Jailhouse Medicine: Chris Morden

Editor’s Note: This week, Northern Express presents two stories involving powerful, second-generation anti-psychotic drugs used to treat schizophrenia. The first is about a young man who died in the Grand Traverse County jail after taking three psychotropic drugs simultaneously. The second profiles a woman who says these antipsychotic drugs have transformed lives, including her own.



It was a mom kind of thing. Back in August of 2001, Betty Morden’s son had been using her hairbrush again, and she wanted to see if he had one of his own. She saw his backpack out in the garage and decided to peek in. But instead of a hairbrush, she was shocked to find a handgun and a handful of $2 bills.
Betty Morden weighed what to do. Her son, Chris, had been a source of great joy and some angst to the Elk Rapids family since he was adopted as an infant. He was funny, loving, and well-liked by just about everyone. Chris was one of 23 children whom Betty and Les Morden had taken into foster care. And he was the only child they adopted because he was so extraordinarly loving.
But Chris, 20, was also overly trusting and could easily be led astray. He had gotten into a few minor scrapes with the law during his teen years. By making a phone call to the Elk Rapids police, Betty and Les felt that he could learn a lesson and get on with a productive life, which had already included so much--a love of wrestling, drumming, even serving as an altar boy.
It turned out that Chris had stolen the gun from a vacant home. He was charged with home invasion and lodged in the Antrim County jail for four months without a trial. When the charges were dropped in December rof 2001, he decided that this was his chance to turn his life around. He applied for a job at a nearby nursing home and studied for a CPR test, a requirement for the job. But on the day he was supposed to take the test, a Grand Traverse County Sheriff’s deputy showed up and arrested him again.
Chris was taken to jail that day on February 2, 2002. Thanks to his easy-going personality, he quickly won over the other inmates. But something was amiss. He mentioned hearing voices that told him too hurt himself. With a history of schizophrenia, the jail officials thought he was getting to much stimulus and put him into his own jail cell. The jail doctor called a psychiatrist, who upped his medications.
The Mordens had left town for a short while after Chris went to jail, believing that he was in safe hands. When they returned, Betty visited Chris on March 15. She as alarmed by how “druggy” he looked. She asked that he get checked out immediately.
Two weeks after Betty complained, Chris was playing cards at about 10 p.m. at the picnic table with his cellmates. His fists clenched up, and it looked as if he was going into a seizure. At first, a cellmate tried to hold him up.  Someone tried to perform CPR and paramedics arrived at 10:18. Chris was pronounced dead at the hospital 32 minutes later.  
The autopsy said Chris was wearing green pants and orange socks. On the center of his chest was tattooed a pair of eyes. On his left shoulder, a tattoo of a broken heart.
There isn’t a week that goes by that someone in town doesn’t stop Betty or Les to say how much they miss Chris and that they continue to pray for the family. He was a great kid who paid for a small mistake with his life, Betty said.

NO APOLOGY
The public had no clue of Chris Morden’s death for months. Grand Traverse County Sheriff Scott Fewins didn’t issue a press release, and he didn’t call Les and Betty Morden to apologize. Another staff employee did call the Mordens, leaving them in shock.
Grieving and feeling guilty, Betty and Les were desperate for information. They wanted a report, anything to explain why their son died in jail. Within days of Chris’s death, they met with the investigator and asked about Chris’ medications. He promptly closed the file and said, “’I’ll get back to you.” But he never did.
They finally sought out attorney Grant Parsons, who filed a suit against the sheriff’s department for violating the state Freedom of Information Act. Thirteen weeks after Chris’ death, they received their first piece of paper—just minutes before the hearing. The sheriff’s reason for denying Morden’s request was that it would hamper an ongoing investigation. That’s a normal reason for a criminal investigation, but this wasn’t a criminal case.
“It’s unfortunate. I feel for them. I felt for them from the very first day,” the sheriff said in a Record-Eagle article, published a dozen weeks after Chris’ death. But Fewins added that there was nothing his staff could have done to prevent his death.
The Washtenaw County medical examiner was holding up the autopsy report because he wanted to explore his theory that Chris had suffered a heart attack from a rare, genetic abnormality in young adults. In fact, Chris’ biological sister was asked to take a test to help prove the theory and maybe save her from the same fate. But she said no. The sheriff’s department wouldn’t release the investigation, complete with the autopsy report, until that issue was resolved. 
But the Mordens felt they were being stonewalled. Their son had died and it appeared the sheriff was just trying to cover his tracks.
The FOIA case went on into the next year, with the Mordens requesting more complete information. In the end, the sheriff’s department was ordered to pay them $500 and to issue an apology, which Les Morden later said hardly sounded like an apology.
“Quite honestly, I’m thinking that I made a mistake. I should have lived up to 100 percent of the law,” Fewins was quoted in a March 2003 Record-Eagle article.
Les Morden later said that the sheriff showed no remorse and Chris was treated with little respect—he was even handcuffed long after any hope of revival.

