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Homeless Woman Hanged Herself from Rings in LAPD Jail, Police Chief Says

Less than an hour after she was booked on suspicion of prostitution, 40-year-old Angela Slack was found hanging by her neck in a Los Angeles police cell, barely alive.

Now, months after the homeless woman died in a hospital from her self-inflicted injury, family members are demanding to know how she could have been allowed to die, and have accused the LAPD of negligence.

“We wrote to the LAPD for information and requested any videos, any photographs. They just didn’t respond to us,” said James Morris, an attorney representing her family. “The family is entitled to know how Angela died and why.”

In a recent report to the police commission, LAPD Chief Charlie Beck said investigators found that Slack used her shirt and a restraining ring in her cell to do herself harm. As a result of this finding, the LAPD has ordered all similar ring restraints removed from LAPD holding cells.

“They should have all been removed already,” LAPD Cmdr. Sean Malinowski said Wednesday.

Slack died at Providence Holy Cross Hospital in Mission Hills six days after she was found unconscious in a Foothill Division cell on March 12, 2015. The Los Angeles County coroner ruled her death suicide by hanging.

In his report to the police commission, Beck said Slack was placed in a Foothill station holding cell at 6:12 p.m. on the day of her arrest. She appeared to be under the influence of a stimulant or alcohol, but she was not incoherent, the report said.

Her cell was outfitted with a metal bench 18.5 inches high that ran the length of the room. Roughly 20 inches above the bench, a mounting cleat with a 2-inch metal ring was fixed to the wall, according to the report. From the ring hung a 3-inch oval clamp and a 9-inch chain with a single handcuff at the end. Slack, however, was never secured to the bench.

A surveillance camera captured the cell door closing, as well as Slack's movements up until 6:35 p.m. After that, she moved to a portion of the cell that could not be observed by the camera, according to the report.

At 6:44 p.m., a station typist walked past the cell and noticed that Slack was “sitting on the edge of the bench" with her stomach "sticking out." The typist noted also that the arrestee's "eyes were closed, her shirt was tied around her neck and she looked dead.”

Officers found that Slack’s long sleeve shirt was wrapped around her neck, while one of the sleeves was looped through one of the restraining rings. A sergeant used a custodian’s knife to cut her down, while fellow officers performed CPR and applied a defibrillator as they were waiting for paramedics.

Slack’s family now blames the LAPD for her death. On Tuesday, they filed a wrongful death lawsuit against the department.

“Once a police officer engages her and takes her into LAPD custody they have a responsibility for her health,” Morris said. “She was arrested for prostitution; a homeless woman, one of the many people disregarded in America that no one seems to care about, and they treated her that way.”

Courtesy of www.latimes.com

Antidepressants Linked Autism : Gilbert Daily Science

After adjusting for maternal confounders, the use of any antidepressant by mothers in the second and/or third trimester of pregnancy was associated with autism spectrum disorder (ASD) at a hazard ratio of 1.87 (95% CI 1.15-3.04) relative to pregnancies with no maternal antidepressant use, according to Takoua Boukhris, MSc, of the University of Montréal, and colleagues.

When the analysis was restricted to SSRI antidepressants, Boukhris and colleagues calculated an adjusted hazard ratio of 2.17 (95% CI 1.20-3.93), they reported in JAMA Pediatrics.

There was no increased risk for antidepressants overall or for SSRIs during the first trimester or in the year before pregnancy.

Scientists don’t fully understand the causes of autism, though many suspect a mix of genetics and environmental factors. Trying to gauge the role of medications during pregnancy is difficult—experts cautioned that there isn’t any clear evidence that allowing depression to continue untreated is safer than taking antidepressants.

“There’s no good study design to tease those apart,” said Siobhan Dolan, a professor of clinical obstetrics and gynecology at the Albert Einstein College of Medicine who isn’t involved in the study. “It’s not, ‘medication is bad and being a depressed mother is a perfectly fine outcome.’ There’s an impact of having depression and trying to raise a child.”

