Developmentally disabled adult dies while in care. $22.75M. San Bernardino County.

Facts and Background

• Facts and Background:

  On February 07, 2019, Casarah Thomas, a severely developmentally disabled adult died while in the care of Shelley's House (an adult residential facility owned and operated by Nineteenee Corp.). While living at the facility, Casarah had been attending an adult day care program called BOT (owned and operated by Yodites and Assoc. Mgmt. LLC).

  An autopsy revealed she had died from a gradual buildup of Doxepin (TCA) in her system due to a previously unidentified CYP2D6 genetic deficiency, which made her a slow metabolizer of that drug.

• Plaintiff's Contentions:

  On February 05, 2019, and February 06, 2019, the two days preceding Casarah's death, her caretakers at BOT and Shelley's House were aware of new symptoms that she had developed, which qualified as a change in her condition. These symptoms were signs of the underlying Doxepin intoxication in Casarah's body, combined with Shelley's House making a medication error and administering the drug Topiramate to Casarah, which had been specifically discontinued by her psychiatrist due to  a previous bad reaction. Per their policies and procedures, as well as the California Code of Regulation, both defendants were required to obtain medical care for Casarah on those days due to what they observed. If they had done so, she would have survived.

• Defendant's Contentions:

  1. Casarah had a long history of being sleepy, closing her eyes and losing balance. Her condition on 2/5 and 2/6 was not noticeably different to a degree that would reasonably have triggered a call for medical attention.

  2. Dr. Jose Gamboa negligently caused Casarah’s death by increasing her Doxepin inappropriately, not performing doxepin blood levels to check for toxicity, not performing “routine EKGs.”

  3. BOT claimed that their own documents explaining Casarah’s symptoms on 2/5 and 2/6 were exaggerated and she was actually relatively normal those days.

  4. Shelley’s claimed that they never observed her to have a change in condition on 2/5 and 2/6 and that she was completely normal (this was a much stronger argument because their records didn’t indicate any issues when she arrived home on 2/5 and 2/6).

  5. It was not their conduct that killed Casarah; rather, it was her unknowable genetic defect and the silent buildup of Doxepin in her system.

  6. Even if Casarah had been taken to the ER on 2/5 or 2/6, it is not known what would have happened as it is too speculative without knowing “additional data points” – ER expert Andrew Lawson.

  7. Casarah was violent and aggressive and her mother had admitted her to their care for those reasons. That should diminish her damages.