MEDICAL MALPRACTICE: $1.3 MILLION
Case name: John P. Johnson, et al. v. Anthony T. Machi, M.D., et al.
Case number: 06-CV-12609
Court: Milwaukee County Circuit Court
Judge: Hon. Dennis P. Moroney
Original amount sought: $1,000,000
Highest offer: $250,000
Special damages: The jury awarded $766,000 for past pain and suffering and $277,000 for future pain and suffering. The court answered the remainder of the damage questions upon stipulation of the parties, including past wage loss of $16,048, past medical expenses of $223,079 and future medical expenses of $58,800.
Verdict date: 7/31/09
Plaintiff attorneys/firm: Patrick O. Dunphy & Kevin R. Martin of Cannon & Dunphy, S.C.
Defense attorneys/firm: Mark E. Larson of Gutglass, Erickson, Bonville & Larson for Dr. Machi and PIC-Wis; Michael P. Russart of Hinshaw & Culbertson for the Injured Patients and Families Compensation Fund
Plaintiff experts: Frederick Goodwin, M.D. (Washington D.C., psychiatry), Bruce Stevens, M.D. (Milwaukee, treating psychiatrist), Daniel Ochalek, M.D. (Milwaukee, treating burn surgeon), Steven Koenig, M.D. (Milwaukee, treating ophthalmologist), Steven Donatallo, M.D. (Milwaukee, treating pain management) and Debra Slack-Finn, M.S.W. (Waukesha, treating psychotherapist).
Defendant experts: Gary Sachs, M.D. (Boston, psychiatry) and James Troy, M.D. (Milwaukee, dermatology).
Plaintiff counsel’s summary of case: On Feb. 23, 2005, John P. Johnson sought treatment from psychiatrist Anthony T. Machi, M.D. for panic attacks and increasing anger and violence that was jeopardizing his job and relationship with his fiancée. Dr. Machi diagnosed Johnson with bipolar disorder, panic disorder, post traumatic stress disorder and attention deficit hyperactivity disorder. Dr. Machi treated Johnson with Lamictal for the bipolar disorder.
The manufacturer of Lamictal published dosing guidelines that provide for a 5-week titration up to 200mg per day. The dosing guidelines further provide that the patient should remain at 200mg per day for two weeks. The manufacturer of Lamictal does not recommend doses above 200mg per day for bipolar disorder. Additionally, the manufacturer recommends that the physician following the dosing titration guidelines as rapid titration can increase the risk of serious rashes such as Stevens Johnson Syndrome / Toxic Epidermyl Necrolysis.
Dr. Machi initially titrated the dose Lamictal in accordance with the manufacturer’s schedule to 200mg per day. After Mr. Johnson was at 200mg per day for one week, Dr. Machi increased the dosage to 300mg per day and, 3 days later, to 400mg per day.
Approximately 10 days after the dosage increase, Johnson was admitted to Froedtert Memorial Lutheran Hospital and subsequently transferred to St. Mary’s Hospital where he was treated for Stevens Johnson Syndrome/Toxic Epidermyl Necrolysis (“SJS/TENS”). The SJS/TENS caused 60 percent of Johnson’s skin to slough. The sloughing of the skin is akin to a second degree burn. The SJS/TENS also caused Mr. Johnson’s mucous membranes to slough. The sloughing of the mucous membranes resulted in Mr. Johnson’s eyelids scarring to his eyeballs and his foreskin scarring to the head of his penis.
Johnson was discharged from St. Mary’s after 20 days and returned to work approximately 6-months later. The SJS/TENS caused permanent scarring, pigmentation changes and hypersensitivity to Johnson’s skin. The SJS/TENS also exacerbated the post-traumatic stress disorder, which required psychotherapy. Johnson underwent surgery for his ophthalmic injury and is left with permanent eye dryness and irritation that are treated with artificial tears. Johnson also underwent a circumcision and is left with permanent discomfort.
The plaintiff claimed that Dr. Machi was negligent in diagnosing Mr. Johnson with bipolar disorder and prescribing the Lamictal and negligent in titrating the Lamictal. Specifically, Dr. Machi was negligent in diagnosing Johnson with bipolar disorder as Johnson never met the DSM-IV criteria for that disorder and, as such, should have never prescribed the Lamictal from the outset. Dr. Machi was also negligent in titrating the Lamictal at a rate faster than that recommended by the manufacturer. Dr. Machi denied each allegation of negligence.
The plaintiff further claimed that the Lamictal and rapid titration rate were both substantial factors in causing the SJS/TENS. Dr. Machi conceded that the Lamictal caused the SJS/TENS but denied that the rapid titration was causal.
The case was tried to a Milwaukee County jury over seven days. The jury deliberated for approximately 21/2 hours and returned a verdict finding Dr. Machi causally negligent.