LAST TWO MONTHS OF LIFE
After getting the autopsy report, the Mordens still didn’t know why their son died. The cause was “indeterminate.”
Yet it became increasingly clear from jail records that Chris had suffered side effects from his medication. Here is a summary rundown from court documents:
• When Chris was jailed on February 2, he was taking a total of three milligrams of Risperdal, an anti-psychotic, and Celexa, an antidepressant. A few days later, he complained about hearing voices and said he wanted to kill himself. His blood pressure was 129/75.
• On February 12, Dr. Marilyn Conlon, a private psychiatrist on contract with the jail through Northern Lakes Community Mental Health, stopped in to talk with Chris. She increased his dosage to four milligrams a day.
• On February 14, Wilcox takes Chris’ blood pressure. It’s 134 over 83.
• On February 27, Chris was found “unresponsive” in his cell. He was curled into a fetal position and rocking back and forth. He didn’t respond to commands. His speech was slow.
• On March 5, Chris said he heard voices telling him to stab himself with a pencil.
• On March 12, Dr. Conlon saw him again and noted that Chris said he wasn’t taking his medications. She said there was improvement, and recommended increasing Risperdal to six milligrams a day, double the dose of a month ago.
• On March 15, Betty Morden saw her son and told jail officials that he was acting “druggy.” 
• On March 19, Dr. Wilcox reported that Chris was suffering from head rushes and side effects, which started with the increase in Risperdal. He took his blood pressure twice at 138 and 138 (he didn’t take the lower number). He  recommended that Conlon see him again.
• On March 23, Dr. Conlon saw Chris, who complained of tingling and head rushes when he stood up. He could not stand up without holding the wall. She did not take his blood pressure. Conlon said “improvement was apparent on Risperdal,” but decided to switch him to Seroquel because of the side effects. She recommended reducing the dosage of Rispderdal to four milligrams, while introducing him to Seroquel beginning with 100 milligrams.
• On March 25, the medication change went into effect. The doctor noted that Chris had lost four pounds since he was first jailed, which is strange because he seemed to be eating a lot.
• On March 26, Dr. Wilcox saw Chris and said he spoke in a low voice and said very few words. He was “statue-like,” walking stiffly without any head or arm movement. Wilcox did not call Conlon.
• From March 27-29, the Risperdal dose was decreased, and Seroquel increased, the antidepressant kept the same.
• Between March 26 and April 1, the jail nurse reported that Morden was better “schizophrenic-wise.” He was able to share a cell and play cards with the other inmates.
• On April 1, Chris Morden suddenly died. 

