On October 15, 2005 a Virginia jury delivered a $1.6 million verdict in a tardive dyskinesia case, Sylvia Jones v. Jeffrey Alan Margolis. The amount was especially large considering the small town setting of Tappahannock in southeastern Virginia. Also, the defendant was a well-known internist in the community.
In 1982 when she was twenty-one years old, her original internist placed Sylvia Jones on Triavil, a combination of the neuroleptic perphenazine (Trilafon) and the antidepressant amitriptyline (Elavil). At that time she had situational stresses that were causing anxiety. Although her most of her symptoms of anxiety cleared up during the earlier years, her original internist maintained her on the drug until 1997. Perphenazine is indicated for the treatment of psychosis but at no time has Mrs. Jones displayed any symptoms of psychosis.
In 1997 internist Alan Margolis, M.D. took over Mrs. Jones treatment and increased the dose of Triavil. Although she no longer suffered from any serious symptoms of anxiety, Dr. Margolis maintained her on this drug until February 2003 when she developed a
severe, painful and crippling torticollis (spasm of her neck). Subsequent physicians diagnosed her as suffering from neuroleptic-induced tardive dyskinesia, a disorder that can afflict any voluntary muscle, including the face, neck, torso, and extremities, as well as speech, breathing and swallowing.
Since 1997 Mrs. Jones has been completely disabled by a variety of motor abnormalities associated with tardive dyskinesia. In addition to the spasms of her neck, her shoulders twist severely and she has facial and abdominal spasms. Her vocal cords are impaired, producing an abnormal tone of voice. She is weakened and cannot carry out tasks requiring coordination or strength. She suffers from chronic pain. Humiliation over her appearance has caused her to be socially isolated.
At no time during her treatment did Dr. Margolis adequately justify the use of a neuroleptic. He failed to monitor the patient, at one point prescribing for her over a period of more than two years without seeing her. He performed no examinations for TD, and he gave no warnings or education concerning the risks and symptoms of TD.
In defense of Dr. Margolis, a Florida psychiatrist argued that the TD wasn’t caused by the twenty years of neuroleptic exposure but by the very last dose that the patient supposedly took after her last visit with Dr. Margolis. A well-known Washington, DC internist argued that Dr. Margolis didn’t have to give the patient any warnings or education concerning TD since he was certain this information had been given by her original doctor twenty years earlier, even though that deceased doctor’s records no longer existed.
Peter R. Breggin, M.D. conducted the initial evaluation of the case and provided consultation in planning the case and then in the courtroom during the trial. Originally scheduled as a rebuttal witness to the defense experts, Dr. Breggin did not need to testify because the defense was so weak that no rebuttal was required. Two treating physicians testified on behalf of Mrs. Jones.