Bryan H. King, a psychiatrist at Seattle Children’s Hospital, wrote in an editorial accompanying the study that further research is unlikely to reveal “a straight line” between the use of antidepressants during pregnancy and autism. Also, the Quebec study wasn’t a randomized control trial, the gold standard for establishing the effects of a particular drug. Instead, it looked at medical records retrospectively, which means that unforeseen factors could account for any link between antidepressant use and autism.

The analysis covered 145,456 singleton births in the province of Quèbec over a 12-year period, in which 31 were born to women using antidepressants during the second/third trimesters. Of these, SSRIs were involved in 22 of the pregnancies.

Exposure to more than one class of antidepressants was associated with the most substantial increased risk of ASD for five infants who were exposed (adjusted HR 4.37, 95% CI 1.44-13.32). But there was no increased risk associated with other classes of antidepressants (such as SNRIs, MAOIs, and tricyclic antidepressants).

Overall, there were 1,054 children with “at least one diagnosis” of ASD (0.72% of the sample). Max Wiznitzer, MD, of University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, told MedPage Today that even if the risk of ASD was doubled with SSRI use, there would be approximately a 2% chance that a child would have autism compared to approximately a 1% chance.

“That’s still a 98% chance that you’re not going to get autism,” said Wiznitzer, who was not involved with the study. “The media will say ‘The risk is two-fold, oh my God!’ But I think what we have to say is the absolute numbers are much more important.”

Other studies have been published on this subject, including a recent study with a larger sample size that found no association between ASD and use of SSRIs during pregnancy.

Causation Not Proven

Eva Pressman, MD, of the University of Rochester Medical Center in Rochester, N.Y., said that while the new study found a stronger association later in pregnancy, perhaps the patients that were unable to come off their antidepressants in the early part of their pregnancy had more severe disease.

“It’s very hard to combine the two studies together and know what’s going on and that’s often the trouble with epidemiologic data,” she told MedPage Today. “I think it does make it clear that we need more studies and we need the sorts of studies that will actually get at the underlying biology.”

Secondary analyses of children of mothers with a history of maternal depression also found an increased risk associated with SSRIs during the second and/or third trimester for 29 exposed infants (adjusted HR 1.75, 95% CI 1.03-2.97).

Sensitivity analyses examining only children with ASD who had their diagnosis confirmed by a psychiatrist or neurologist did have an increased risk of ASD, but the authors noted the risk was not statistically significant.

Wiznitzer commented that there was no information about how children were diagnosed, and that well-known depression rating scales have a high false positive rate.

He added that if there was no statistically significant difference when specialists diagnosed ASD, that might say something about ASD diagnosed by other health professionals.

“If the specialists couldn’t find a statistical difference, what do we make of this larger database with other people who have less expertise — were they actually making diagnoses correctly or were they over-labeling?” Wiznitzer said. “Kids of parents with depression and anxiety are at higher risk of presenting with different types of behaviors that could be mislabeled or misconstrued as ASD.”

An accompanying editorial by Bryan King, MD, of the University of Washington in Seattle, suggested that the potential increase in ASD could come from diagnostic substitution — a phenomenon that has also been proposed by other recent studies.

“Might an increase in diagnoses of ASD be mediated by an increase in the frequency of intellectual disability or some other neurodevelopmental risk factor?” he wrote. “An increase in one diagnosis might actually be regarded as positive if it resulted in a decrease of a more severe condition.”

Study Details and Limitations

Boukhris’ team examined data from the Quèbec Pregnancy/Children Cohort from 1998 to 2009. Overall, 4,724 infants were exposed to antidepressants in utero (3.2%), with 4,200 infants exposed in the first trimester (88.9%) and 2,532 exposed in the second and/or third trimester (53.6%). The mean age of autism diagnosis was 4.6 years (SD 2.2), with a median of 4.0 years. The mean age of children at the end of follow-up was 6.2 years (3.2) with a median of 7.0 years. Boys with ASD outnumbered girls by a 4:1 ratio.

King commented on the mean age of diagnosis, considering that ASD cannot be reliably diagnosed at birth and in early infancy.

