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).