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Mental health law briefing 160 – Damages for negligent dosage of lamotrigine

Awards of compensation for alleged negligence in prescribing psychiatric medication are fairly rare. However, a recent Court case has illustrated that compensation can be significant.

In a recent case, damages were agreed as part of an agreed settlement, for a patient who underwent a course of private treatment from a consultant psychiatrist who allegedly prescribed inappropriate and excessive dosages of Lamotrigine as a mood stabiliser. Following the issue of proceedings, breach of duty was admitted on behalf of the treating psychiatrist.

The drug regime caused the patient to suffer a serious reaction known as Stevens-Johnson Syndrome, a life threatening condition affecting the skin and mucous membranes. The drug dosage had both serious short term and long term implications for the patient, including multiorgan  failure from which she almost died and required intensive care and prolonged treatment. She suffered severe blisters and erosions on her limbs, face, mouth and  genital areas and suffered hair loss. It took 2 to 3 years for her hair to grow back.

The long term implications of the drug dosage were that the patient suffered permanent damage to her mucous membranes, including to the ocular surfaces of both eyes, causing recurrent conjunctivitis, ingrowing eyelashes and conjunctival scaring. She also developed fibromyalgia, causing muscular pain and fatigue, with a prognosis of recovery of around 7 years, there being various percentage  chances of her condition remaining following a period of between 14 to 28 years postonset of these symptoms.

There was also evidence that the patient (who had had a history of episodic depressive episodes with one episode of hypomania at the time of the treatment) had suffered a posttraumatic stress disorder and an exacerbation and delay in the resolution of symptoms of depression and some ongoing sexual dysfunction, due to a combination of labial scaring and psychological factors.

The patient was also at risk of permanent corneal scaring and associated visual loss. She was estimated to have a risk of some future visual loss at 10% to 20% over her lifetime, with a risk of total loss of vision in one or both eyes in the region of 1% to 2%. She was unable to return to her post as a Hospital Consultant for a period of six months, and when she did return it was on a part time basis. She therefore made a claim for partial ongoing loss of earnings and pension loss.

Although breach of duty was admitted on behalf of the psychiatrist, the issues of causation and quantum remained in dispute.

The claim for damages included a claim for past care and assistance and future household tasks, as the patient would not be able to undertake such tasks as a result of the effects of the fibromyalgia.

With regard to the risks of future loss of vision, it was argued that although the total loss of vision was small, the implications would be very significant for the patient’s lifestyle and earning capacity and should not simply form part of “general damages”, i.e. the damages for pain and suffering that would have been awarded as a lump sum.

Accordingly, the patient maintained that she was entitled to a provisional damages award; the settlement reached on her behalf was on the basis that the prospect of a loss of vision at some indefinite point in the future amounted to a separate event. The settlement was concluded on this basis.

The agreed damages awarded to the patient were provisional damages of £450,000; it was agreed by the legal advisors that around £60,000 represented general damages for pain, suffering and loss of amenity.

The wording of the settlement agreement in relation to future damages included a provision that if at a future date the patient suffered a loss of vision directly referable to the negligence, which materially affected her daily functioning and/or work over and above that which she currently suffered, and for which she had already been compensated, then she should be entitled to apply to the Court for future damages.

Alexandra Johnstone
© RadcliffesLeBrasseur


This briefing is for guidance purposes only. RadcliffesLeBrasseur LLP accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.