doctor and clinic held liable in methadone patient auto accident

[clinton (OP)]

https://insurancenewsnet.com/oarticle/2016/01/28/methadone-doctor-clinic-admit-negligence-in-patients-fatal-car-wreck.html#.Vq2A9JjnbqC

Newswires
 January 28, 2016 NewswiresNo comments
Methadone doctor, clinic admit negligence in patient’s fatal car wreck
Star Tribune (Minneapolis, MN)
Jan. 28--In an $8.5 million court settlement, a Brainerd doctor and clinic have admitted that they negligently provided methadone to a patient who injected the potent medication and caused a car wreck on the drive home that killed two people.

But the liability insurers for Dr. John Stroemer and his Pinnacle methadone clinic are now arguing that they aren't responsible for the settlement amount, and so it's not clear when the families will receive payment.

Nevertheless, the families of the victims, Carlton County road workers Zachary Gamache and Mitchell Lingren, feel a sense of justice over the public admission of negligence, said their attorney, Philip Sieff.

"Do they have cash in their pocket? No," said Sieff, of the Robins Kaplan firm in Minneapolis. "But that wasn't what this was all about in the first place ... The families were highly motivated to try to bring to light what continues to be a serious problem" in how methadone is dispensed.

The October 2012 incident began when patient Vanessa Brigan drove 100 miles from her home in Cloquet to the Pinnacle clinic to receive methadone, a drug that helps people overcome addictions to opioids such as morphine but has addictive qualities and dangers of its own.

Despite knowing she wasn't supposed to drive while taking methadone, Brigan injected the drug illicitly and tried to return home. Shortly before 9 a.m. Oct. 1, 2012, her car crossed the median on a rural stretch of Highway 210 and triggered a fatal three-car collision.

Brigan was sentenced in 2014 to six years in jail.

The victims' families argued that Stroemer and clinic staff missed numerous signs, including needle marks on Brigan's arms, that she was abusing the medication and represented a risk to drive home while under its influence.

Their case received a boost last September when Stroemer, and not just his clinic, were named as defendants, and the judge allowed the families to pursue punitive monetary damages for their suffering.

Under terms of the settlement, the Lingren family will receive 75 percent of the money because Lingren left behind a wife and children.

Sieff said he is pursuing legal remedies to compel payment by the two insurers -- the Minnesota Joint Underwriting Association and West Bend Mutual Insurance Co.

Specially designated methadone clinics have taken on increased in importance in Minnesota in the wake of an increase in overprescribing and a spike in the number of patients addicted to legal prescription opioids and illegal ones such as heroin.

Some clinics have sustained disciplinary actions, though, for failing to assess and monitor patients before dispensing methadone, a synthetic drug that reduces cravings for opioids by occupying the same receptors in the brain that opioids target.

Sieff said he and his clients hope the public settlement will encourage safer prescribing practices statewide.

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[Narkotikon]

I'm confused, I thought methadone patients were legally allowed to drive because, in theory, the methadone is making them stable. Therefore they shouldn't be too impaired to drive. Or maybe that a local, state law? But even then, how are patients supposed to get to the clinic? They can't all have drivers.

It seems like the journalist, like so many others, is misinterpreting the truth and laws to suit their agenda, which in turn uses scare tactics. Now some reader is going to get up in arms saying all methadone clinics should be closed because all methadone patients will cause auto accidents. Please.

As for the doctor and clinic not monitoring her adequately, and not noticing her tracks and stuff, that is negligent, and that's on them.

[Chip]

Nark, for the person to be that stoned, they would gave had to at least triple dose or more OR be overdosed, to start with.

I was only just recently discussing MMT and driving with my doctor and he said that it was cool when the patient was dosed properly, ie. they start entering withdrawal by the 24th. hour - my rule of thumb for the right dose, too.

[Narkotikon]

Nark, for the person to be that stoned, they would gave had to at least triple dose or more OR be overdosed, to start with.

I was only just recently discussing MMT and driving with my doctor and he said that it was cool when the patient was dosed properly, ie. they start entering withdrawal by the 24th. hour - my rule of thumb for the right dose, too.

