William D. Kickham
William D. Kickham
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My readers of this blog know that I’ve previously written about the subject of bullying (a 3-Part post; after reading each post, click on “Next” to take you the Parts 2 and 3) in schools in Massachusetts – and of the tragic consequences that follow. The last time I wrote of this subject, had to do with the suicide death of Carl Joseph Walker-Hoover in the New Leadership Charter School in Springfield. Just a few weeks ago, the equally horrific story of Phoebe Prince was placed before a stunned public. Phoebe Prince was a beautiful young girl whose family recently emigrated from Ireland, to start a new life here. Except that new life was met with death – death at the hands of a sadistically cruel group of ‘mean girls’ from the school Prince attended, South Hadley High School. Those girls targeted the Prince girl because she was apparently the object of a male student’s attention. (It’s also been stated by more than one person at the school, that these girls targeted Prince because she was pretty.) The girls repeatedly bullied the Prince girl, taunting her physically as well as through mentally sadistic use of social media such as Facebook and MySpace, calling her a ‘slut’ and worse. The Prince girl’s parents approached the school’s administrators on more than one occasion, pleading with them to take strong steps to protect their daughter from these abusive classmates, only to see the mildest, most anemic of responses taken to protect this poor girl.

On January 14 2010, Phoebe Prince went home and hung herself in her closet. Her sister found her.

The shocked protests from parents throughout the town arose, their voices shocked and sickened. The South Hadley police promised a ‘full and complete’ investigation. The media both reported on – and editorialized on – the school’s failure to act aggressively to protect the girl. Legislators fumed about “doing something about this” in the state legislature. All the while, the South Hadely School Department engaged in two predictable – and pathetic – tactics: Demurral and denial. And the sadistic ‘mean girls’ who essentially murdered this innocent youth? Whose repeated assault and battery and mental torture drove her to take her own life? Legally, they may be untouchable. There may be nothing that can be done to prosecute them. These twisted, ugly girls (ugly in the deepest, most lasting sense,) were actually widely rumored to openly laugh at how they ‘snowed’ police investigators who earlier questioned them about their actions and Prince’s suicide. It’ not yet clear that the Northwestern District Attorney’s office, might be able to prosecute these girls.

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It’s no secret among people who know me, that, as a Boston Massachusetts product liability lawyer, I’m one of the sharpest critics in the legal community of the pharmaceutical industry, and particularly, pharmaceutical advertising. Yes, I’m fully aware of the societal value that pharmaceutical companies can and do bring to bear, in addressing a number of diseases and medical conditions. And I believe that they are entitled to make a healthy profit in so doing. But what I’ve – and we’ve – all witnessed in the last 10 or 12 years, is the way that pharmaceutical companies pimp their products to the general public through television, radio, and print advertising. It is often obscene, and in my opinion ought to be legislated as illegal. However, there’s a sticky little thing called “commercial free speech”, which delves into an entirely separate subject of First Amendment issues, which I won’t distract my readers with right now. Not that it isn’t very important, but I’ll save that for another day.

Long gone are the days when pharmaceutical company sales reps solely called on – of all things – doctors’ offices – to sell their products. No, they got around that. Their thinking: “Why rely on doctors to write prescriptions for our products, when we can generate demand at the consumer level? Yeah, we’ll flood print and broadcast media with ominous-sounding ads showcasing all kinds of diseases and medical problems, and in the process, get millions of people to march into their doctors’ offices, and demand to be given prescriptions for our products.” This seemed like an even surer bet than taking doctors out to lunches and dinners, and hosting them with everything from golf outings to “professional seminars” at warm, sunny destinations. (Which they still do, but that practice has been gradually dropping, as regulators see more and more how incestuous and unethical a practice it obviously is.)

Take a little test: The next time you’re watching a TV show (ideally during prime time, (8:00-11:00 PM,) keep a pen and paper next to you. Write down the number of advertisements that you see about any kind of drug or health product. Ninety per cent of the time, it’s a pitch from a pharmaceutical company, talking about the horrors of this or that medical condition, and urging you to “Ask your doctor about_______.” Do the same thing the next time you’re reading a newspaper or a magazine. Or listening to the radio (except when driving.) Chances are you’ll realize that the average viewer, reader or listener is inundated, constantly, by drug companies trying to get you to “Ask your doctor” about whether you “might have” some medical problem or condition, and whether their product “might help you.” Not only are ads in newspapers across the country regular fare, but full page ads. Any idea what a full page ad in an average major city daily newspaper goes for, say, Monday through Friday? About $10,000.00 – and more on weekends. Hawking everything from Aspirin to Zithromax, for every condition from high cholesterol to depression to heart disease to smoking, they never cease their constant drumbeat to “Ask your doctor about ______.”

