Psychotropic Drug Was Prescribed for Pain; Summary Judgment for Doctor, Nurse Upset
Inmate Claims No Consent to Taking Medication of Such Nature; Concurring Opinion Says Required Information Is Minimal
By a MetNews Staff Writer
All members of a three-judge Ninth U.S. Circuit Court of Appeals panel agree that a District Court judge erred in granting summary judgment in favor of a doctor and a nurse based on the plaintiff being put on a psychotropic drug without telling him what it was, but one judge, Eric D. Miller, wrote separately to stress that only minimal information on the nature of medication need be supplied.
The opinions were filed Friday. Circuit Judge Lucy H. Koh wrote a memorandum opinion in which District Court Judge Donald W. Molloy of the District of Montana, sitting by designation, joined.
District Court Jon S. Tigar of the Northern District of California granted summary judgment in favor of Dr. Michael Burleson and nurse practitioner Iver Lien, both of Eureka, a city in in Humboldt County, on the basis of qualified immunity. However, neither defendant/appellee sought to justify the judgment on that basis.
They urged affirmance on the ground that no duty to the patient, Everett Spillard, had been breached.
Qualified immunity applies only to state and local officials, and Burleson and Lien both worked for a private healthcare company that had contracted with the county to provide medical services at Humboldt County Jail. Plaintiff Everett Spillard was an inmate there, awaiting trial on child molestation charges.
Spillard, who suffers diabetes and chronic nerve pain, had complained of peripheral neuropathy (numbness, pain, and physical weakness) in both feet. He requested gabapentin but was prescribed nortriptyline.
According to his brief on appeal:
“[R]ather than prescribe Mr. Spillard medication approved to treat his condition, Defendants gave Mr. Spillard an antidepressant that altered his mental state and did nothing to alleviate his chronic pain. Worse yet, Defendants gave him the drug without ever obtaining his consent. Only later did Mr. Spillard, who has no history of mental illness, learn that he had been given psychiatric medication he had neither requested nor wanted.”
Nortriptyline has not been approved by the Federal Drug Administration in the treatment of neuropathy and has adverse effects for persons with diabetes.
Spillard allegedly learned of the nature of the drug after he had been transferred to San Quentin following his conviction. (The defendant was sentenced to 15 years to life in prison.)
His brief argues:
“…Defendants did not even try to show an overriding justification for administering psychiatric medication to Mr. Spillard without his consent. That failure alone precludes summary judgment.
“What is more, there is a genuine dispute of material fact as to whether nortriptyline was medically appropriate to treat Mr. Spillard’s nerve pain.”
Rejecting the defendant’ position on appeal, Koh said in Friday’s majority opinion:
“Contrary to their position, the due process rights ‘to be free from unjustified intrusions to the body, to refuse unwanted medical treatment and to receive sufficient information to exercise these rights intelligently’…are not categorically limited to antipsychotic drugs…or situations where the ding at issue is administered for mental health reasons….The record shows that nortriptyline is ‘pharmacologically categorized as an antidepressant medication,’ and had the potential for serious side effects. Factual questions also remain as to whether Spillard’s use of the drug was involuntary or unwanted, as Spillard was not aware that the medication he was taking was nortriptyline until he was transferred out of Humboldt County Jail.”
Citing the U.S. Supreme Court’s 1992 opinion in Riggins v. Nevada, the appellant’s opening brief says the “undisputed fact” that Spillard had not consented to take nortriptyline “means that Mr. Spillard’s due process rights were violated unless Defendants can show (1) an ‘overriding justification’ and (2) ‘medical appropriateness’ ” for the prescription. Koh declared that “[u]nder Riggins, Defendants-Appellees have not shown as a matter of law that their administration of nortriptyline” met those standards, precluding an affirmance on the alternate basis.
Miller remarked that the majority “emphasizes that ‘Spillard was not aware that the medication he was taking was nortriptyline’ but it does not say why Spillard needed that information in order to make his treatment voluntary.” He continued:
“No court has held that an inmate must receive every piece of information about a psychiatric drug in order for the administration of that drug to be voluntary. Such a rule would require the inmate to be given a list of every possible side effect, together with the complete results of all clinical trials. Instead, courts have applied a deliberate-indifference standard and. relatedly. required that prison medical staff respond to inmates’ reasonable questions about their treatment.”
He expressed the view that “Spillard had a right to some information about his course of treatment, but only the information that a minimally competent, non-indifferent physician would have provided.”
Contradicting the characterization of
nortriptyline by the majority and by the appellant, Miller said the drug “is
apparently in common use for neuropathic pain, and the defendants need not have
every side effect of the drug.” He added, however, that “the failure to tell Spillard about the drug’s function as an antidepressant, or simply to identify the name of the drug for him—even though he never asked for that information—might conceivably represent” a denial of the patient’s “right against unwanted administration.”
He said he “would reverse and remand to the district court for further proceedings on the issue of voluntariness.”
The case is Spillard v. Ivers, 21-16772.
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