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Young woman committed suicide while being treated for anxiety and depression (01HDC14511)

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(01HDC14511, 11 November 2003)

Right to services of an appropriate standard ~ Reasonable care and skill ~ Right to be fully informed ~ Sufficient information ~ Explanation of condition ~ Information about treatment options ~ Information about risks ~ Side effects ~ General practitioner ~ Death ~ Mental illness ~ Depression ~ Medication management ~ Risks of therapy ~ Drug interactions ~ Follow-up care ~ Patient monitoring ~ Record keeping ~ Right 4(1) ~ Right 6(1)(a) ~ Right 6(1)(b)

A complaint was made by a woman about the services provided by two GPs to her daughter, who suffered from severe anxiety and depression and committed suicide. The complaint was on the grounds that the GPs prescribed inappropriately, did not adequately involve the family, and failed to recognise an adverse reaction. The woman also complained that her daughter was not provided with sufficient information about the options available for treatment and the risks and side effects of the medications.

The Commissioner held that one GP did not breach Right 6(1) as it was accepted that a variety of treatment options had been discussed. While all the details were not recorded in the notes, there was no evidence to suggest that the GP did not provide sufficient information. The expert advice was that a reasonable GP would not record all the details of the information provided. It was also accepted that the original prescriber of medications, in this case a psychiatrist, is responsible for explaining the risks and benefits, adverse effects, and withdrawal symptoms of the medications prescribed.

The GP also did not breach Right 4(1) because his decision to commence the patient on medication was reasonable and it was not necessary for him to have delayed treatment to further clarify her diagnosis. Furthermore, on the basis of the information available to him at the time, which included his view that the potential benefits of medication outweighed the risks to the patient, the medications he prescribed were appropriate and he took sufficient steps to ensure that the patient was monitored. It was also the Commissioner's opinion that it would have been inappropriate for the GP to involve the family, unless the patient had specifically requested him to do so.

The complaint against the second GP focused in part upon the decision to use clonazepam, a benzodiazepine, to treat the patient's anxiety. It was complained that this was not appropriate and that the GP failed to recognise signs of dependence. The Commissioner held that this GP did not breach Right 4(1) of the Code, even though clonazepam is only formally indicated for epilepsy, as it can be used for other purposes. The Commissioner was satisfied that clonazepam is an appropriate drug to use for the treatment of anxiety, and that the GP was following a widely accepted practice. Even though the GP continued to prescribe clonazepam for about ten weeks before recording that he was attempting to reduce her dose, his prescription was appropriate because he was using less than the maximum recommended dose, he was trying to reduce it and to change to less addictive medication, and he was getting help from other health professionals. The Commissioner also commented on the difficulty of differentiating any possible signs of withdrawal from benzodiazepines from symptoms and signs of pre-existing anxiety.