Why did Chris Brackett die?

Lawsuit settled, but questions remain

Johnny Brackett was leaving work one evening five years ago when his wife called, screaming. Their son, Chris, was dead.

When Brackett got to Chris' garage apartment eight minutes later, paramedics were struggling to bring the 27-year-old back to life. Chris, Brackett remembers, was purple.

"I knew it was drug-related, and the methadone was the first thing I thought of," Brackett says.

It took Brackett and his wife two years to file suit against the methadone clinic that medicated Chris the day he died. Johnny Brackett says he had feared suing the clinic would stir up too much grief.

Brackett and the clinic, Lakeland Centres, settled out of court earlier this month, after more than three years of litigation. A Gwinnett County Superior Court judge dismissed the lawsuit May 16.

But debate about what killed Chris Brackett — and who is responsible for his death — continues.

The director of Lakeland Centres declined to comment for this story. But attorney David Davenport, who represented the clinic, says the five-figure settlement was a way to avoid a trial that could have cost six figures.

The clinic, Davenport says, accepts no blame. He describes the settlement as "a business decision regarding the lawsuit and not an admission of liability.

"However, the clinic's existence and mission is to help individuals like the deceased with their problem and regrets Mr. Brackett's death," he says.

But to Johnny Brackett, the settlement check, signed by a clinic representative, is proof he got his retribution. He wasn't after money, he says, but wanted the clinic to take responsibility for what happened to Chris.

"That's some admission of guilt or wrongdoing," he says of the clinic's willingness to pay. "It means a victory, a moral victory."

On Jan. 2, 1996, Chris walked into his father's convenience store and asked if they could talk in the back office. He said he wanted to start taking methadone, and he wanted his father's advice and support.

"He thought this was his way out," Johnny Brackett recalls. "He had a positive attitude about wanting to get out from under this thing that controlled his life."

His life, over the past 10 years, had changed.

In 1985, USA Today named Chris Brackett the nation's highest-scoring high school soccer player. Georgia Southern awarded Chris a soccer scholarship.

"When he got down there, I think that's when the bad news got on him," Johnny Brackett says. "He got exposed to a lot more than he could handle."

The day after father and son spoke in the convenience store's office, they rode together to a clinic in Norcross. It was Chris' first attempt to use methadone to curb his drug addiction — to pain pills, he told his father; to pills and heroin, he told one of the Lakeland Centres counselors.

Chris spent two hours answering the counselor's questions, according to his father, who was sitting in the waiting room. Court records state that the clinic physician approved Chris for the standard 30-milligram starter's dose of methadone, a synthetic opiate that curbs cravings for heroin or prescription pain pills.

Chris returned the next morning and took his second dose, which had been upped to 40 milligrams, according to court records. He drove himself home, to Cherokee County, and called his father. Chris promised his dad that he'd come over and cut the rest of the firewood he had started chopping a few weeks back.

"He said, 'OK. I'll see you later,'" Johnny Brackett remembers. About four hours later, Chris lay on the couch and quit breathing.

The Cherokee County coroner and the Georgia Bureau of Investigation both confirmed that a combination of methadone and other prescription drugs (likely Valium or Xanax) killed Chris Brackett.

But had the case gone to trial, it might have been difficult to prove the clinic was at fault, according to methadone expert Howard Lostsof.

"The facts are very difficult to come by in these situations," says Lotsof, who sits on the board of directors of the National Alliance of Methadone Advocates.

"Fatalities [from methadone] are very uncommon," Lotsof says. "In a clinical setting they're minimal. What I'm dubious of is there's no way of telling whether [Chris] went home to take something else."

Only a forensic scientist equipped with highly sophisticated equipment could determine when Chris took the other prescription drugs — whether he continued to take them after his first dose of methadone. And even a scientist might have trouble reaching a firm conclusion, Lotsof says.

If it could be proved that Chris Brackett quit taking the drugs after he started on methadone, the clinic might have been negligent in giving Brackett methadone, according to the lawsuit. Court records show that Chris did tell the counselor at Lakeland Centres that he typically took a Valium and Xanax, without a prescription, everyday.

"Mr. Brackett should never have been started on the methadone protocol," according to an affidavit filed with the lawsuit and signed by Dr. Donald Jasinski of Johns Hopkins Bayview Medical Center.

"The treatment center should have known that he was not a suitable patient," the affidavit states. "It is medically well-documented that benzodiazepines [Valium and Xanax] adversely and sometimes fatally interact with methadone."

But if Chris Brackett took the other drugs after he started treatment, the clinic could not have anticipated that he would be an unsuitable patient, according to Lotsof.

Nonetheless, the clinic should have warned Chris of the possible interaction between methadone and Valium or Xanax, says the medical director of Southside Clinic, one of 10 methadone clinics in metro Atlanta.

But a clinic doesn't have to abstain from giving methadone to someone taking Valium or Xanax, medical director Dr. Dominic Mack says.

"If you find out that a patient is prescribed another drug or abusing a drug you take it into consideration," says Mack.

Mack says the risk of a dangerous drug interaction is not necessarily threatening enough to rule out methadone treatment. He says methadone enables patients to care for their families, keep marriages together and hold a job. He considers it the best treatment for opiate addiction, when used effectively.

"With any medication you have people who will have extreme side effects," Mack says. "And you can't sometimes foresee the problems that the patient may have with the medication."

Both Mack and Lotsof, however, say methadone must be doled out responsibly to be effective treatment.

That hasn't always been the case in Georgia.

The rules and regulations that govern methadone's distribution in Georgia have been weakly and arbitrarily enforced (see "Dealing Drugs the Legal Way," CL, April 4).

State inspection reports of clinics, which CL obtained through Georgia's Open Records Act, show that some clinics gave methadone to patients who did not first prove an opiate addiction. The reports also indicate that some clinics did not properly monitor patients' use of other drugs. At several metro Atlanta clinics, the state took more than three years to conduct follow-up visits to clinics that were in serious violation of state and federal rules.

And last year, five people died methadone-related deaths — compared to 14 heroin-related ones — in Fulton County alone.??