LAWSUIT
The family initially filed a lawsuit for medical malpractice, which was dismissed because it was filed after the statutory deadline.
   In December of 2004, the family filed suit that took a different tack. It claimed that Morden’s serious medial needs were treated with “deliberate indifference” and that his constitutional right to be “free of cruel and unusual punishment” was violated. The suit named several parties, including the psychiatrist, the sheriff, the jail doctor, nurse, and social worker. It was dismissed last year against everyone but the psychiatrist, Dr. Marilyn Conlon.
The lawsuit alleged that Conlon knew that combining three anti-psychiatric drugs could cause serious, and even fatal side effects, but yet she never consulted personally with Dr. Wilcox, nor did she ever read Morden’s medical records.
“In spite of the many red flags, caution signs, and deafening sirens, defendants continued to fuel the toxic fire of medications that caused Morden’s suffering and ultimately, his death.  Morden’s symptoms sufficiently indicated, and this Court should correspondingly find, that he was suffering from acute drug toxicity, a serious medical condition,” wrote attorney Linda Turek.
Turek was referring to what’s called NMS, neuroleptic malignant syndrome, an often fatal disease, but treatable if caught in time. Symptoms include lead pipe rigidity, high fever, dehydration, sweating, a fast heart rate, agitation, an elevated white blood cell count, autonomic instability (basic functions controlled by the nervous system, such as heartbeat), difficulty swallowing, and high blood pressure.
Turek alleged that the psychiatrist should have ordered an EKG, which would have confirmed the disease at a very low cost. 

QT SYNDROME
The lawsuit asserted that the three drugs combined—the antidepressant and two second generation anti-psychotics—can exacerbate an electrical conduction abnormality called a “prolonged QT syndrome.” A prolonged QT means tiny changes in the way the heart beats, which changes the efficiency of the blood flow between the upper and lower chambers. It potentially causes the heart to stop.
Bader Cassin, of the Washtenaw County Medical Examiner’s office, testified that “in his opinion,” Morden did not die of NMS, but more likely  “cardiac arrhythymia caused by medications.” (This is not necessarily lawsuit material. Many medications list sudden cardiac arrest as a rare side effect.) 
Dr. Wilcox said he believed there was nothing that could have prevented Chris’ death, which he described as an “electrical eccentricity.”
Conlon’s attorney, Charles Gano of Petoskey, argued that Conlon did not show “deliberate indifference.” In fact, the evidence showed precisely the opposite. Morden was seen frequently by Dr. Wilcox and the Northern Lakes Community Mental Health social worker. He was under constant observation by the jail nurse and guards. Conlon herself saw him on three occasions, and adjusted his medications within safe parameters. In her capacity as a visiting psychiatric consultant, she had to rely on the jail doctor to notify her of problems.
Gano also argued that court precedent says a doctor’s medical judgment will not be second-guessed. Mordens’ own expert witness, Dr. Silberberg, said that Conlon did not intend to harm Morden, and showed no lack of concern—she was only professionally negligent and used poor judgment.

NO TESTS ORDERED
Thirteenth Circuit Court Judge Phil Rodgers agreed that there was a factual issue regarding whether Conlon could have done more. He said a jury should decide this issue and rejected a motion for summary dismissal in August of 2006. Dr. Silberberg testified that Morden did have NMS and that Conlon should have told Wilcox to stop giving him the antipsychotics, monitor him, and transfer him to the hospital, Rodgers wrote in his opinion.
“Conlon admitted during her deposition that she never spoke with Wilcox, she never accessed Morden’s records, she never checked Morden’s vital signs, she never ordered any tests, and she never did anything to rule out NMS even though she knew the antipsychotic she was prescribing could cause NMS,” he wrote.
“From the evidence presented, a reasonable juror could conclude that Conlon did not only provide ‘inadequate care,’ but she was also ‘deliberately indifferent’—she was not concerned about whether Morden had NMS or whether injury or death would result from the recommendations for treatment that she made.
“Simply put, a reasonable juror could conclude that Dr. Wilcox got ‘hung out to dry’ by his psychiatric consultant who could not be bothered to review Morden’s medical records or take vital signs or communicate with him about his concern that Morden was overmedicated and as a result, Morden was not properly diagnosed or treated and he died.”Last month, the Court of Appeals threw out the civil case against Conlon.
Her actions did not rise to the standard of “deliberate indifference.” She had increased Chris’s Risperdal dose to help with his psychosis and to stop him from hurting himself or others. That higher dose was within the standard of care. 
 Additionally, the court dismissed the constitutional claim of “cruel and unusual punishment.”  The court ruled that Turek speculated, but did not prove, that Chris Morden had died of NMS. Even if he had died of NMS, Dr. Conlon is “cloaked in qualified immunity for her treatment” of Chris Morden because the constitutional right was not clearly established at the time of this incident.