“When considering the true prevalence of ASD, one might want to exclude children younger than 2 years from the denominator because they have not yet had a chance to manifest symptoms of ASD or be evaluated for it,” he wrote.

Other limitations acknowledged by the authors are the study’s use of prescription-filling data for antidepressants, which may not reflect actual use. They also noted that they lacked data on maternal lifestyle, such as smoking or body mass index, as noted that the cohort was predominantly of lower socioeconomic status, which may limit the generalizability of the findings.

Pressman urged caution when interpreting the study, saying that stopping SSRIs would not be beneficial for pregnant women who are severely disabled by depression or for whom other medications do not work.

“I think it’s really important that we don’t take this study and say ‘everybody should come off of their SSRIs during pregnancy,’ because you have to be very careful with a sweeping recommendation like that,” she said. “It’s really hard to change the practice of medicine because of what you found in 31 infants.”

Wiznitzer said that the authors themselves admitted that they didn’t consider all the variables when examining the risk for ASD and that those variables are important.

“It’s a good study with a large population, but all it is is number crunching,” he concluded. “The benefits of treating maternal depression far outweigh any small risk [to offspring] that might be present.”

Courtesy of www.albanydailystar.com

GSK Scores Midtrial Dismissal Of Paxil Birth Defect Suit

GlaxoSmithKline PLC on Monday scored a midtrial dismissal of claims that its antidepressant Paxil caused cardiac birth defects as a Pennsylvania state judge ruled that the plaintiffs hadn’t presented sufficient evidence to support their case.

Judge Kenneth Powell in the Philadelphia County Court of Common Pleas granted GSK’s motion for compulsory nonsuit after ruling that physician Robert Kiehn had not testified that he would have altered his decision to prescribe Paxil to plaintiff Elisabeth Balser if presented with more adequate warnings about potential risks associated with the drug.

“It is not reasonable to infer based on the testimony that was presented that Dr. Kiehn would not have prescribed Paxil had he known the additional risk,” Judge Powell said in a ruling from the bench on Monday afternoon. “Based on the testimony presented by the plaintiff, all the jury could do is guess. I cannot permit the jury to speculate as to causation.”

Attorneys for GSK moved for a nonsuit on Monday morning after the plaintiffs rested the nearly two-week-old case they presented on behalf of Braden Rader, who was born with tetraology of fallot, which is a combination of several congenital heart defects, allegedly caused by Balser's use of Paxil during the early stages of her pregnancy in 2003.

Balser’s is the first of nine cases queued up for trial as part of a mass tort program in Philadelphia.

Joseph O’Neil, an attorney with Lavin O’Neil Cedrone & DiSipio representing GSK, told Judge Powell during oral arguments on the nonsuit motion that a claim over the company’s alleged failure to provide adequate warnings could not go to the jury because Kiehn had not testified that he would have acted any differently if provided with additional information about the risk of potential birth defects.

“That is a deal breaker,” O’Neil said. “To allow this case to go to a jury is to allow the jury to engaged in pure, unadulterated speculation as to what Dr. Kiehn would have done."

Adam Peavy, an attorney with Bailey Peavy Bailey Cowan Heckaman PLLC, argued that portions of Kiehn’s videotaped deposition had been improperly excluded from their case under Judge Powell’s interpretation of a pretrial order barring mention of subsequent remedial measures GSK may have taken to address problems with the drug.

Among those, he said, was the fact that Paxil was upgraded under Food and Drug Administration guidelines to a so-called Pregnancy Category D drug in September 2005, which warned physicians that studies in pregnant women had demonstrated a risk to fetuses.

While court records indicate that Kiehn had testified in his deposition that he would never have prescribed a drug with a Category D ranking, Judge Powell barred those questions from being played for the jury.

“To suggest that the question was never asked is not accurate,” he said. “It was asked multiple times about what he would’ve done with a different warning, or if he was warned about Paxil causing birth defects. Your honor excluded that evidence.”

