A jury awards over $8 million after a man died by suicide less than a month after being prescribed Citalopram
Key Takeaways
Following a trial lasting five days, the jury delivered a verdict favoring the plaintiff, determining that Dr. Estes and Venture Associates bore 51% responsibility for the death of Pieraccini.
Pieraccini’s family will receive a settlement worth around $8.36 million.
Recently, A jury in Henry County, GA, found that physician Jameson Estes, MD, was liable for the 2016 death of John Pieraccini of Atlanta. Pieraccini was 27 when he had a new patient appointment with Dr. Estes at Venture Medical Associates in August 2016. Pieraccini had recently moved to Atlanta to take a job with Delta Air Lines and was reportedly experiencing anxiety. Symptoms included panic attacks, palpitations, shortness of breath, excessive worrying, and fear of losing control.[]
During the August 2016 appointment, Dr. Estes diagnosed Pieraccini with an unspecified anxiety disorder. Reportedly, he did not perform a mental status exam. He prescribed Pieraccini both Xanax and Citalopram. According to the complaint document, the prescriptions were “in amounts and for durations which constitute significant departures from the standard of care.” Records show that Pieraccini was prescribed 20 mg of Citalopram daily with six refills and .5 mg of Xanax, up to three times as needed for panic attacks, with two refills.[]
Dr. Estes and Pieraccini did not establish a specific follow-up appointment. Instead, Dr. Estes recommended that Pieraccini return in three months. Pieraccini began taking both prescribed medications following the appointment.[]
On September 17, 2016, Pieraccini went out for dinner and drinks with his fiancé. After returning home, he shot himself in the head with a handgun. He was transferred to nearby Grady Hospital for emergency medical care but was not able to be resuscitated.[]
Pieraccini’s family filed a malpractice suit against Dr. Estes and Venture Medical Associates. The complaint alleges that Dr. Estes failed to exercise a reasonable degree of care and skill in diagnosing and treating Pieraccini for a serious mental health condition. The complaint also states that Dr. Estes’s failure to complete a mental status evaluation and screen Pieraccini for depression was a departure from the standard of care and that a firm follow-up appointment earlier than three months after the initial examination should have been established.[]
The defense argued that Dr. Estes’s evaluation of Pieraccini was thorough and that Pieraccini did not show any indicators of depression or warning signs of possible self-harm. Lawyers for Dr. Estes also claimed that Pieraccini had been drinking heavily on the night of September 17, 2016. Reportedly, Pieraccini and his fiancé were too intoxicated to drive home that evening and were given a ride by the restaurant’s manager.[]
However, attorneys for the plaintiff countered that Pieraccini hadn’t been educated about Citalopram. They argued that he didn’t know the dangers of drinking while taking Citalopram and that he wasn’t aware of the subtle signs that the medication could be increasing depressive symptoms. The legal team claimed Dr. Estes was responsible for making Pieraccini aware of this.[]
After a five-day trial, the jury returned with a verdict in favor of the plaintiff. They found that Dr. Estes and Venture Associates were 51% responsible for the death of Pieraccini. The jury determined the total value of wrongful death damages for Piercanni to be $16.4 million. Since Dr. Estes was found 51% liable, Pieraccini’s family will receive an award of around $8.36 million. However, additional fees, including for non-acceptance of a settlement offer, haven’t yet been added to the award total. Lawyers for the plaintiff anticipate bringing the total award up to around $12 million.[]
Malpractice when patients die by suicide
Patient suicide is a common reason psychiatrists can face malpractice suits. Typically, in malpractice cases involving suicide, the focus is on the foreseeability of the patient’s suicide and whether the physician missed any steps that might have prevented it. Of course, a suicide can occur without the presence of any previous risk factors, and having numerous risk factors doesn’t mean that a patient will attempt suicide. However, judgments in malpractice cases are often based on factors such as the thoroughness of patient evaluation and the treatment steps implemented in response.[]
Guidelines from the American Psychiatric Association, including Practice Guidelines for the Psychiatric Evaluation of Adults, can provide good screening tools for patient evaluation. Additional screening guidelines, such as the Patient Health Questionnaire (PHQ-9) and the Substance Abuse and Mental Health Services Administration’s Suicide Assessment and Five-Step Evaluation and Triage (SAFE-T) guide, have also been developed in recent years. These tools can identify patients who might be at risk so that physicians can take further action. Documentation of these assessments being administered can also help physicians maintain a record of actively taking steps to prevent the suicide of any patient.[]
“We often think of patients with depression as the ones to watch and worry about as at-risk for suicide,” says physician Jean Gaggino, MD. “And they certainly can be. But you’ve also got these patients who are impulsive or who something has happened to. And you don’t know by their history. You don’t know by looking at them. That’s where these screening tools can really catch people. They’re quick; some of them are five, six questions, and they can spot things you might not otherwise.”