Clinical Depression and the Law

Recently, we have seen a spate of news reports on violence committed by people clinically depressed. In addition, there have been accusations of rape and abduction by a "stripper" against 3 Duke lacrosse team members only to find out that, none of the accusations were true, the accuser herself had multiple partners that fateful night, none of whom were Duke lacrosse team members, and that she had a previous diagnosis of "bipolar disorder" and depression and was not taking prescribed medications. In a Lansing State Journal report this morning, a women is suing a pastor and Mt Hope Baptist Church for failing to catch her when she came to the alter one Sunday and was smitten by the Lord, swooned and fell down, striking her head. She had no immediate troubles the day of nor the days after the fall. However, since her fall, her depression, which had been stable prior to the event, was now causing her back and head pains, inability to concentrate, walk, and carry out productive activities.

An article in PEDIATRICS this April reported a study assessing parental depression and pediatric health care use. The pattern of increase use of expensive health care resources (emergency room/in hospital care/ specialty clinic visits) and decreased use of preventive services by depressed parents reprsented one of the hidden costs of adult depression.

My own recent experiences involves three medical liability cases in which I have been a medical expert. In each case, the mother of the child has been clinically depressed prior to the event in which the infant died, they stopped taking prescribed antidepresant medications. Two cases have now been withdrawn by the plaintiffs with no settlement just days before going to trial; the third case is still in progress prior to trial. One case, the infant, who had a complex congenital problem with his esophagus resulting in difficulty in swallowing liquids and foods, who was fed and left unattended for more than a hour immediately following a feeding, he aspirated and died. The mother was clinically depressed and was not taking prescribed medications. Another case, the infant died and the story told by the mother, that the infant was fed and lay down to sleep alive and well one hour prior to being found stone cold with rigor mortis. The mother's story did not fit with the known facts of the processes and timing of those processes that go on after a person dies. Again, the mother had been clinically depressed prior to the infants death and was not taking her prescribed medications. The third case, the infant died of complications from being born prematurity. The law suit was brought two years after his death because the mother reported that she could not get over watching her child die in the Neonatal Intensive Care Unit and that her long standing depression was worse; she also had stopped taking her medications.

From the above, I am left with a question: since it appears that clincal depression has such major public consequences, let alone the private effects depression has upon the individual, and the diagnosis has been established yet the depressed individual, likely as part of their depression, does not take their therapies, how does society deal in a proactive way with the myriad of ways that clinical depression expresses itself, and has devastating long term consequences? To me the externalizing of one's depression is larger than the issues of whether guns are easily accessable, or what does one believe when told by an accuser of terrible things that have happened to her, or parents who engage in self focused behavior and neglect their child, or suffer unconsolable depression having witnessed terrible tragedies. There are enormous social consequences which I believe are impacting upon the costs to our health care delivery system.