Todd Davis, an attorney with King & Spalding also representing GSK, said that the plaintiffs could have asked the question a different way during the deposition or, after the pregnancy category questions were barred from being played for the jury, flown Kiehl to Philadelphia to testify in person.

“Plaintiffs here had the opportunity to ask the right question of Dr. Kiehn and they didn’t do it,” he said. “They failed to present that evidence, and without that evidence they cannot proceed.”

Judge Powell agreed in his bench ruling.

“The court recognizes that the plaintiffs asked a question related to Paxil’s inadmissible Category D label, however the question was stricken,” he said. “Plaintiffs could have asked admissible questions of what Dr. Kiehn would have done had he known that Paxil was a potential teratogen or that it caused embryo-fetal death, but they did not do so.”

Peavy slammed Judge Powell’s ruling in a brief interview with Law360 on Monday afternoon.

“We’re disappointed with the judge’s exclusion of highly relevant evidence that would have proved that Dr. Kiehn would never have prescribed Paxil to Ms. Balser,” he said. “His exclusion of that evidence throughout the entire trial has impacted our ability to pursue our case.”

He said that the judge had barred mention of the new pregnancy category as a subsequent remedial measure “without reference or consideration to the exceptions to that well known rule.”

He was unequivocal when asked about the possibility of asking the state’s Superior Court to review Judge Powell’s decision.

“Oh, there will be an appeal,” he said. “Absolutely.”

GSK, meanwhile, praised the decision in a statement to Law360 and rebutted any alleged links between Rader's condition and Paxil.

"The scientific evidence does not establish that exposure to Paxil during pregnancy caused Braden Rader’s tetralogy of fallot heart defect," a company spokeswoman said. "In fact, there are no studies finding that Paxil causes tetralogy of fallot. It is always saddening when a child is born with a heart defect, which, unfortunately, can occur regardless of whether the mother was taking medication during pregnancy. The causes of the vast majority of heart defects are still unknown, although many are caused by genetics."

Rader is represented by Adam Peavy of Bailey Peavy Bailey Cowan Heckaman PLLC and James Morris Jr. of Morris Law Firm.

GSK is represented by Todd Davis of King & Spalding and Joseph O’Neil of Lavin O’Neil Cedrone & DiSipio.

The case is Braden Rader et al. v. SmithKlineBeecham Corp. et al., case number 110903672, in the Court of Common Pleas of Philadelphia County, Pennsylvania.

Courtesy of www.law360.com

Pediatric Cardiologist Testifies To Paxil-Heart Defect Link

A Rush University pediatric cardiologist testified in Pennsylvania state court Monday that exposure to GlaxoSmithKline PLC’s antidepressant drug Paxil while in utero was connected to a 12-year old boy's rare heart condition.

Expert witness Ra-id Abdulla said that a review of the medical records of plaintiff Braden Rader and those of his mother revealed that her Paxil use during pregnancy contributed to him being born with tetralogy of fallot, a combination of four heart defects.

Abdulla, the editor-in-chief of the Pediatric Cardiology Journal, told jurors that Rader's fetus was exposed to Paxil during the first 30 to 35 days of life.

“That is the critical period of time for heart development,” he said.

Rader's suit is the first of nine cases over Paxil that are queued up for trial as part of a mass tort program in the Philadelphia County Court of Common Pleas.

Abdulla also told jurors that Rader had undergone two heart surgeries — the first several months after he was born and the second in 2015 — and that the boy would need future invasive surgery.

“This is a lifelong commitment,” he said of the medical condition.

Abdulla did face a vigorous cross-examination from King & Spalding attorney Todd Davis, who aimed to cast doubt on the doctor's qualifications to assess the cause of birth defects and the science connecting the drug to the condition.

Davis also suggested that Abdulla reviewed incomplete medical records in his assessment and did not go beyond these records to talk to Rader's treating physicians. But the doctor testified that this was standard practice among clinicians.

“Every week in every single medical center, we meet once or twice to discuss patients we haven't seen,” he said. “We rely on medical records to come up with plans for management.”

