazella’s dose of Paxil. They also stopped his Zyprexa and added a benzodiazepine to calm his anxiety. This led to an improvement in his condition.
One week later Mr. Mazella and his wife finally saw Dr. Beals for the first time in 11 years. By then, Mr. Mazella was feeling better, probably due to CPEP’s reduction in his medication, and possibly due to the addition of the benzodiazepine.
According to Mrs. Mazella, Dr. Beals was very angry that his patient had sought emergency treatment instead of calling him again or waiting for his return. He was especially angry that his existing treatment orders had been over-ridden with the reduction in the dose of Paxil, the discontinuation of the Zyprexa, and the addition of the benzodiazepine. According to Mrs. Mazella, her husband became very upset at Dr. Beals criticism, and Dr. Beals in turn refused to see his patient again, telling him to go back to CPEP for his treatment. Dr. Beals made no provision to follow up with Mr. Mazella until he could find another doctor to take over the case.
The meeting with Dr. Beals left Mr. Mazella in a state of extreme anxiety and depression, and Mrs. Mazella immediately took her husband again to CPEP. Two CPEP evaluations confirmed Mrs. Mazella’s description of the alleged abandonment and its negative impact. The psychiatrist in charge concluded, “This rejection, abandonment, and invalidation by Dr. Beals has affected him greatly on an unconscious level. I believe this is an additional stressor that contributed to another setback.”
It is very unusual for a psychiatrist to write into a medical record such a severe criticism of a colleague in his or her own community. Her language indicated that she believed Mrs. Mazella description of the abandonment.
Based on review of the medical records for the first trial and again for the second trial, Dr. Breggin concluded that Dr. Beals did abandon Mr. Mazella. Dr. Beals denied abandoning his patient; but he did not make or record a follow-up appointment. Furthermore, he did not arrange to discuss his patient’s dire condition with CPEP or other healthcare providers, as would be expected after referring such a demoralized patient to an emergency service. He also admitted in a letter to Mr. Mazella’s primary care doctor that Mr. Mazella was recently doing better until feeling “horrible” during the session with him.
The medical records document the futile efforts of Mr. and Mrs. Mazella, and their emergency providers, to find Mr. Mazella a psychiatrist. Some of the psychiatrists they contacted did not return the calls, some said they were full, and one offered a several-months long waiting period.
Mr. Mazella killed himself 25 days after last seeing Dr. Beals and 21 days after his Paxil was changed to Effexor (venlafaxine), another antidepressant that can cause or contribute to suicide in adults.
Mr. Mazella was an esteemed member of the community, first as the coach of his high school’s state championship basketball team and then as vice principle of the high school. He had two previous, relatively short-lived, bouts of depression and anxiety, approximately 15 and 20 years earlier with complete recovery each time within a few months, once without taking antidepressants and once while taking them.
Ernest DelDuchetto was the attorney for the plaintiffs.
For More Information about Antidepressant Harmful Effects
Dr. Breggin has recently created the Antidepressant Resource Center, making an enormous amount of information available, including dozens of scientific papers as PDFs that are organized by subject matter. There are, for example, separate categories of articles on antidepressants causing suicide, violence, mania, withdrawal symptoms, and harm to fetus and newborn child of women exposed to the drugs during pregnancy. There are separate categories for articles about children and adults. For the Antidepressant Resource Center, go to 123antidepressants.com.
Dr. Breggin’s most relevant and recent books are Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families.