In a new Idaho Supreme Court case, the court issued an important ruling in a medical malpractice case as to whether a section of the Idaho Tort Claims Act (ITCA) shields the state and its employees from liability. The case also gives us a good look into SSRI malpractice lawsuits in 2023.
- Example Idaho settlement amounts and jury payouts
- Another 2023 Idaho Supreme Court medical malpractice opinion in Beebe v. Northwest Specialty Hospital
Facts of Mattison v. Idaho Department of Health and Welfare
Over the course of approximately two months, Mattson received outpatient mental health services from the defendants. During this time, she was prescribed Prozac and reported several issues related to the medication, including increased anxiety and headaches. Despite these complaints, Mattson continued taking the medication as prescribed.
On the day of her attempted suicide, Mattson described her experience as an “out-of-body” or “out-of-mind” event. She woke up, unsuccessfully tried to call in sick to work, put on her work uniform, retrieved a handgun, purchased a bottle of vodka, drank the entire bottle during her drive to the Department, parked in the lot outside, and shot herself in the head.
Ms. Mattson and her husband filed a lawsuit in 2018 against the Idaho Department of Health and Welfare and its employee, Ms. Gallegos, a certified physician assistant. The couple accused the defendants of medical malpractice and failure to obtain informed consent in connection with the outpatient mental health services Mattson received from them.
During the pretrial, the parties were deposed. After these depositions, the Defendants sought summary judgment on both claims, asserting that they were entitled to judgment as a matter of law. They claimed they had met the community standard of care in treating Mattso and obtained her informed consent. They also argued that they were protected by governmental immunity under Idaho Code section 6-904A(2).
In opposition, Mattson and her husband argued that summary judgment was not appropriate as there were disputed issues of material fact in both medical malpractice and informed consent claims. They claimed there was enough evidence of a breach of the applicable standard of care and a causal relationship to the suicide attempt for a jury to hear the case. They argued that Defendants were not entitled to immunity under Idaho Code section 6-904A(2) as it doesn’t apply to noncustodial outpatient mental health services claims. Even if immunity applied, they claimed there was a triable jury question regarding the “reckless, willful, and wanton conduct” exception to immunity.
The district court granted summary judgment to the defendants on two grounds: (1) they were immune from liability under ITCA, I.C. § 6-904A(2), as Mattson’s claims arose from injuries sustained while she was receiving services from a “mental health center”; and (2) the “reckless, willful, and wanton conduct” exception to immunity did not apply as a matter of law. The court agreed with the Defendants that immunity under Idaho Code section 6-904A(2) applied. The court also found that there was no triable jury question regarding the “reckless, willful, and wanton” exception to immunity, as it was unforeseeable that Mattson would acquire a firearm, purchase and consume an entire bottle of vodka, and then shoot herself. In other words, no reasonable person could foresee and find that the Defendants’ actions or omissions rose to the level of “reckless, willful, and wanton conduct.
The couple appealed.
Idaho Code section 6-904A(2) grants immunity for negligence claims resulting from injuries to or by individuals receiving outpatient mental health services. The Idaho Department of Health and Welfare (IDHW) is a state agency responsible for overseeing and managing various health and human services programs in the state of Idaho. So no one can argue it is not a govermental entity. And the ITCA states that a governmental entity is liable for damages arising from the negligent or wrongful acts of its employees within the scope of their employment if a private person would be liable under state law.
The plaintifss tried to jump through a loophole, claiming that the “mental health center, hospital, or similar facility” clause in section 6-904A(2) exlcludes from its grant of immunity claims by patients who were injured while receiving noncustodial outpatient mental health services. The court was not buying that argument.
The court did argue a triable jury question exists regarding whether the alleged negligence of the Defendants constitutes “reckless, willful, and wanton” conduct under Section 6-904A. Even if the government and its employees qualify for immunity for ordinary acts of negligence under Idaho Code Section 6-904A(2), immunity is not granted when the degree of negligence amounts to “reckless, willful, and wanton conduct” as defined by Idaho Code Section 6-904C(2). Section 6-904C(2) defines “reckless, willful, and wanton conduct” as present only when a person intentionally and knowingly does or fails to do an act, creating an unreasonable risk of harm to another, which involves a high probability that such harm will result. If there are enough facts for a reasonable person to find the alleged negligence of a defendant amounts to “reckless, willful, and wanton” conduct, then granting summary judgment based on Section 6-904A(2) immunity is improper, which is what the court found.
SSRI Litigation and SSRI Malpractice
This is an Selective Serotonin Reuptake Inhibitors (SSRIs)suicide malpractice case. SSRI litigation was a big thing 20 years ago. SSRIs are a class of antidepressant medications commonly prescribed to treat depression and anxiety disorders. They work by increasing the levels of serotonin, a neurotransmitter, in the brain. Some well-known SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).
SSRI suicide litigation came about because SSRIs are linked to an increased risk of suicidal thoughts and behaviors, particularly among children, adolescents, and young adults. These claims argued that the manufacturers of these drugs failed to adequately warn patients and healthcare providers about the potential risks associated with SSRIs.
There was one key expert willing to take on the pharmacutical industry 20 years ago: Dr. David Healy. He is arguably the single most powerful force that lead to the FDA conducted a review of clinical trial data issuing a black box warning for all antidepressants, including SSRIs, for the risk of suicide.
A black box warning is the strictest warning the FDA can require for prescription drugs. The warning highlights the increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants and urges healthcare providers to closely monitor patients for worsening of symptoms or the emergence of suicidal thoughts and behaviors. This effectively ended the litigation because this was the warning Dr. Healy was saying was needed. But there are still SSRI malpractice lawsuits for failing to see the signs of SSRI-induced suicide.
The SSRI Malpractice Claim in This Case
In this case, Dr. Healy testified that there were clear warning signs in Mattson’s psychiatric history that indicated a prior intolerance to SSRIs like Prozac. He noted that although Mattson’s alcohol intake was recorded, it was not recognized as a potential means to counteract the agitation caused by these drugs. Dr. Healy suggested that Defendants should have either stopped the Prozac or switched to a different class of antidepressants, such as Mirtazapine (Remeron), based on Mattson’s increasing agitation and emotional blunting within the first two weeks of using Prozac, which are symptoms of induced suicidality.
Dr. Healy further explained that Prozac was not tested on severely depressed patients at high risk of suicide, like Mattson, and has little benefit for treating severe depression. Moreover, had Defendants adequately warned Mattson and her husband about the potential hazards of Prozac and the need for proper monitoring due to the risk of suicide when starting treatment, Mattson’s treatment-induced suicide attempt could have been averted.
Dr. Healy’s expert opinion on Prozac causing Mattson’s suicide attempt was based on various factors, including the induced toxic state in Mattson, characterized by akathisia (psychomotor agitation) and a degree of emotional blunting. He noted that the timeline of Mattson’s issues and the violent nature of the event align with what is known about SSRIs and suicide induction.
Ultimately, the appellate court reversed the district court’s decision regarding the alleged negligence could possibly rise to the “reckless, willful, and wanton conduct” exception to immunity. So the court is saying that the plaintgiff has alleged sufficient facts at the summary judgment stage to demonstrate that a reasonable person could find the defendants’ acts or omissions were reckless, willful, and wanton.