Doctors are held responsible for known, rare side effects of drug after mis-diagnosis

The family of Jamar Jones sued the Detroit Medical Center and Danny F. Watson, a neurologist, after Jones died following a drug reaction.  The family complained that Watson erred in prescribing Tegretol for Jones without an adequate work-up. 

Jones' family gave a history indicating that Jones had experienced three episodes of mild seizure-like behavior after a car accident.   He was referred to Watson and two [negative] CT scans were performed.  With no additional work-up, apparently, Watson prescribed Tegretol for Jones, who began experiencing rare side-effects and was hospitalized.  Jones died within a month, diagnosed with  Stevens-Johnson syndrome, a very rare allergic reaction to Tegretol.  The family alleged that the work-up performed by Dr. Watson was inadequate and did not support a diagnosis of "probable partial complex seizure disorder" or the decision to prescribe Tegretol. 

Watson's expert witnesses initially admitted that Tegretol was the "cause in fact" of Jones' death, however, his attorneys later challenged that admission and also argued that Watson was entitled to summary disposition because Stevens-Johnson syndrome is so rare that Jones' death was not legally foreseeable to the doctor.  The Defendants argued that in order to recover, the Jones family would have to prove that Jones' death was a more-probable-than-not complication of the erroneous prescription.  The trial court and Court of Appeals rejected Watson's arguments and found that if Watson is proved to have violated the standard of care in prescribing Tegretol, then his error was a legal or proximate cause of Jones' death.  

• The Court of Appeals pointed to the evidence showing that Stevens-Johnson syndrome is a "known complication" of Tegretol therapy.  Since Tegretol creates a known risk of death, an error in prescribing Tegretol is a legal "cause" of the death---even though few patients will suffer that consequence.  The Court likened the analysis to speeding on the highway.  Most occasions of traveling over the speed limit don't result in a loss of control, an accident, or a death; nevertheless, when one does break the speed limit, the excessive speed is a legal cause of a resulting car wreck or death.  It is the exposure of another to risk of injury that makes the Defendant responsible for the outcome--the exact outcome need not be "more likely than not," if the risk is a known risk and foreseeable to the negligent actor.  A negligent actor is always responsible for the foreseeable consequences of his actions, even if they are not "likely" to result.  As the Court explained, "the issue is not how often the negligence will result in an injury-causing event, but rather whether the increased risk is directly linked to the negligence.  Therefore, if a physician prescribes a medication, reasonable minds could not differ that it is reasonably foreseeable that doing so could cause the patient to have one of the known reactions to that medication. [Emph in the opinion]"