That's what I thought too.

So she was either abusing her take homes, or she was being overdosed. In any case, I think that's her fault, not the clinic's. They're not responsible if she abuses her take homes. How are they going to know? I doubt she told them.

And as for overdosing her, they can only go by word of mouth and peak and troughs, and those can be faked. So she's ultimately responsible for getting her dose right. Plus lots of MMT patients take more than they need, for whatever reasons. Not all of them drive recklessly or cause accidents.

The only way I can see the clinic being responsible is if they knowingly overlook obvious side effects caused by too much methadone: nodding off at the clinic, slurring her speech, etc. If they noticed things like that, then yeah, they're responsible too.

Even so, I still don't like journalists and news organizations who do sloppy fact checking, unknowingly or knowingly skew the facts, or whatever to push their agenda. Under normal, proper circumstances, MMT patients, as well as SMT patients, can legally drive,mane drive responsibly and safely.

We have enough stigmas and stereotypes to deal with. We don't need another mass hysteria of people questioning all of our driving.

[Griffin]

I read about this yesterday, and was thinking about posting it but got distracted. Unfortunately the law isn't on her side, and more than likely she will be convicted for vehicular manslaughter, dui, and probably negligence or whatever. Even though pretty much every study that has been performed on people maintained on done, show that it doesn't affect your motor skills, opiate naive people on the other hand are affected quite a bit.

As for the docs, getting sued I think it's bullshit, and seems more like typical money grabbing rather than them trying to get justice, awareness, and pay for the costs of the funeral and damage and such. However they will probably win the suit, if they can prove any type of negligence in on the clinics side.

Even a simple violation at their clinic for something minor like a counselor having one to many patients on his case load or even something that has nothing to do with the case could be all they need to prove negligence and possibly even get the clinic shut down, and/or have the doctor or company's license suspended.

To me the problem isn't someone driving on methadone who is stable, and in this particular case it probably has more to do with having to drive 100 miles each way in the morning. Especially when addicts typically have sleeping problems to begin with, all of the hoops they have to go through to get there on time, work, and everything else on top of driving the 200 miles to the clinic and back is not easy.

As for making sure abuse isn't happening, that sides a lot on the counselors and dispensing nurses. The nurse is usually the one in charge of diversion checks which are federally mandated to be done randomly twice a year. If you don't have all the right bottles, or you took the wrong days bottle without noticing, you will lose all take homes including Sundays indefinitely. The mandatory UAs are a lot easier to get around, but with the diversion check you have only a few hours to get there sometimes after they call and if you miss it, you lose all takehomes indefinitely.

Making sure the counselors aren't over worked with a huge caseload makes a huge difference, making sure that their patients are doing their mandatory monthly counseling or group session can help curbing abuse. If the counselor is good and built a good relationship with the patient so they are comfortable enough to tell them if they are using, had a relapse, or need more or different care is pivotal.

The counselors and nurses are the biggest part of curbing abuse, yes doctors can allow patients to go up too high in dose but they can only be raised if they see the doctor and both the doctor and nurse document the reasons for the increase in dose. After you become stable you only have to see the doc once a year for a physical.

The nurses and counselors can usually tell when someone is over medicated. If they are trying to go up on their dose, and they can't keep their eyes open because they are nodding from yesterdays dose, abusing their take-homes or other drugs and not sleep deprivation from withdrawal There is a pretty big difference between nodding and being tired. Some people do look like they are nodding when they are just tired or the other way around but usually you can tell pretty easily.

A big piece of curbing abuse, is to not kick out someone for using, its counter-productive. I do agree that giving them take homes is risky and not a good idea. If someone is in a wreck who is a methadone patient, it should be pretty easy to tell if they are stable on their dose or not. If they've been on that dose for 3+ months, and aren't showing signs of abuse then it shouldn't be considered anything other than an accident if that is the case.

I think they should test to make sure they weren't high or drunk while driving and being reckless and endangering others. But as everyone who knows about what happened to me that the laws behind determining intoxication from drugs are complete and utter bullshit. Our laws for driving on alcohol aren't much better at determining if someones at risk of hurting others.