Abdulla also testified that the link between Paxil and heart defects has already been “assessed, documented, and judged” by the American Heart Association. This did not stop Davis from pushing him on the absence of studies that revealed a direct connection between Paxil use and changes to human or animal embryos.

As the cross-examination approached the finish, Abdulla became increasingly critical of Davis's questioning, calling hisapproach “pseudoscience.” But the doctor retained his composure and kept to a level tone.

“Medically speaking, it's utter nonsense,” Abdulla said of the attorney's insistence on evidence of a direct linkage. “That's not the way we come up with conclusions.”

“The issue of Paxil causing heart disease — that ship has sailed,” he said.

Rader is represented by Adam Peavy of Bailey Peavy Bailey Cowan Heckaman PLLC and James Morris Jr. of Morris Law Firm.

The case was presented for GSK by Todd Davis of King & Spalding.

The case is Braden Rader et al. v. SmithKlineBeecham Corp. et al., case number 110903672, in the Court of Common Pleas of Philadelphia County, Pennsylvania.

Courtesy of www.law360.com

Paxil Linked To Heart Defects In Babies, Philly Jury Told

After being barred from presenting opinions in federal multidistrict litigation over the antidepressant Zoloft, a Philadelphia jury heard testimony on Thursday from an expert witness about what she said were clear links between GlaxoSmithKline PLC’s antidepressant drug Paxil and cardiac birth defects.

University of Montreal researcher Anick Berard, whose testimony was rejected from the Zoloft MDL after a federal judge ruled in June 2014 that she’d strayed from established epidemiological methods, told the jury that more than a dozen studies on Paxil showed a consistent association between the drug and cardiac birth defects.

“Paxil, when taken during the first trimester of pregnancy, is more likely than not to be a cause of heart defects in newborns,” she said during about two hours of direct examination before Judge Kenneth Powell.

Berard’s testimony comes in the first of nine cases over Paxil that are queued up for trial as part of a mass tort program in the Philadelphia County Court of Common Pleas.

GSK faces claims that 12-year-old Braden Rader was born with a rare condition known as tetralogy of fallot, a combination of four heart defects, after his mother took Paxil while she was pregnant in 2003.

The road to trial for the Paxil cases in Philadelphia has been somewhat tortured.

The nine Paxil cases were removed to federal court by GSK in October 2011 before being remanded after a federal judge determined that the company was a Pennsylvania resident and that there was no diversity jurisdiction.

After a landmark Third Circuit ruling in a separate case in June 2013 finding that GSK’s 10-foot-by-10-foot office in Wilmington qualified it as a Delaware resident, the company moved once again to pull the Paxil cases out of Philadelphia and have them heard in federal court.

While a federal judge rejected a motion to remand the cases back to Philadelphia a second time, the Third Circuit ruled last August that GSK’s second removal had been untimely.

In addition to losing the fight to have the Paxil cases removed to federal court, GSK also lost a bid in Philadelphia to have Berard’s testimony barred on grounds that her expert report was “remarkably similar” to the one she’d submitted in the Zoloft litigation.

Their motion was rejected last month.

Todd Davis, an attorney with King & Spalding representing GSK in the Rader case, however, worked during cross-examination on Thursday to suggest that Berard’s opinions had shifted depending on the particular case that she was working on.

He pointed to a string of studies cited in her expert report in the Paxil litigation that she had previously criticized during depositions in both the Zoloft MDL and litigation over the antidepressant Celexa.

“Scientists shouldn’t be cherry-picking data based on what litigation they’re in,” Davis said.

Berard countered that the studies Davis singled out had not been used in forming her causation opinion, but were instead cited in her report simply because it fell within the broad universe of material she’d reviewed on the topic.

She said she’s included them in her report after being accused in other litigation of not being exhaustive enough in singling out relevant research.

The case was presented for the Raders by James Morris Jr. of Morris Law Firm.

The case was presented for GSK by Todd Davis of King & Spalding.

The case is Braden Rader et al. v. SmithKlineBeecham Corp. et al., case number 110903672, in the Court of Common Pleas of Philadelphia County, Pennsylvania.

Courtesy of www.law360.com

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