THE IRONY
Psychiatric drugs are powerful and their interactions complex. Almost all primary doctors defer to a psychiatrists, who are specially trained to identify side effects and determine if they are significant.
So it was with Dr. Wilcox and Dr. Conlon.  Wilcox depended on Conlon to prescribe the drugs. Conlon counted on Wilcox to let her know of any medical problems. But could Wilcox, as a primary doctor, recognize a significant side effect?   
Dr. Wilcox said in his deposition that a patient suffering from NMS would be so sick, even a janitor could see it. He didn’t call Conlon after March 23 to tell her of the side effects, as she had already adjusted his medications.
In fact, Conlon was particularly knowledgeable about second-generation antipsychotics. She was often paid to hold informational lunches on behalf of Janssen Pharmaceutical (maker of Risperdal), Bristol-Myers Squibb, and Otsuka, maker and co-promoter of the anti-psychotic drug, Abilify. 
She said in her deposition that she was well aware of the potential complications of combining the three drugs, but counted on Dr. Wilcox to “chart by exception”—to note any abnormalities in the patient’s charts. Yet she never asked for them.
Isolation of care often happens these days, and in better places, said Seymour Halleck, a psychiatrist and retired University of North Carolina professor.
“When combining powerful drugs like Cylexa, Risperdal and Seroquel, you have to know the physical status of your patient. If she didn’t access his records, that’s probably not good. But it could be entirely true that he could have died anyway.”

SUPREME COURT APPEAL
The Mordens intend to appeal the case to the Michigan Supreme Court on grounds of medical malpractice, and neither they nor their lawyer would comment on the case for fear of jeopardizing their chances. 
The possibility of the case getting heard is questionable, considering previous state Supreme Court rulings on statute of limitations. If the court refuses to consider the case, neither side will get its day in court.
Barbara Budros, staff attorney for the 13th Circuit Court, believes many malpractice lawsuits are filed because the offending party never apologizes owing to the counsel of insurance companies that advise not to say anything, much less apologize.
“If the sheriff had been a little bit compassionate, it would have made a big difference. People need to go with their gut and emotions and stop worrying about their legal liability. It’s just amazing. People just want to be treated with compassion when something goes wrong.”

Anxiety over Anti-Psychotics

Many psychiatrists prefer second-generation anti-psychotics like Risperdal and Abilify to the cheaper old ones such as Haldol. They say patients feel less druggy, and are more willing to take them. Yet the new drugs are controversial. 
Jim Gottstein, president of the Law Project for Psychiatric Rights, said that side effects from the newer drugs are killing people.
“The drug companies are not being honest about the extreme toxicity of these drugs. If this was happening to any group of people besides those diagnosed with serious mental illness, there would be a huge uproar,” Gottstein said.
The new drugs increase the risk of obesity, type II diabetes, heart complications, and stroke, especially in older patients. Drug manufacturer Eli Lilly, maker of Zyprexa, is facing thousands of lawsuits because it downplayed the drug’s side effect of obesity and marketed the drug as appropriate for patients who were neither schizophrenic nor bipolar.
Critics say drug companies are earning billions of dollars on these drugs when only a tiny percentage of people are actually diagnosed with schizophrenia and bipolar disorder.
A massive 2005 National Institute of Mental Health study showed that the second generation of anti-psychotics “have no substantial advantage” over the older, far cheaper ones. So far, the study has had little, if any, effect on sales.


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