This is really just sad to me all the way around, not only did people lose family members and friends it's worsening the stigma around MMT and makes people hate it and think people shouldn't be allowed on it. Also this ladies life is probably ruined, she will probably be traumatized from the event, do a considerable time in jail, as well as have to deal with everything else that goes with being convicted of a crime. Everyone loses.

I wish there was a big enough MMT lobby to get these issues fixed, and that we were at the point where there is no more stigma and people realized how much better harm reduction and MAT therapy works, so that ignorant people will believe the studies that all prove that methadone doesn't affect your motor skills after becoming stable. Until then both sides are going to continue to suffer.

I see one of these stories in the news every week, that someone on MMT was in a wreck, and caused damage or killed someone. Since the person is on MMT they are always at fault and charged with whatever they put on them, even if they were sitting at a stop sign and the person not on MMT was the one who caused the entire thing. It's so frustrating, I feel like a lot of people are getting screwed because they are on the clinic.

What is worse than the wrecks I think is that I keep seeing very very young children die from OD after accidentally getting into their parents or someone else's methadone. At least once a week I will google methadone and I will see a new news story of a wreck, as well as a new one about a small child dying from a methadone OD.

What is sad is that a lot of them could of been prevented, if the people whose use the methadone are careful, and handle their meds like they are supposed to. One last week was from a couple who was giving a girl a ride home and she mixed her done with a drink in a mcdonalds cup and then left it in the car next to the kid when they dropped her off. The parents weren't on MMT and didn't know she was on it, and didn't know why their kid was unresponsive afterwards.

If they would just keep the meds locked up, take all of their dose at once, don't mix it with anything outside of its original container, don't leave it out, it should go from lockbox to mouth and the empty bottle should go back into the lockbox that's always locked. I think most kids drink it when its in a regular sized cup mixed with a drink probably to mask the taste, if you have kids you shouldn't do that, or you should tape it to your hand until its completely gone, and has been rinsed with water.

Whats the worst is when parents purposely give their children an opiate and cause them to OD. I don't understand anyone who would do that, and it makes me sick to read about. They will give it to the child to sleep, or because they are teething, or because the parents want some alone time and then they come back and the child has overdosed.

I think you basically signed over your right to have free time when you decided to have a kid. I don't have a kid, and I don't want that to be offensive to any of the wonderful parents on here. I know that having a kid takes your life but if you have to get some alone time hire a babysitter, or put them with your family, significant other, or a daycare.

There is no excuse for murdering your child. If I had a kid, I would be very cautious/nervous about having my kid breastfeed if the mom was on opiates. I have heard that they can do that if the mom is on MMT and the baby is still going through NAS to help ween them off but have done zero research on the subject and even if safe I'd prefer to use formula, but only in that scenario as I think breast feeding is an important part of having a healthy kid.

Not to be a creeper or anything but, I have wondered what the protocols are if the mother was on MMT during pregnancy and after. Is it safe for them to breastfeed. Also what is the protocol for moms who take anti depressants while breast feeding and what drugs you absolutely can't take if you are? I have always thought that one of the many contributing factors to the rise in mental illness is from moms who are on anti-depressants while breastfeeding, and that maybe even formula could contribute a bit as well.

Has anyone seen the videos on youtube there are hidden cameras and show how people react to a mom breastfeeding in public, it's really interesting. They will set a gorgeous lady on a bench with a low cut shirt with a ton of cleavage showing and they will record how all of the people who walk by her react. A lot of people stare, give compliments, some guys came over and tried to get her number.

Then when they put the mom on the same bench breastfeeding, people were extremely rude to her, telling her to go somewhere else to do it, that she shouldn't do that in public and how gross it is. Even though she was more covered up and had less showing than the first girl whose cleavage was out.

After that they put them next to each other on the same bench with the producer standing behind them just as a civilian waiting on the bus. Pretty much all the people were still being super rude to the mom. The producer would ask them why is it okay for the pretty girl to be showing more of her boobs than the mom, but it wasn't okay for the mom to do something completely natural. Most of them said because she is hot and breastfeeding is disgusting and shouldn't be allowed in public.