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Here’s an interesting case – far from decided or even litigated yet – but interesting nonetheless. It’s a hybrid of both medical malpractice and wrongful death (actually, wrongful death arising from alleged medical negligence.)

The parents of two young children, whose mentally ill aunt literally carried them to their deaths on a Lowell highway in 2008 have sued McLean Hospital in Belmont, alleging that the hospital was negligent in treating the woman, Marcelle Thibault, 39, whose actions killed the children and herself.

Ken and Danielle Lambert, of Brentwood, New Hampshire, argue in the complaint filed in Suffolk Superior Court that the renowned Massachusetts psychiatric hospital provided negligent care to Danielle Lambert’s identical twin sister, Marcelle Thibault, and is therefore legally responsible for the wrongful deaths of their 5-year-old daughter, Kaleigh, and 4-year-old son, Shane. Thibault, the children’s aunt, was also was killed on Jan. 11, 2008, when she intentionally carried the children into high-speed traffic on Interstate 495 in Lowell. Following the deaths of their children and Thibault, the Lamberts told the Boston Globe that psychiatrists had diagnosed Thibault with bipolar disorder in September 2007 and discharged her six days later after prescribing psychotropic drugs and outpatient therapy.

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It’s January. It’s snowing. It’s Massachusetts. Add it up, and you’ve got plenty of skiers here. As just as much as going to the beach in summer is popular here, so is skiing in winter. Though not all skiing is downhill (vs. cross-country,) most is – and without a doubt, most of the injuries that result from skiing, involve the downhill variety.

Downhill skiing is dangerous business. Anyone who’s ever done it, can attest to this. Even the least challenging “Bunny Trails,” can pose significant risk to a skier – whether novice or experienced. Witness the death last year of Natasha Richardson, Liam Neeson’s late wife. She was on skis, but barely moving, and fell down, striking her head against an icy surface. She died from a subdural hematoma that resulted from the impact. True, most ski injuries result from moderate to high-speed collisions, but this tragic event illustrates the point: Skiing is very dangerous.

With that reality in mind, and considering the number of persons who frequent commercial ski resort operators in this state every winter (hundreds of thousands) you’d think that there would be a lot of injuries each year, and a lot of lawsuits against ski operators. You’d be right as to the first, wrong as to the second. Why? Because the ski resort industry, both nationally and in Massachusetts, is very powerful. A multi-billion dollar industry, the ski resort industry has successfully exerted their influence in both the Massachusetts state legislature, and in the courts, to limit their liability for injuries occurring at their facilities. The result, historically, has been a very hostile environment for plaintiffs seeking to hold commercial ski resorts liable for injuries that occur as a result of their negligence. In the past 20 years, successfully bringing such a suit, never mind winning one, has been a daunting legal task. The reasons have been due to a combination of very strict legislative enactments pushed into law by the ski resort industry, as well as judicial rulings that have been very hostile to plaintiffs.

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2009 ended with a big bang when it comes to Massachusetts injury law, specifically, Massachusetts medical malpractice. A lot of legal specialists such as me are paying close attention to a jury verdict that was handed down last month in a Suffolk County medical malpractice case: A $15 million award to the parents of a boy who died after being treated at Children’s Hospital in Boston.

The case, brought by the parents of a 3 year-old boy who died in December 2004 after undergoing surgery for a birth defect at Children’s Hospital, has caught the attention of both plaintiffs lawyers as well as insurance defense attorneys. The boy’s parents, Brian and Andrea Fox of Philadelphia, said they brought the suit because they believed that doctors at Children’s Hospital had lied to them about the treatment their son received at the hospital. After four days of deliberations in Suffolk Superior Court, the jury found that two doctors at the hospital caused the boy’s death: Dr. James Lock, and Dr. James A. DiNardo, an anesthesiologist. Dr. Lock had until last year been the physician in chief at Children’s Hospital.

