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Should daughter's prescription have been kept from parents? By David Lea OAKVILLE BEAVER STAFF 9 · Wednesday, June 16, 2010 OAKVILLE BEAVER · www.oakvillebeaver.com If a patient's life is at risk should their doctor warn that patient's family, even without the patient's consent? Rhonda Carlin says if her family doctor and others had done this, her daughter might still be alive. Rhonda testified to this effect, on Friday, during the fifth day of a coroner's inquest into the death of Sara Carlin. Sara, 18, an Oakville resident and graduate of St. Ignatius of Loyola Catholic Secondary School, hanged herself in her parents' basement on Sunday, May 6, 2007. At the time, she had been taking Paxil, an anti-depressant, which Health Canada has issued advisories for due to the possible increased risk of suicidal events for children and adolescents who take it. From the outset of the inquest, Gary Will, the Carlins' lawyer has been attempting to link Paxil to Sara's downward spiral and death, while the Coroner's Counsel, lawyers representing Paxil manufacturer GlaxoSmithKline and lawyers representing three doctors associated with treating Sara, have brought forward other theories about her suicide. These include theories that she was driven to suicide through drug and alcohol consumption or because of the sadness she felt over the death of her brother Brendan, who died of a drug overdose on New Year's Eve 1999. During her Friday testimony Rhonda stated unequivocally that she believed the Paxil was responsible for her daughter's death. Rhonda said she noticed radical changes in Sara's behaviour after she was prescribed Paxil at age 17 (without the family's knowledge) in February of 2006 to deal with some anxiety she was feeling about leaving home for the University of Western Ontario. Sara Carlin Rhonda said Sara gradually changed from a responsible, athletically and academically focused girl into someone who really did not care about anything. Sara's friends have also testified that around this time excessive drinking and drug use, particularly cocaine, also became a problem. After Sara's shocking death, the Carlin family researched Paxil with Rhonda stating that doing this answered a number of questions about what had been happening to her daughter. "We discovered all the warnings that are out there including a warning to doctors that it should not be prescribed to anyone under 18, warnings that it could cause suicidal thinking, warnings that it could cause younger people to lose their inhibitions and become unafraid of things they might have been afraid of before," said Rhonda. "There were warnings that it would cause you to do things that were out of your character, risky behaviour, drinking, all the things that were happening to Sara that we were struggling to understand and I'm sure that Sara was struggling to understand." Rhonda described one particularly disturbing possible side effect of Paxil use, which she discovered, called Akathisia. "It's such an inner torment that can occur as a side effect of Paxil where one researcher said suicide is a welcome release," said Rhonda. "When Sara came home that last night she put on her pajamas. There were make-up pads on her desk so she had started to take her make-up off and she suddenly cut a piece of electrical cord and violently hanged herself. Why would she do that? I believe it was because of this side effect. She needed to escape and she wanted something fast." When asked by Will why she is participating in an inquest, which has caused her family so much pain, Rhonda said it is because others are in danger and no other family should have to experience the same suffering as her family. "I've learned all this (about Paxil), but it's too late for her, it's too late for me, I don't get a second chance with Sara," said Rhonda, choking back tears. "I think other families can learn from this and I don't want other families to experience what we went through. I want them to know when their child is put on a powerful antidepressant and I want them to know what the side-effects are. I want Sara to be able to save some other young lives, that's why we're here." When asked what recommendations she would like to see come out of the inquest, Rhonda said she would like to see changes to the way Paxil is prescribed with the patient's family engaged and all parties warned about the side-effects. At a minimum, she said the patient should be made aware of all the possible side-effects, so the patient understands what's going on if they start happening. During cross examination, GlaxoSmithKline lawyer Teresa Walsh pointed out that Rhonda was not in the treatment room when Sara went to see the family doctor about Paxil and therefore has no idea what the doctor told her about the sideeffects. Rhonda also took issue with the way Paxil is prescribed. In her testimony, she said it should not be given out so freely. Before Paxil is prescribed, she said some manner of psychiatric evaluation should be preformed to see if the patient actually needs it. "When Sara was put on Paxil she was the farthest thing from being depressed she could be," said Rhonda. "She was happy. She was shopping. She was planning for her future." The three doctors' lawyer Steve Schenke asked Rhonda a number of questions about doctor-patient confidentiality such as when she visits a doctor if she expects their conversation to be kept confidential. He also asked her if she was asking the jury to say it is okay for a family doctor to talk to a patient's family member about that patient's health without that patient's consent. Rhonda said she was not asking for anything so vague. "I look at Paxil as being a life and death drug, which needs exceptional precautions," she said. Rhonda said that when her daughter was placed on Paxil proper follow ups were not done. Sara was referred to Halton ADAPT (Alcohol, Drug and Gambling Assessment, Prevention and Treatment Services) when drugs and alcohol became involved. Previous testimony noted Sara only attended one session and then never returned. Her parents were, reportedly, not told of this. On Friday, the inquest also heard from Health Canada representative Dr. Marc Berthiaume who confirmed that Health Canada advisories were issued for Paxil (Paraxotine) in 2003 and 2004 as the drug had been associated with an increased risk of suicidal events in children and adolescents under the age of 18. See Paxil page 10 O'Connor MacLeod Hanna LLP welcomes Alia Rosenstock O'Connor MacLeod Hanna LLP, Halton's largest full service law firm, is pleased to welcome Alia Rosenstock to our team of specialized professionals. Alia Rosenstock practices in the areas of Municipal and Real Estate Law. Her law practice focuses on representation of private and public sector parties on minor variances, consents, development applications, expropriations, tax sales and heritage matters. Alia's practice involves appearing before local and regional committees and council, Committees of Adjustment and the Ontario Municipal Board and Ontario Courts. Alia can be reached directly at Tel: 905.842.8030 ext. 3350 Fax: 905.842.2460 Email: rosenstock@omh.ca 700 Kerr Street, Oakville, ON, L6K 3W5 www.omh.ca Vision ­ To be the most livable town in Canada Public input needed for Harbours Financial Strategic Business Plan June 24, 2010, 7 ­ 9p.m. Town Hall, 1225 Trafalgar Road, Oakville Room Members of the public are encouraged to provide input into the Harbours Financial Strategic Business Plan to help maintain the financial sustainability of the Oakville and Bronte harbours for years to come. Getting valuable feedback from the public will keep us on track in providing not only essential, but value-added harbour services to our clients. The Harbours Financial Strategic Plan will focus on diverse issues including town and club operated moorings, boating activities and services, dredging options and alternatives, lease renewals, and transient moorings. In addition, the natural environment and recreational enhancements for both boaters and non-boaters will be reviewed. A public meeting will be held on Thursday, June 24, 2010, from 7 to 9 p.m. in the Oakville Room at Town Hall, 1225 Trafalgar Road. Comments, suggestions and questions can also be emailed to harboursinput@oakville.ca. The deadline for written public input is July 16, 2010 in order to be considered in the final development of the plan. For more specific information about the plan, please visit www.oakvilleharbours.ca/financialplan.htm.