Did drug dosage or improper restraint cause Atascadero High grad's death?

ppemberton@thetribunenews.comApril 9, 2013 

A mentally ill woman had dangerously high doses of prescription drugs in her system when she died during a confrontation with caregivers, a toxicologist testified Tuesday.

Yet, the psychiatrist who prescribed her the medication said the 33-year-old woman died because of the way her caregivers physically restrained her.

Testimony continues in San Luis Obispo Superior Court in the monthlong civil trial against Genesis Developmental Services, now known as Novelles Developmental Services Inc. The organization provided care to Lauren Arcady, an Atascadero High School graduate, so she could live in the community instead of a mental health facility.

Attorneys for Arcady’s parents, Kathleen Reed and Alexander Arcady, are suing Genesis, saying two of their employees caused the woman’s death.

Arcady died June 26, 2010, at her Santa Maria home. A half-hour before her death, the family’s attorneys claim, caregiver Vanessa Gonzales took photos of Arcady with her cell phone. Arcady became upset at some of the photos, then stormed to her room. There she was improperly restrained in a prone position against a bed by Gonzales and another caregiver, Cristina Camacho, who each outweighed Arcady by 70 and 30 pounds, respectively.

That restraint, the plaintiffs argue, caused Arcady to suffocate.

Attorneys for Genesis, however, argue that a potent mix of drugs, combined with a rush of adrenaline, caused sudden death.

“Citalopram was prescribed to Miss Arcady in a very high dose,” testified Neal Benowitz, a toxicologist from San Francisco, who examined Arcady’s records for the defense.

The anti-depressant, mixed with an anti-psychotic drug a week earlier, could have triggered a cardiac arrhythmia — a condition in adrenaline rush, Benowitz told a jury.

According to a progress report written by her psychiatrist, Jeffrey Davis, Arcady had recently engaged in increasingly intense aggressive behavior “out of the blue” — a sign of an adverse drug reaction, Benowitz said.

While defense attorney Thomas Beach said the dosage of Citalopram was higher than the manufacturer’s suggestion, Davis said the amounts were OK by FDA standards at the time. Arcady, who suffered from schizophrenia, had received many different treatment plans, Davis said.

“She’s been treated by a number of psychiatrists with multiple medications over the years,” Davis said.

While reports showed Arcady’s heart had a slightly irregular electrical cycle, which can be caused by adverse reactions to drugs, Davis said the degree was “not clinically significant.”

According to the Santa Barbara County District Attorney’s Office, an autopsy report and a criminal investigation inconclusively established the cause of death. The coroner’s report listed the cause of death as probable cardiac arrhythmia and excited delirium combined with her developmental disability and multiple drug ingestion.

Attorneys for Genesis have noted that Arcady was known to have violent outbursts, featuring screaming, kicking and throwing objects. Just before her death, they said in court filings, she began kicking and hitting a window when the caregivers steered her toward the bed and held her sleeves until she calmed down.

When Arcady stopped breathing, the caregivers said, they called 911.

In court filings, the plaintiffs said injuries on Arcady’s body prove otherwise.

When asked what he thought was the cause of death, Davis said, “sudden death in the context of prone restraint.”

James Murphy, an attorney for Arcady’s family, said during previous testimony that it would be odd for a deadly drug reaction to occur at the very moment Arcady was struggling with her caregivers.

“It seems to me that if somebody dies while in prone restraint … there might be a causal connection between the restraint and the death,” he said.

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