Vioxx Judgments Overturned

While Vioxx judgments grabbed headlines because of the huge sums awarded at trial, some judgments against Merck have been overturned by the appeals courts.

Let's look at the first case of Ernst v. Merck. The verdict in that case was delivered in August 2005 by a state jury. The Texas appeals court has now reversed the finding of liability against Merck. The court ruled unanimously that Vioxx did not cause the death of Mr. Ernst. It found that there was no evidence that Ernst suffered a heart attack induced by a blood clot, and hence it was not shown that Vioxx caused his death.

The jury had awarded $24.45 million compensatory damages and $299 million in punitive damages, though the punitive damages were later (in 2006) reduced to $1.65 million as limited by Texas law.

Ernst died of arrhythmia after taking Vioxx for eight months. But the appeals court ruled that no adequate evidence was provided to prove that Vioxx caused the blood clotting leading to his death.

Counsel for Carol, Ernst's wife, unhappily remarked, "Appellate courts in Texas have a reputation of standing up for corporate executives over and against widows and orphans."

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Major Types of Mesothelioma Induced by Asbestos

The most serious damage caused by exposure to asbestos is the condition called mesothelioma. This condition is due to the growth of tumours of the mesothelium. The mesothelium is the membrane tissue that covers the outer surface of most internal organs. It produces a lubricating fluid enabling the organs to move around easily and smoothly.

Most tumours of the mesothelium are cancerous, but some are benign. In common usage, mesothelioma is used to refer to the malignant type of tumour.

Mesothelioma is the condition of abnormal growth of cells of the mesothelium. This can cause damage to tissues and organs near the localised site, but it can also spread to other parts of the body. The spreading is called metastasis.


Pleural and Peritoneal Mesothelioma
The two major types of mesothelioma are pleural and peritoneal mesothelioma. Pleural mesothelioma is that which spreads in the chest cavity and sometimes in the lungs, while periotneal refers to the abdomninal cavity.

Peritoneal mesothelioma can affect the liver, spleen or bowel and is more lethal, with a median survival rate of 10 months. The median survival rate of pleural mesotheliom is 17 months.

The survival rate is calculated from the time that symptoms are experienced. Symptoms may take years or even decades to show up. For this reason, asbestos is sometimes called "the hidden killer".


The Hidden Killer
In Britain 4000 people die of asbestos. The Health and Safety Executive has been running an asbestos awareness raising campaign. The chairman of the Health and Safety Commission has warned that it is an on-going problem, even though asbestos has been banned. Any building built or refurbished before 2000 could contain asbestos, she said. As part of the campaign the HSE has produced a video called Asbestos: The Hidden Killer.

John Ritter's Lawsuit - Doctors Cleared By Jury

The $67 million lawsuit brought by John Ritter's widow Amy Yasbeck against two doctors for the wrongful death of the actor has failed. The jury cleared the two doctors of negligence.

The suit was brought against the cardiologist who treated Ritter in the emergency room, and a radiologist who had examined him two years before his death.

The underlying argument was whether the cardiologist should have discovered the real cause of Ritter's sudden collapse which was due to an aortic dissection. He was instead treated for a heart attack.

The defendants' contention was that even had an x-ray shown up Ritter's condition, it was too late for anything else to have been done that could have saved his life.

The case against the radiologist was whether he had sufficiently warned Ritter of the potential danger of his condition. But the evidence was that Ritter had been warned but failed to take up follow-up treatment.

It seems this was never a strong case against these two doctors. Amy Yasbeck has already received over $14 million from other medical defendants.

Vioxx Second Lawsuit - Merck Not Liable

Lawsuits against Merck over the use of Vioxx did not always go in favour of the plaintiffs.

Shortly after the first trial in August 2005 in Texas (the Ernst case), the second Vioxx case was decided by a jury in November 2005. The case was heard in New Jersey.

The trial involved weeks' of testimony, dealing with the drug's risks. Much of the evidence was similar to that heard in the Texas case.

The plaintiff Frederick Humeston was a 60-year old postal worker who had a heart attack, which he survived, in September 2001 after taking Vioxx for less than two months.

The jury were asked to decide whether Merck failed to warn of known risks, whether it led to the heart attack and whether Merck misled doctors about Vioxx.

The jury found in favour of Merck. One juror later indicated that they decided that Humeston's heart attack was more likely due to stress and anxiety and not Vioxx. There was also evidence suggesting the Humeston was prone to complaining about his workload, while his employer was also investigating him for suspected malingering.

Merck was obviously relieved by this verdict, but numerous other cases were already looming.

Lawsuit Against Doctors For $67 Million For John Ritter's Death

The lawsuit is brought by Amy Yasbeck, John Ritter's widow, against two doctors for wrongful death and malpractice. She is suing for $67 million in damages.

Ritter collapsed in the studio in September 2003 while filming for his TV show 8 Simple Rules. He was immediately taken to the hospital across the road, but died hours later.

He was treated for a heart attack. It appears however that his sudden collapse was due to a pre-existing condition known as an aortic dissection. This was not discovered in time when he was receiving treatment in the hospital.

The suit claims that had a chest x-ray been done, that would have led to the right diagnosis and the correct treatment would have saved Ritter's life. The defence says that he was suffering an acute heart attack when the cardiologist arrived, and all was done that could have been done to save him.

