PROVO — Could health care providers treating David Ragsdale in late 2007 have had any way of knowing he would open fire on his wife, killing her just after the new year? Could the medications they provided played a role in making him so dangerous?
The Utah Supreme Court, which convened at BYU's J. Reuben Clark College of Law, considered those questions and others in a hearing Wednesday.
Ragsdale pleaded guilty to aggravated murder in the Jan. 6, 2008, shooting that left Kristy Ragsdale dead in a Lehi parking lot with 13 gunshot wounds. He was sentenced to life in prison without parole.
Court-appointed attorney William Jeffs filed a lawsuit in April 2010 on behalf of the Ragsdales' then 3- and 6-year-old sons alleging that Pioneer Comprehensive Medical Clinic in Draper, and a doctor and nurse working there, were responsible for the slaying. The suit argues that steroids and drugs prescribed for and taken by David Ragsdale were a factor in the shooting.
In July 2011, 3rd District Judge Denise Lindberg granted the clinic's motion to dismiss the case. Jeffs' attorneys appealed the ruling to the state's high court.
"This is a case of affirmative misconduct in that the drugs prescribed to Mr. Ragsdale were the cause for this violent outburst," Jonah Orlofsky, who represented Jeffs before the state supreme court.
Orlofsky said Ragsdale's acts "were foreseeable" and that Ragsdale's doctor and nurse's alleged "negligence" made the outcome "likely." But Justice Thomas Lee questioned whether someone could predict harm, especially to someone other than the patient.
"Is it ever reasonably foreseeable that there is injuries to third parties?" Lee asked.
Orlofsky said that it is a question for the court to analyze.
Stephen Owens, an attorney for Ragsdale's nurse practitioner, first questioned whether nonpatient plaintiffs had a right to file a lawsuit when David Ragsdale declined to do so. But the five Supreme Court justices focused their questions on whether health care providers must consider potential harm to third parties.
"You allege that you want doctors to think of patients exclusively, not third parties," Justice Jill Parrish said. "I'm having a hard time thinking of a situation where a patient's interests diverges from societal interests."
The specifics of the Ragsdale case were also considered.
"Didn't this cocktail of meds make Mr. Ragsdale uniquely dangerous?" Lee asked.
"The question is, does saying he's suffered 'toxic side effects' make him uniquely dangerous?" Owens said, questioning the implication of placing fault on the clinic and its employees. "We want troubled people seeing health care providers and the health care providers treating them."
A number of medical organizations, including the American Medical Association, filed a friend-of-the-court brief in support of the clinic, doctor and nurse practitioner.
The lawsuit alleges that family nurse practitioner Trina West began prescribing two of what would become several medications, the powerful steroids testosterone and pregnenolone, on April 16, 2007. West increased David Ragsdale's doses of both drugs about two weeks later.
The lawsuit states that in each instance, West did not consult her supervising physician, Dr. Hugo Rodier, or any other medical doctor about placing Ragsdale on the drugs or increasing the dosages.
On July 9, 2007, the lawsuit alleges, West added Concerta, a psychostimulant known as methylphenidate that has similar risks associated with methamphetamine, to the drugs Ragsdale was taking.
West allegedly diagnosed Ragsdale with attention deficit disorder to justify the prescription for Concerta, the suit states.
On Sept. 5, the dosage of Concerta was doubled.
A few months later, Kristy Ragsdale obtained a restraining order against David Ragsdale, a day before he returned to the Draper clinic experiencing "toxic side effects from the combination of his prescribed medications," according to the lawsuit.
In addition to Concerta, pregnenolone and testosterone, Ragsdale was also taking Valium, and the antidepressants Doxepin and Paxil. He was also taking Propecia for hair loss.
Blood toxicology reports showed Ragsdale was within the prescribed ranges for all his medications and found no traces of any illicit substances at the time of the shooting.
During his sentencing hearing, Ragsdale said he believed the drugs played a part when he "snapped."
"I want you to know that I am confident I would not have taken Kristy's life had I not been on the medications I was on, but that being said, I take full responsibility for my actions," he said.