A tardive dyskinesia malpractice case was settled in trial following testimony by psychiatrist Peter R. Breggin, M.D. on behalf of the plaintiff in November 2001. The settlement amount was not disclosed but was considered more than satisfactory by the plaintiff. Dr. Breggin was the plaintiff’s only expert. Dr. Breggin has a longstanding concern about tardive dyskinesia and first began writing and warning about it twenty years ago.
Tardive dyskinesia is a drug-induced movement disorder that is usually irreversible. There are no adequate treatments. Drugs that are used to treat psychoses, such as schizophrenia or mania, can cause tardive dyskinesia. The FDA has mandated that all neuroleptic or antipsychotic drugs carry a uniform warning about causing tardive dyskinesia. These drugs include Zyprexa, Seroquel, Risperdal, Geodon, Clozapine, Thorazine, Serentil, Mellaril, Prolixin, Haldol, Loxitane, Moban, Trilafon, Orap, Navane, and Stelazine.
Other drugs used to control gastrointestinal disorders can also produce tardive dyskinesia, including Reglan, Compazine, and Propulsid.
The abnormal movements of tardive dyskinesia can afflict any muscle group of the body, including the face, eyes, mouth, tongue, larynx, neck, shoulders, torso, diaphragm, arms, legs, feet and hands. The disorder can impair the ability to walk, to speak, to breathe and to swallow. It is highly variable in expression and severity. One variety involves painful spasms of muscles that can literally torture the unfortunate victim (tardive dystonia). Another variety involves a potentially agonizing inner agitation that drives people to move their arms or legs, or to pace (tardive akathisia). Some cases are painful, disfiguring, exhausting and ultimately disabling. Sometimes serious cognitive problems or dementia (tardive dementia or tardive dysmentia) can occur.
Tardive dyskinesia can afflict children and infants. Infants develop the disorder when they are given medications such as Reglan, Compazine and Propulsid for gastrointestinal disorders. Dr. Breggin has been in an expert in several cases in which Risperdal has caused tardive dyskinesia in children. Sometimes the drugs were mistakenly prescribed for the control of behaviors that were in fact caused by stimulant drugs that the child was already taking.
Tardive dyskinesia often looks so “strange” or “bizarre” that it is mistaken for a “mental illness” rather than a neurological disorder. The longer the tardive dyskinesia patient continues to be treated with the offending neuroleptic drugs, the more likely that the patient will develop a severe and disabling case. Therefore, it is critical to identify the earliest possible signs of the disorder and to stop all neuroleptic medication as quickly as possible.
The identification of the disorder is made difficult by the tendency of neuroleptic drugs to suppress or mask the very symptoms they are causing, so that the symptoms abruptly break out when the drug is reduced or stopped.
Doctors must be very careful to limit the use of neuroleptics and to periodically examine patients in a thorough fashion for signs of abnormal movements. Physicians should educate patients and families about the dangers of tardive dyskinesia. They should document in the record informed consent, the justification for the neuroleptics, plans for future discontinuation of the drugs, and periodic examinations for tardive dyskinesia.
Thus far, all five tardive dyskinesia cases that have gone to trial with Dr. Breggin as an expert witness have been won or settled in favor of the plaintiffs. These five cases have taken place in Pennsylvania, Louisiana, New Jersey, Alaska and Canada. In four of the cases, the jury found for the plaintiff. One jury award was for $6.7 million. In the fifth and most recent case, the defendants settled after Dr. Breggin’s testimony and therefore the case did not go to the jury.
In examining the reasons for success in these cases, Dr. Breggin stated that the standards of care in regard to neuroleptic treatment and tardive dyskinesia are among the most clearly defined in psychiatry. When they are ignored or disregarded by physicians, the results can be devastating to the patient.
Attorney Danny McGlynn of Baton Rouge, Lousiana was the trial lawyer for the Pennsylvania and Lousiana cases, and has developed considerable expertise in this arena.
Dr. Breggin has also been a medical expert in several dozen other tardive dyskinesia suits that have settled before going to court. The settled cases include malpractice suits against doctors and health facilities, and product liability suits against manufacturers of antipsychotic drugs. Only the most difficult cases tend to end up in trial.
The latest case took place in New Jersey and involved allegations of malpractice against doctors and a clinic. (Daye vs. University of Medicine and Dentistry of New Jersey et al. in the Superior Court of New Jersey Law Division: Essex County.) The plaintiff was an African-American woman who was treated as an outpatient with several different neuroleptic (antipsychotic) drugs. She developed severe tardive dyskinesia and tardive dystonia. Her neck and her back were especially afflicted, causing a painful arching (extension) of her muscles. She also suffered from facial grimaces. The tardive dyskinesia disabled and disfigured her, and tended to make her look mentally ill.
Dr. Breggin testified that the plaintiff”s doctors had not properly informed and educated the patient about the dangers of tardive dyskinesia, that they had failed to properly monitor her, and that they had failed to diagnose the disorder in its early stages when it may have been reversible. He testified on a variety of related medical topics, including the nature of clinical trials and the FDA drug approval process.
The attorneys for the plaintiff were Jack Wurgaft and Eric Kahn.
For further documentation and detailed discussions of the harmful effects of neuroleptic drugs, including tardive dyskinesia, consult the following books:
(1) Peter Breggin, M.D. Brain-Disabling Treatments in Psychiatry (Springer Publishing Company, 1997, updated and revised 2008) for extensive scientific analyses of neuroleptic drug effects and also standards concerning clinical trials for the FDA approval of drugs.
(2) Peter Breggin, M.D. and David Cohen, Ph.D., Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medication (Perseus Books, 1999) for a more popular, abbreviated discussion of neuroleptic drug effects.