## Facts

- Victor Motus was prescribed the antidepressant Zoloft (sertraline) by Dr. Gerald Trostler after presenting with unhappiness, sleep difficulty, and depressive symptoms.
- Dr. Trostler provided Victor Motus with a Zoloft sample packet obtained from a Pfizer representative; the individual sample packet did not contain warnings.
- Dr. Trostler did not read Pfizer’s Zoloft warning materials and prescribed based on his clinical experience and journal articles.
- Dr. Trostler was aware of literature suggesting some antidepressants were associated with increased suicide risk but discounted those studies based on his experience.
- Six days after starting Zoloft, Victor Motus died by suicide.
- Flora Motus sued Pfizer on wrongful death/negligence, strict liability (failure to warn), survival, fraud, and breach of warranty theories, alleging Pfizer failed to warn that Zoloft could cause violent or suicidal thoughts and conduct.

## Issues

1. Under California’s learned-intermediary doctrine, whether Pfizer’s alleged failure to provide adequate warnings to the prescribing physician was a substantial factor in causing Victor Motus’s suicide.
2. Whether plaintiff could establish causation without evidence that an adequate warning would have altered Dr. Trostler’s prescribing or monitoring decisions.
3. Whether a rebuttable presumption that an adequate warning would have been heeded applies in prescription-drug failure-to-warn cases under California law.

## Decision

- The Ninth Circuit affirmed summary judgment for Pfizer on all claims.
- The court held that, even assuming Pfizer’s warnings were deficient, plaintiff failed to present evidence that the alleged inadequacy contributed to the suicide.
- The court declined to reach Pfizer’s federal preemption arguments because causation was dispositive.
- The court stated it expressed no view on whether Zoloft causes suicidal behavior or on the substantive adequacy of Pfizer’s labeling.

## Legal Principles

- In California prescription-drug cases, the manufacturer’s duty to warn runs to the prescribing physician, not the patient (learned-intermediary doctrine).
- A failure-to-warn plaintiff must prove causation by showing an adequate warning would have changed the physician’s prescribing, advice, or monitoring and would likely have prevented the injury.
- Where the prescribing physician did not read or rely on the manufacturer’s warnings, the plaintiff must still produce evidence that a stronger warning would have altered the physician’s conduct.
- California law does not supply, in this context, a general presumption that an adequate warning would have been heeded by the prescribing physician.

## Conclusion

The court affirmed judgment for the manufacturer because the plaintiff did not establish proximate cause under the learned-intermediary framework: the record lacked evidence that a different warning would have changed the prescribing physician’s decisions in a way that would have prevented the suicide.


Motus v. Pfizer Inc., 358 F.3d 659 (9th Cir. 2004)