As an experienced criminal defense attorney whose offices serve the entire State of Florida, John Musca evalutes unique criminal cases that may improve public policy, practices and public opinion. Once such case it that of Ryan Ehlis. The Ehlis case marks a serious flaw within the justice system.
In January 1999, Ehlis, a college student in Bismark, North Dakota, began taking Adderall to control his Attention Deficit Disorder and to help him with his studies. Within 10 days of taking the prescribed medication he slipped into a psychotic fog, shot and killed his infant daughter, then shot himself in the stomach. He said God told him to do it.
The criminal court found him innocent after testimony by a psychiatrist and by the manufacturer of the drug that the "psychotic state" was a very rare side effect of Adderall use. Various doctors testified Ehlis suffered from an "Anphetamine-Induced Psychotic Disorder". This is a DSM label for a psychotic disorder caused by medication prescribed to help a less severe disorder. Medical experts and Shire US, Inc., the manufacturer of Adderall, commented that "despite the slaying, Adderall remains a safe and effective drug for controlling AD/HD. "
In a later civil court case, the United States Court of Appeals, District Court of North Dakota, affirmed the lower court's decision to dismiss a lawsuit brought by Ehlis against Shire. Ehlis contended that Shire knew Adderall could induce psychosis and failed to adequately warn of the associated risks. The court ruled the "learned intermediary doctrine" barred the claims of failure to warn. This doctrine provides that a pharmaceutical manufacturer has a duty to warn a physician of the risks involved with a drug, and the physician acts as a "learned intermediary" between the manufacturer and the patient. "Thus, a warning to the physician is deemed a warning to the patient; the manufacturer need not communicate directly with all ultimate users of the prescription drugs."
The treating psychiatrist for Elhis stated he (1) knew substance-induced psychosis was "within the DSM-IV," meaning diagnostic criteria exist for this condition, regardless of the psychosis was caused by stimulant or other medication; (2) was aware some people can become psychotic without overdosing on certain medications, including Adderall; (3) knew the risks of psychosis was listed and identified in the package insert as a side effect for Adderall when he prescribed Adderall for Ehlis; (4) believed the statement in the insert was accurate; (5) continues to prescribe stimulant medications for adults since the incident involving Ehlis; and (6) continues to prescribe Adderall, because Adderall is a good medication. Ehlis' psychiatrist evaluated him in a 45 minute session and prescribed a medication resulting in the death of his child, and serious injury to himself.
