Pubdate: Thu, 16 Nov 2006 Source: Abbotsford News (CN BC) Copyright: 2006 Abbotsford News Contact: http://www.abbynews.com/ Details: http://www.mapinc.org/media/1155 Author: Trudy Beyak CONFLICTING VIEWPOINTS IN DOCTOR'S CASE Is a former Abbotsford doctor innocent or guilty of criminal negligence in the death of a young woman struggling with drug addiction? Defence lawyers this week argued that Dr. James Swanney is not guilty of criminal negligence causing death in relation to the death of 20-year-old Christena Constible. Swanney appeared serious and uncomfortable as he sat in courtroom 416 on Tuesday at the Supreme Court of B.C. in New Westminster. The physician wore a dark pin-striped suit, a blue shirt and tie with red stripes as his lawyers made their closing arguments before Justice Brenda Brown. Various experts, testified during the trial, giving conflicting viewpoints about why Constible died, said defence lawyer Michael Tammen. Crown alleges that Swanney should have given Christena, 20, a drug screening test before giving her methadone on May 11, 2000, and was negligent giving her methadone from a bottle returned to him by another addict without knowing its strength or purity. Constible died later that evening. Defence lawyers painted a picture of Christena as a troubled, anxious young woman who was suffering from depression and drug addiction. The young woman went off methadone, cold turkey, in March and was suffering withdrawal symptoms, defence lawyer Terry Robertson said. Christena's father John was pressuring her to stay off methadone, which was curious since the only time she seemed stable and had turned her life around was when she was on methadone, Robertson argued. Her father, however, said Robertson, wanted her off methadone. By the 10th of May, she was pleading for heroin, according to Robertson, who referred to testimony that heroin was the only drug that made her feel happy. She started weaning herself off methadone in Sept. 1999, Robertson said, adding that she went "cold turkey" on March 17, 2000. Constible died of a mixed drug overdose of methadone, chloralhydrate and venlafaxine according to a coroner's inquest. Robertson argued that Swanney, as a family physician, could not have foreseen that vanlafaxine, which he prescribed for Constible, was a depressant of the central nervous system, and it was not known at that time to be a drug that was abused by addicts. Swanney, in fact, took away all her prescription drugs, said Robertson, before he dispensed 20 mg of methadone to Constible, which she took at his office on May 11, 2000. He then gave her 20 mg of methadone to take later at home. Christena went home with her mom and fell asleep on the couch and was fine when her mom went to bed about 10:30 p.m., Robertson said One of the Crown expert toxicologists testified that a combination of methadone and Vanlafaxine likely caused Christena's death. The amount of methadone, alone, however, did not cause her death, Robertson said. He explained, that according to expert testimony the amount of vanlafaxine found in Christena's body was in the toxic range, four times the amount normally used for therapeutic use. However, there is no way to know with legal certainty how it got into her system and that this is what caused her death, argued Robertson. "The cause of death is very difficult to determine," he said. Tammen, meanwhile, argued that the court should question the credibility of the testimony given by Christena's mom and dad during the trial. He also raised the fact that Diane Robinson, a substance abuse counselor, was concerned about Christena's life. Shortly before Constible died she had said that she only had three options -- to get more prescription medications, use heroin or to kill herself, Tammen said. The Crown has not painted a complete picture of the days before Constible's death, Tammen said. On Friday, May 8, 2000, Swanney took away all of Constible's prescription medications and decided she needed to get back on the methadone program to stabilize her and help her through her difficulties. On Sunday, May 10, Swanney tried to get Constible into the psychiatric ward at MSA General and was told there was no bed available. In previous hearings into Swanney's care of Constible, it was heard that Swanney gave Constible methadone that had been returned to him. She swallowed the contents of one vial in Swanney's office. Swanney gave Constible a second vial to take home. She died that night. Tammen said the various Crown experts were like "armchair quarterbacks" discussing what would have been the best course of action for Swanney to take in treating Constible. But, if Swanney had not given Christena methadone would she have lived beyond May 11th? he asked. "No one will ever know," he said. It is still a mystery how there were toxic levels of venlafaxine in Constible, he said. "In my submission, nobody can prove what caused her death," he said. Tammen said the various drug addiction experts had a great debate about how Constible should have been treated by Swanney. "The experts were all over the map," Tammen said. Crown's concluding arguments started yesterday in the trial that is now in its sixth week. (Coverage will continue in Saturday's edition). - --- MAP posted-by: Elaine