Anesthesiology Resident Addiction and Suicide

A CA-1 in her second month of anesthesiology residency began self-administering propofol, giving doses upwards of 150mg.

One evening in the call room she was not responding to calls or pages.

An attending searched for and found her, disoriented and confused.

She was sent home.

The following week she met with her program director and came clean about her drug use.

She was referred to the institutions workforce clinic for evaluation with an addiction psychiatrist.

She denied wanting to hurt herself or having suicidal ideations.

She was not depressed.

A 6 week intensive outpatient program was prescribed, followed by group sessions and frequent appointments with close follow ups.

She returned to work several months later with weekly urine tests and screens for track marks.

She did well for some time.

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6 months later she relapsed with propofol.

With the help of her long distance boyfriend, and a medical school friend, she got the courage to call her program director.

In that discussion she recognized the field was too high risk for her, and that she should resign.

She expressed lots of worry over her decision to resign, over her loans, and if she had a future in medicine.

The day after the phone call with her PD no one could get a hold of her.

The doorman of her building was sent to check on her, whereupon her body was found.

There was a handwritten note apologizing for not being strong enough.

She had committed suicide via propofol overdose.

Her family brought claims against the hospital, workforce clinic, physician safety program, and outpatient addiction treatment program.

Experts in addiction medicine were hired. Here is the plaintiff’s expert.

The defense hired an expert as well

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Outcome

In returning to work the resident had signed a comprehensive release that indemnified the hospital from all “causes of action of any nature whatsoever.”

The plaintiffs attempted to argue this document was ambiguous, and that her signature was unwitnessed and possibly inauthentic.

The judge responded there was no testimony from a handwriting expert, and that this physician was being given an opportunity to continue with her professional life, and understood what she was signing.

The case was dismissed.

MedMalReviewer Analysis

1. Many of us know individuals who have succumbed to the dangers of our specialty. Easy drug access, stressful environment, solitary work. Our specialty has inherent risks, and for some people it is not a safe career path to choose.

2. As mentioned by the defense expert, suicide is extremely difficult to predict. This is true even for psychiatrists who deal with high-risk suicidal patients on a daily basis. This resident had many protective factors including a supportive family and plans for the future (vacation and new job search). I don’t believe that the assessment of suicide risk was below the standard of care in this case, but it’s worth noting that occupation loss, especially amongst highly talented individuals, can increase suicide risk. When a resident realizes that their hopes of a career in a chosen field have been permanently terminated, it strikes at the very core of their self-identity. It feels like all the years of struggle and sacrifice have been lost, which is extremely destabilizing. The fact that she denied suicidal ideation in the months preceding her death (while she still believed she could complete training and become an anesthesiologist) may not provide any insight into how she would act when her dream was crushed.

3. I was under the impression that trainees who self administer anesthesia drugs should be re-trained in a safer specialty. ASA has a statement on substance abuse that recommends return to the specialty after treatment on a case by case basis, but that statement does not appear to be aimed at trainees.

4. This was a tragic and unnecessary outcome. This young woman could have retrained into another field and likely would have had a successful and prosperous career in medicine. Be on the lookout for colleagues, no matter the size of your department.