Massachusetts juries have awarded medical malpractice awards of this size before (awards this high don’t happen often, but they have happened.) What’s unusual about this jury award is not only its amount, but the fact that most jury awards, and non-jury settlements, of this amount, are given when the victim is still alive, and will require several or many years of specialized medical and custodial care. Awards and settlements of that size are designed to pay for the future expenses of such care, which over time can easily cost millions. So when a jury awards damages that are this high, in a case where the victim is deceased, it’s very noteworthy. Also important: The boy’s parents will not receive the full $15 million, but an un- unspecified, lesser sum. This is because the attorneys for the plaintiffs and the defendants entered into an agreement before the case went to the jury, informally called a “High-Low Agreement.” This agreement is designed to guarantee the plaintiffs a minimum amount of damages, regardless of the jury’s verdict, in exchange for a cap on a possibly higher damages figure that the jury may award. Lawyers for both parties would not reveal what this figure is, and that too is standard procedure: These agreements are under seal. The jury did not know this, however, and what’s outstanding here is, not knowing this, how much they awarded the plaintiffs.

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In my last post, I discussed the importance of a jury being able to see the amount of medical bills that were generated to pay for a plaintiff’s medical care – vs. the amount of discounted medical bills actually paid by a health insurer (as part, of course, of a suit alleging injuries caused by a defendant’s negligence). At trial in July 2006, in the case I blogged about previously, the defendant (Griffith) argued that because the plaintiff (Law) did not have to pay the full $112,269 that was billed for her care by her medical providers, only the lower, discounted figure that was actually paid by her health insurer – $16,387.14 – should be shown to the jury for the purpose of their assessing any damages. In that Superior Court case, the judge in that case agreed with the defendant – a highly unusual ruling, given state precedent in these cases. The result: The jury was only allowed to see the $16,387.14 figure. And the result of that? The jury awarded this plaintiff – who suffered substantial injuries which generated over $112,000.00 in medical bills – only $48,500. Undaunted, the plaintiff appealed this judge’s ruling to the Massachusetts Appeals Court, and that court ruled that the Superior Court judge erred on the medical bills issue, and ordered a new trial. Not to be outdone, the defendant then petitioned the Massachusetts Supreme Judicial Court (SJC) for a final answer, and that is where the case sits now. How’s that for some “legal tennis?” Not uncommon.

As a Boston injury lawyer, I can assure you that the stakes behind this case are enormous: Juries are not “experts,” or vocational economists, in case valuation. When assessing damages that they might wish to award a plaintiff for personal (physical) injuries, they rely on the amount of the medical bills put before them. If they see a total figure that is relatively small (i.e., the amount of medical expenses actually paid,) as opposed to a much higher figure (i.e., the amount of medical expenses billed,) they will intentionally reduce the amount of any award they render. That is only common sense. Think of it this way: Assume you or someone you love is seriously injured due to someone else’s negligence – it could be a car accident, a slip-and-fall injury, or any variety of injuries. Assume that the medical expenses involved in the treatment of these injuries amount to $100,000. That figure reflects a number of things, but most importantly, it reflects and illustrates the severity of the injuries suffered. This is key for any jury reviewing the matter, later – when all the physical results of those injuries are not always visible to the eye. Assume that the plaintiff’s health insurer negotiated with the medical providers, to pay 20 cents on the dollar – a total of $20,000. Now, assume that instead of the jury being allowed to see these $100,000 in medical expenses, they are only allowed to see only what the insurance company actually paid – $20,000.

Do you think such a jury would view your injuries as being as severe as they actually were, if it sees medical expenses of only $20,000? It won’t. Appearances are everything to juries; they are comprised of human beings, and as my late father used to caution me, “You cannot remove the human element” in any trial. It’s unavoidable.

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I have a favorite saying (which my wife Debbi would readily tell you,) that “The devil is in the details.” Along those lines, the Massachusetts Supreme Judicial Court is now considering a case that has very serious implications for anyone filing a Massachusetts personal injury suit in the future. The entire focus of the case that the SJC is weighing, (Law v. Griffith; SJC No. 10463) centers on medical bills and how juries assess damages that they may award to plaintiffs.

You see, juries are allowed to take into consideration a number of factors when assessing and awarding damages when they find in favor of a plaintiff. Some of these factors can include:

• Evidence of conscious pain and suffering • Evidence of lost income – past and future • Past medical bills

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In my final post in this case, let’s ask who are the real targets of this suit – the nurse practitioner, the supervising doctor, or Harvard University? For those of you who said “Harvard University” (thinking correctly that it’s the world’s most famous university with billions of dollars in assets and endowments,) you’d be wrong. You see, shockingly enough, Harvard University, as an educational institution, is considered legally to be similar to a “charitable organization”, and as such in Massachusetts, enjoys limited immunity against liability suits. The operative statute is referred to among lawyers as the “charitable immunity cap.” Created by the legislature many, many years ago, its purpose was to shield charities such as hospitals and educational institutions from high liability judgments, such as might result from a medical negligence suit, so that they could be safeguarded in their “charitable” missions, from potential financial ‘ruin.’ Currently, the “charitable immunity cap” is $20,000.00; meaning that is the maximum they can be held civilly liable to pay in any liability judgment against them.

