Psychiatry Expert Witness Reviews Bipolar Diagnosis

Plaintiff initiated treatment with defendant psychiatrist at age 40, though she had been medicated for depression and other disorders since age 14. She reported a diagnosis of bipolar disorder from her previous caregivers. In the past, she was placed on a variety of medications, including Depakote, Effexor, Lexapro and Paxil. She frequently used alcohol and drugs, which the defendant told her that she must not do in order for her treatment to work.

She alternated between depressive and manic behavior, and was sometimes suicidal. The defendant repeatedly adjusted her medications in order to improve her symptoms. She continued to use recreational drugs and the defendant advised her to join a narcotics anonymous group and not to use cocaine again. She also was taking more of her prescription medications than prescribed.

He released her to return to work but remained concerned about the level of stress she was under. He treated her for five years, until she went to a family practitioner who diagnosed her with Attention Deficit Hyperactivity Disorder (ADHD). The physician started her on Adderall, which she said immediately helped calm her down and helped her function in her new job.

She then took too much Adderall, and subsequently decided to stop all medications and reported feeling better. The defendant refused her any additional care because she refused to accept his diagnosis of bipolar disorder.

Plaintiff alleges the psychiatrist breached the standard of care in his treatment of her.

Question(s) For Expert Witness

1.) Did the care and treatment rendered to plaintiff comply with the standard of care?

2.) Was there was any negligence on the defendant’s part that caused or contributed to her alleged injuries?

Expert Witness Response

It is my opinion based on my education, training and experience, as well as from my review of plaintiff’s medical records, that defendant’s belief that plaintiff suffered from bipolar disorder in this case was reasonable given the fact that she carried that diagnosis from her earlier admission. She also described symptoms during her visits both early on and later in treatment that were consistent with manic episodes. Thus, it was reasonable for defendant to believe she was suffering from bipolar disorder.

It is also my opinion, based on my education, training and experience, as well as my review of plaintiff’s medical records, that there was no breach in the standard of care. He was not negligent in his care and treatment. He properly assessed, examined and treated her. He appropriately treated her for her working bipolar diagnosis with supportive visits and medications. He properly monitored the medication regimen that he ordered for her and changed the medications in response to her symptoms. Additionally, the records show that in many instances, plaintiff took more medications than she was prescribed, and was taking excessive amounts of Xanax during the time he was treating her. Defendant responded properly and within the standard of care by discontinuing her Xanax and prescribing her chlordiazepoxide instead because there was less chance of misuse.

Furthermore, he refused her requests to increase her medications. Defendant also warned plaintiff to cease her recreational drug usage and discussed this with her family.

It is further my opinion, based on my education, training and experience, as well as my review of plaintiff’s medical records, that to a reasonable degree of medical probability, no negligent act or omission by defendant led to any injury claimed.