Carney v. Tranfaglia3/26/2003
Essex.
November 19, 2002
Medical Malpractice, Expert opinion. Negligence, Medical malpractice, Psychiatrist, Causation. Psychologist. Doctor, Controlled substances. Controlled Substances. Evidence, Expert opinion. Practice, Civil, Instructions to jury, New trial.
In response to special questions posed in a medical malpractice case, the jury answered that the negligence of the defendant, a psychiatrist, was not a substantial contributing factor in causing the premature death of his patient, Patricia Carney Poretta. Based on that verdict, a judgment was entered for the defendant.
Poretta had died of chloral hydrate intoxication. The theory of the plaintiff's case was that the psychiatrist, Dr. Tranfaglia, had been negligent in prescribing chloral hydrate as medication for sleep disorder to Poretta, who had struggled for years with substance abuse, anxiety, depression, and panic attack. In the hands of such a patient, the plaintiff contended, a supply of chloral hydrate was like a hand grenade on which Poretta, predictably, would pull the pin, either by accident or intentionally.
On appeal, the plaintiff claims error in: (1) the exclusion of expert testimony about causation; (2)a portion of the jury instructions about what the jury might conclude as to causation if they found that Poretta had decided to end her own life; and (3)the denial of a motion for a new trial.
Facts. Taking the evidence in the light most favorable to the plaintiff, we summarize salient facts that the jury could have found. Poretta first came into the care of Dr. Tranfaglia on November 17, 1992, after an emergency admission to the Anna Jaques Hospital "for evaluation of depression with suicidal ideation."
Then twenty-seven years of age, Poretta's life had long been troubled. At age fourteen she developed serious psoriasis, a disfiguring and itchy ailment of the skin, all over her body. In her teenage years she made a suicidal gesture and had "significant substance abuse problems." There was a medical record notation that her mother was an alcoholic. As a child, Poretta was sexually abused. Her parents divorced. After Poretta's fiancé left her in 1985, she went to California to be with her sister. While Poretta was in California, her sister was shot in the face by a boyfriend. Poretta had a relationship with a man in California that ultimately broke up. She returned to Massachusetts, nine months pregnant. The son born to her was, at the age of two, diagnosed as retarded and suffering from a form of autism. Poretta married James Poretta during the summer before her death. Her relationship with him had been on and off and not without volatility. Police on July 1, 1993, responded to a call because the couple were fighting and knives had come into play. During the period from November 17, 1992, until her death on October 31, 1993, Poretta's mother successfully took legal steps to take custody of Poretta's child; i.e., mother and daughter were locked in legal combat about a profoundly personal issue. Poretta was sexually assaulted by a neighbor. Not long before her November 17, 1992, admission at Anna Jaques Hospital, she had suffered a miscarriage.
Before seeing Dr. Tranfaglia, Poretta had seen many doctors. She received medication for depression, anxiety, pain, and sleep difficulty. The medications included Percocet, Serax, Xanax, Zoloft, Paxil, Klonopin, Ambien, Dalmane, and chloral hydrate. Poretta abused drugs, and that proclivity was known to Dr. Tranfaglia. During the period following her admission to Anna Jaques Hospital on November 17, 1992, there were multiple admissions at a variety of institutions related to excessive use of her medi
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