Both financially and legally, the real targets here are both the doctor and the nurse practitioner. Why? Because each of them is required to carry policies of professional liability insurance. These professional (malpractice) liability policies typically provide coverage of at least a million dollars each, and it is these policies that would provide indemnification (liability coverage) for each of these defendants. This type of insurance would pay for the verdicts or judgments issued against each defendant, subject to each policy’s limits. Harvard University is being named as defendant here, in its legal capacity as the employer of each of these to defendants. This is known as the legal doctrine of “respondeat superior.” Notwithstanding that Harvard would be named as a defendant in the suit, the university’s legal liability is still limited to the charitable immunity cap that it enjoys. So in the practical sense, this lawsuit, like all Massachusetts medical negligence or Massachusetts wrongful death cases, is a suit against the individual medical professionals who are alleged to have committed the specific negligence alleged.

Will this family win this suit? Obviously, I haven’t reviewed any of the relevant pleadings, or been party to any discovery yet conducted. It’s too early to say. But, as a Boston medical malpractice lawyer with over 15 years experience in this field, the facts as reported don’t look too promising for these defendants. Regardless of what happens, I wish the family of this young man the best in the days ahead. The loss of a child, never mind to suicide, is a devastating event for any family.
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In my previous post, I reported on a wrongful death and medical malpractice lawsuit filed by the family of a Harvard University student who committed suicide while under the care of the school’s Health Services Department. Now I’ll explain the legal basis for why this suit is being filed, and why the family is accusing the defendants here with negligence.

The fact that patients taking Accutane, Prozac or Wellbutrin should be monitored for development of any suicidal thoughts is not news to anyone – certainly not to anyone in the medical community. Furthermore, according to the suit, young Edwards told the nurse who prescribed these drugs that he had taken Prozac when he was younger, but that it made him experience feelings of being “out of control.” Despite this, the nurse prescribed allegedly him the combination of Adderall, Wellbutrin and Prozac – knowing that he was also taking Accutane, known to create a higher risk of suicide in many patients. What this family (the plaintiffs) must legally prove here (as must all plaintiffs in medical malpractice suits or medically-related wrongful deaths suits,) is that the actions of both this nurse practitioner and her supervising doctor fell below the “standard of care” required of medical professionals of the same qualifications, intelligence, and experience, operating under similar circumstances.

The term “standard of care” refers to professionally-recognized, widely-accepted routine custom and practice in any given profession. There is no one standard of care applicable to all professions, but different ones that apply to and are particular to, different professions. For example, in this case, professional organizations such as the American Medical Association and the American Psychiatric Association will have published certain minimum steps and “best practices” that should be followed when evaluating and treating a young adult presenting with certain mental health complaints. Expert witnesses and academic authorities can also tesify to certain minimum standards of care that these defendants were required to adhere to in caring for a patient such as young Mr. Edwards. Whether or not their care deviated from or fell below these standards, has yet to be determined.

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My apologies for not having posted here for awhile – I’ve been sidelined with either a minor flu or bad cold. Not a big deal; worse things can happen to people.

As the story behind today’s post makes very clear. This is the story of a very promising young student attending Harvard University, where he was embarking on a career toward medical school, and who showed all the promise that one could ask for. Tragically, that promise was cut short when the student, John Edwards of Wellesley, aged 19, committed suicide on November 29 2007. This past week, his parents filed a wrongful death suit against Harvard University, alleging that Edwards received substandard care from the University’s Health Services, which caused or contributed to his suicide.

Edwards originally sought help at the college’s health services office, because he reported that he was unable to study or concentrate for long periods of time. A nurse practitioner at the school’s infirmary prescribed Edwards “Adderall“, which is a drug that is designed to treat attention deficit hyperactivity disorder (“ADHD”, as it’s sometimes referred to.) In what I as a Massachusetts medical malpractice lawyer find surprising to say the least, the nurse prescribed this drug, even though Edwards had never been diagnosed with this condition. Some time afterward, when Edwards complained of anxiety and depression, the nurse practitioner also prescribed Edwards two additional medications: Prozac and Wellbutrin, which of course are powerful antidepressants. An important element in all this, is that Edwards was already taking another medication to treat acne, Accutane, and this drug is been widely linked to generating suicidal thoughts in patients who take it.

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