One of the things that surprised me is a lot of the people being rude to the mom were women. I don't know if they are jealous, or thought there boyfriends were staring or what. They would try to explain that it's a lot easier for people to look away than it is to explain to a baby that he can't eat because it offends some people and that he would just have to be hungry until she could get him home to feed him.

What does everyone else think about it, I have never really had a problem with it. It weirded me out when I was younger just because they were boobs but after I turned 15, my nephew was turning 1-2 I realized that kids come first over everything, and that its natural and imo healthier/safer. I think its polite to try and cover up as much as possible, they have blankets and other things that are specifically made for that. As long as she doesn't take off her shirt and bra completely and start rubbing her boobs asking you if you want some too its all good.

heres another video of the same thing

[Sand and Water]

About the article---wouldn't injecting it ( as the reporter says, "illicitly"), have a big impact on her level of impairment?  I could see a different scenario if (like a member here), she took as prescribed, but this isn't the same as far as onset etc. Just curious b/c it reads to me she injected a PO med?

Had another question but for some reason my typing is all "skippy" and odd, (have i keep fixing text), so just curious about effect of ROA if anyone knows how different the effects might be?

[Z]

Injecting it is minimally more strong.  Drinking methadone is about 80% bioavailability, and injecting is closer to 100%.  Just from memory so it might be even higher orally.


I'm going to guess that the doctor would be charged if they thought he was prescribing too high of a dose for the patient causing intoxication.  The problem is that the patient can lie about withdrawl symptoms to get a higher dose.  Doctors can't test really beyond a peak and trough, and I've been told that it will only show an absolute concentration of methadone.  That's sort of useless since we all respond differently to the dose, and have different levels of tolerance.  The only thing it will really show is the metabolization between the tests for split dosing.

[Chip]

@Sand and Water

It's not about whether there is a different effect from the two but rather once you start IV'ing then you're tempted to "feel it" hence the multiple doses.

that also means finding something to hold you on the days you left yourself short which in turn is another problem.

then your tolerance gets bigger and the more you need - yet another problem.

I advise people to never inject their treatment meds but people will still at least attempt it if they feel desperate or curious.

it is folly, trust me.

It's like smoking: the more you use, the more you want.

if you never start then you can avoid so much hassle and unstable behavior.

[Guts]

About the article---wouldn't injecting it ( as the reporter says, "illicitly"), have a big impact on her level of impairment?  I could see a different scenario if (like a member here), she took as prescribed, but this isn't the same as far as onset etc. Just curious b/c it reads to me she injected a PO med?

Had another question but for some reason my typing is all "skippy" and odd, (have i keep fixing text), so just curious about effect of ROA if anyone knows how different the effects might be?

Also it's damn near impossible to inject your entire dose in America unless you're on a small amount... it's 10 mgs a ml so if you're on 120 mgs you need a 12 ml syringe...

@Griffin So when the 2 guys come and question the guy when he's with both girls is obviously scripted. They are all wearing similar clothes and their acting sucks. But, my sister, breast feeds everywhere. Like just pops her boob out and goes at it. She'll pull her kids pants down and literally hold their dick and let them pee on the sidewalk. Well the grass I think... but still, like dogs. One of her kids just totally pantsed himself at a restaurant because he doesn't understand and he's like 3. And they don't wear underwear or diapers... point is, I don't really give too much of a fuck but I can see how people could get bent about it... she just doesn't give a fuck... but yeah I dunno what the whole stance against breast feeding in the US is about...

[Griffin]

Yeah I think some of it is scripted but the message behind it is true and a ton of people are against it here. When someone posted it on facebook it seems like a bunch of people I knew from Oklahoma came out of the woodwork to bash it and explain why it should be illegal and how it is morally wrong and stuff. Then again those people are very dumb, the kind of people who think we should nuke the middle east and run the world.