The other doctor sued is the radiologist who had previously carried out a body scan on Ritter. It is claimed that he failed to warn Ritter of the potentially fatal condition.

The damages are based on the expected earnings that Ritter would have got from his TV series. The defence rejects this as speculative as there was no certainty that the show would have continued to be successful.

Mesothelioma and Asbestos

Asbestos

Cases related to asbestos stem from the widespread use of asbestos in and about the 60's and 70's. Asbestos was found to be an efficient material against fire. Its then highly valued fire-proofing or fire-retardant quality made it a popular substance to be used in construction.

Like many drugs and pharmaceuticals, in respect of which many cases have been brought, asbestos was intended to benefit rather than to harm. Asbestos was designed and meant as a safeguard against fire.

Because of its widespread use over an extensive period of time, not only were those who were directly engaged in the manufacture of asbestos products, but many others especially those in the construction field, became exposed to it. Also at risk were those who were involved in the manufacture of industrial heating equipment like furnaces, and even household electrical products.

Mesothelioma

The most serious, but less common, injury caused by exposure to asbestos is mesothelioma, which is death-inducing cancer. Others forms of cancer are also caused. Another serious condition is asbestosis, a lung condition which can be seriously disabling and will in time also lead to death. The latency for the onset of disease can be as long as forty years.

The largest awards have generally been made in mesothlioma cases, followed by other malignancy claims, asbestosis and non-disabling conditions.

The main categories of complaint by plaintiffs are that they became exposed due to failure of warning of the dangers of asbestos, and that inadequate protection was given to those working with or around asbestos.

Ref: www.rand.org

Vioxx | First Lawsuit

The first lawsuit against Vioxx was filed by Carol Ernst for the death of her husband from a heart attack in 2001. In 2005 the Texas jury in the trial found Merck liable and made an award of $24 million to Carol Ernst for mental anguish and loss of companionship, and a further award of $229 million in punitive damages.

This was seen as the tip of the iceberg and it was at that time estimated that Merck's liabilities could run up to something like $25 billion.

By the time of this verdict, over 4,000 lawsuits against Merck had been filed. The drug had been recalled by Merck in September 2004, following growing concerns over the dangers it caused.

Ref: CNNMoney.com

Cardiac Arrest

There is concern about the incidence of cardiac arrests suffered by patients in hospital. This is due to the fact that defibrillation procedures could often not be carried out within the first two critical minutes.

A Norwegian study:

Our findings indicate that defibrillation should have priority during the first 3 minutes of VF/VT. Later, patients benefit from CPR in conjunction with defibrillation. Patients presenting with non-shockable rhythms have a grave prognosis, and the outcome was not associated with time to BLS or CPR quality.

VF/VT=ventricular fibrillation/pulseless ventricular tachycardia
CPR=cardiopulmonary resuscitation
BLS=basic life support


Ref:
The early minutes of in-hospital cardiac arrest: Shock or CPR? A population based prospective study
Eirik Skogvoll and Trond Nordseth

A brief history of Vioxx

Vioxx is a branded name of the nonsteroidal anti-inflammatory drug called rofecoxib. It was developed by Merck & Co. for the treatment of osteoarthritis, conditions of acute pain, and dysmenorrhoea. Rofecoxib was also marketed under the brand names Ceoxx and Ceeoxx.

It was approved by the FDA in May 1999 and was widely used by physicians worldwide.

However, there were growing concerns that its use led to higher risk of heart attack, and Merck voluntarily withdrew it from the market.

It is estimated that Vioxx or the other brands had been prescribed to over 80 million people around the world and Merck had sales of about US$2.5 billion from Vioxx prior to its withdrawal.


See Rofecoxib.

Vioxx Verdicts

Personal injury law suits, as in the Vioxx cases, are a big time legal practice in the US. There are even lawyers who specialise as Vioxx attorneys. In few other countries, if any, do the laws grant comparable awards by way of compensatory and punitive damages against defendant corporations, though the trend to increased amounts is on the rise.

In the US, known for its litigious mentality, the small aggrieved plaintiff can look to huge damages for injury caused by the big medical firms and corporations. Law firms who take up such cases are as a rule paid on a contingency basis. That is they get a cut from the amount of damages awarded. And usually quite a large cut. The ethics of such a system is a matter of debate. On the other side, the big corporations also pay huge fees to their attorneys to defend their case.

In one Vioxx case an elderly gentleman called Leonel Garza was awarded $7 million in compensatory damages for suffering a heard attack after taking Vioxx. That verdict caused some outcry as Mr Garza was already overweight, suffered from high cholesterol and had a history of a previous heart attack and bypass surgery. The evidence was not even that clear that Mr. Garza was prescribed or that he took Vioxx at all. One doctor said he only gave a sample pack of 8 pills, against Garza's widow's testimony that he had given him an eight days worth sample. And another doctor denied her testimony that he ever gave Garza a 30 day Vioxx prescription or even any Vioxx prescription.

Despite what appears to be weak evidence the jury found for Mr Garza. A sympathy verdict.

Click link for more on the Garza Vioxx case.

No doubt medical firms have to be held to the highest standards. But when people see that huge payouts can be achieved even in a very weak case, that feeds and encourages the litigious instinct. Further there is always a chance of a big settlement when the big firm would rather have a case brushed under the carpet than to fight it in the full glare of an open court trial.