Law360 Legal News
Psychiatrist Can’t Ax Verdict Over ADHD Drug Death
By Jonathan Capriel
June 11, 2024

A Missouri Court of Appeals panel’s opinion affirmed the lower court’s handling of the trial and the jury instructions, which Gateway Psychiatric Group LLC and Dr. Gordon Robinson had argued contained “inconsistent alternative theories of negligence, contained more than ultimate facts, and misdirected, misled, and confused the jury.”

The medical practice and Robinson challenged several of the lower court’s decisions, including the admission of the death certificate of the patient, referred to as K.P., and the discussion of damages for aggravating circumstances during trial, but the panel said none of the challenges had legs.

The main issue with the death certificate was that it listed K.P.’s cause of death as “intraventricular hemorrhage secondary to acute Lisdexamfetamine toxicity,” which the appellants disputed, but the panel said there was “other substantial evidence of K.P.’s cause of death” that backed that assertion up.

The long-form report from the St. Louis County Medical Examiner’s Office was entered into evidence “without objection from appellants,” the panel said, even though it “contained all of the information in the death certificate and more, including the cause of death as determined by the Medical Examiner’s Office.”

And when it came to the aggravating circumstances damages, the jury ultimately elected not to assess any, so the panel said it considers the point moot.

“The most appellants can muster is speculation that, ‘[while] the jury did not award damages for aggravating circumstances, we have no reason to believe that the argument didn’t taint their overall deliberations,'” the panel said, an argument that it called “particularly speculative.”

That’s because the trial court ended up knocking the $5 million verdict down to $801,061 under the state’s medical malpractice liability cap.

“Without more, we can conclude only that any decision by this court regarding the admissibility of aggravating circumstances damages in this case would have no practical effect on any existing controversy,” the panel said.

Robinson began treating K.P. in 2013 and continued treating her until her death almost three years later. Aside from ADHD, K.P. had several other health conditions that she was being treated for, including alcohol addiction, amphetamine abuse, anxiety, bulimia and anorexia. At one point, K.P. attended a treatment program in California to help with her alcohol dependence – she wasn’t on Adderall, an amphetamine, at the time, according to the opinion.

She took a different drug that wasn’t habit-forming to treat her ADHD, but when she returned to St. Louis, she relapsed on alcohol and as a result returned to Robinson, who prescribed her amphetamines while she was admitted at Harris House, an addiction treatment center, the opinion said.

Robinson prescribed her a 50 mg dose of Vyvanse at first, then doubled the prescription to two 50 mg doses a day. But the U.S. Food and Drug Administration has set the maximum daily dose of the drug at 70 mg per day, according to the panel, because of the high chance of abuse.

At times, Robinson would renew K.P.’s prescription for months without seeing her, according to court records. This double dose also caused issues with her insurance, which would only pay for one dose a day, and friction with her mother, who could not afford to pay for the second dose.

She was also abusing it, the opinion said, often taking up to 135 mg a day. She lost weight and developed a “picking habit” which resulted in her removing one of her eyebrows and developing scabs that she constantly reopened.

Then, in 2016, following an argument with her mother over paying for the Vyvanse prescription, K.P. retreated to her room. About 15 minutes later, K.P.’s mother’s fiancé went to check on her and found her unresponsive. She was declared brain-dead several days later, according to the court.

Debbie Pyzyk, K.P.’s mother, is represented by John G. Simon, Kevin M. Carnie Jr. and Patrick R. McPhail of the Simon Law Firm PC.