I saw a lot of people from all over the US comment about it being wrong, disgusting, and how it should be illegal, they could be trolling but I think a lot of people think that way. There is a difference in breastfeeding in public and being discreet and respectful and taking your shirt and bra off completely at a restaurant when the kid isn't even hungry to garner attention. I think that people who are against it are hypocritical, and that it is a dumb argument. The reasonings against it like it being gross are really stupid, I haven't heard a logical reason for not doing it.

[Guts]

I really don't get it... there are many proven benefits and formula is expensive. I think there's a notion that if you don't use formula it'd partly because you can't afford it or something? I dunno... it's like circumcision... doesn't make too much sense but, hey, we're fucking first world over here dammit.

[Narkotikon]

I don't mind breastfeeding in public, if it's done discreetly.

Now taking your bra and top off, going tribal in public, and letting your kid breastfeed in open view, while you yourself are exposed, is tacky, IMO.

It's like you could feed your kid on one side, and have a breast exam on the other. That's offensive to me.

As for breastfeeding v. formula, I don't really have any strong feelings either way. Is breast milk better for the baby in terms of natural nutrition and especially for the baby's immunity (colostrum)? Sure.

But do all women enjoy breastfeeding or even want to do it? No. Formula is adequately nutritious, if only more expensive.

I think there's too much shaming going on when women choose not to breastfeed, for whatever reason. It's like some women (and men) will try to make them feel guilty for not doing it.

I think that's particularly true for some lactation specialists / consultants in hospitals. One of my sisters is an RN in a hospital that deals primarily with children.

She's told me she has learned to avoid talking to a lot of the lactation specialists there because they're basically breastfeeding bullies. They resort to shaming and down talking to the mothers who don't want to do it.

.....................................

That's funny about your sister, Guts. Kinda gross too, IMO. 

I'd be embarrassed and mortified if I had a sister who let her kids drop their pants and piss all over things in public, even if it's only the grass.

We're civilized humans. We have bathrooms. Indoor outhouses for some, I guess, but still. People should do that shit in private.

I guess I'm an uptight prude when it comes to that type of thing. It disturbs me when people don't put the toilet seat AND lid down after they flush.

It also disturbs me when people use the bathroom and don't wash their hands. I don't care if it's only number one. You're still touching your junk. Other people don't want other people's junk germs on their things.

This kind of stuff is one of the reasons why I'd find it very difficult to live with a roommate. Or really anyone who doesn't share my hygiene practices. Much less headache to stay alone.

[Guts]

True... I guess I never thought about it the other way because breast feeding seems to make more logical sense... I was also going to say and I don't have tits but we won't go there.

But yeah man she's probably not as bad as I make it sound... like she'll wear a button up shirt and pop out one boob not just both... one on each side... can that be done? Point is she just kinda does it... not like she is out to show everyone boobs and baby dick... I think she really believes in it.

With the peeing thing, I think she really just does it cuz it's easier. I mean I think that's really her only justification... I guess she is the primary bread winner and primary care taker of 2 kids at the moment and that makes it okay in her head or... makes her just not give a fuck. I dunno I don't talk to her THAT much.

She is a doctor though who shops at good will and is pushy about her views though... because she's a doctor and she knows. No its not that bad and we get along ok but it's fun to make fun of.

[Narkotikon]

It must have been the way you described it the first time.

The second description isn't nearly as bad, and it's even what I'd consider acceptable. Not that I'm some universal arbiter on breastfeeding (or bathroom habits). Just speaking my opinions.

[dizzle]

They never said exactly how they know this woman was injecting her dose?

I mean, she's at a methadone clinic, A FUCKING METHADONE CLINIC, wouldn't it be somewhat assumed she'd have track marks?


Injecting methadone is pointless and wouldn't cause the extreme high that this article and our moderator imply. There is a MINOR rush but nothing I'd call impaired, this isnt' about the accident she caused, it's about money and fearmongering bullshit agaianst methadone patients.

the media in our country is just another workhorse for the war on drugs/terror/political machine and DEA/FBI/CIA/white house. The funniest part to me is 95% of the people that read the news allow their opinions to be formed for them by the very agencies that are doing the bad shit..... it's a sweet deal for those in power though.