Primum Non Nocere III

(part one) (part two) (part four) (part five) (part six) (part seven) (part eight)

(Part three in an ongoing series...the summary I ran by a few lawyers last summer is reprinted below...)


August 28, 2007


Re: E---- and Reasons for Considering Litigation:

(I)

E---- spent a few weeks at Pomerado Hospital with a condition known as hemiplegic migraine. An accurate approximation of describing this illness would be to draw analogies from stroke victims, as her condition was very similar: Half of her body ceased to function normally; starting from severe headaches, and eventually manifesting itself throughout the right side of her body, with drooping muscle in the face (no facial control on the right side), fingers turning inward (claw-like) in the right hand, little feeling or control over the muscles in the left leg and so forth.

Before this unfortunate incident in April, E---- had a very active and full life: she was set to get her master's degree in June, anticipating being able to start work on her doctorate in the fall and worked as a marketing director at a local cabinet company.

It's a very rare condition. This was her third incident in as many years, and the worst of the three. Doctors generally seem perplexed and have never been able to do much other than treat the symptoms with large doses of various drugs, and this is predominantly composed of steroids and narcotics. In fact, it took her neurologist several days to admit that such a thing as Adult Onset Hemiplegic Migraine even exists if not transferred genetically, though Elizabeth's mother had tried to convince him that that was the case.

She spent 13 days in the hospital from late April to early May, 2007, and went back in from May 11 to the 19, with one trip to the emergency room in between.

Upon release from Pomerado Hospital on May 19, 2007, E---- was sent home with various medications to be prescribed. Primarily pain medication, steroids to be decreased in the coming months, and a drug called Depakote. This drug was prescribed with the intent of reducing the chance of future migraines, and with the admonition that a greater risk of seizures would ensue if the drug was not taken.

Depakote is a drug designed to affect the brain. It is also prescribed for Epilepsy and bipolar Disorder.

This drug, ordered by her neurologist to be Depakote, and which was written on the discharge papers as Depakote EC (which is the same thing, with "EC" meaning enterine coated and therefore designed to begin dissolving once reaching the intestines), was incorrectly written as Depakote ER by her primary physician when he filled out her necessary prescriptions.

Depakote ER (extended release) is a drug whose strength is engineered so that it is to be taken just once a day, and generally at a 500mg dose. The incorrect prescription read "Depakote ER, 500mg, three times a day." This is what her primary physician wrote, what CVS Pharmacy filled and what Elizabeth began taking. Because of this oversight, she was now ingesting a daily dose, of the stronger version of the drug, three times a day, seven days a week.

Copies of all paperwork are available.

(II)

By June 6, 2007, the high levels of steroids had been significantly reduced (she was on 1000mg a day while in the hospital), and it became obvious to family members for several days that something was gravely wrong with E----. Her mother recalled another neurologist's administration of a drug called Topamax, administered with the same intention, that had E---- either in a zombie-like state or completely terrified all the time. That drug was stopped immediately. Now, like symptoms were presenting themselves, and calls of concern were placed to the neurologist, who ordered that her bloodwork and a liver panel be done. The family decided to remove one of the three prescribed daily doses that day, noticed an immediate change.

E---- was still grappling with recovery on many levels: home oxygen machines, walking short distances without the aide of a walker or wheelchair, etc.

Calls were made to the neurologist regarding the results of the bloodwork, not returned, and visits with her primary physician, previously scheduled, were attended. During one of these in late June, the bloodwork results from the neurologist had been sent over beforehand, and it showed a Depakote level of 18. By his own admission, her primary doctor had no idea what this meant. More calls to the neurologist's office ensued, and the family was told the earliest appointments were in late August / early September.

Insisting on being seen, E---- and her mother went to the neurologist's office on July 27, 2007, where - it was to become blatantly obvious - the neurologist looked at E----'s bloodwork, the tests he himself had ordered, for the very first time. Immediately, he began to repeat that he would never prescribe Depakote ER. When asked to define what levels of Depakote are considered normal, he stated between 4 and 12. Queried on what E----'s level of 18 meant, he responded "toxic." He changed her prescription from the incorrect (and "toxic") Depakote ER, 500mg, three times a day to Depakote, 250mg, three times a day (which, incidentally, is exactly half of the dose she was supposed to have been prescribed upon leaving the hospital May 19). And he wanted E---- to have her bloodwork done again in a week.

By July 29, 2007, copies of the prescriptions were obtained from CVS, and it became clear that it was her primary doctor (the internist who, by his own admission, is completely unfamiliar with the drug Depakote) who had written Depakote ER by mistake. Her neurologist, though having prescribed a dose that was written and filled incorrectly with a much stronger drug, is not negligent is this regard, but he chose to ignore pleas to look into this matter from when the family first asked on June 6 (other than ordering bloodwork to be done), to when he saw the results for the first time July 27. It remains an open question just how much irreversible damage would have occurred if, following the prescription as written and the lead of the doctors, the family continued to feed E---- three doses of Depakote ER for the seven weeks between June 6 and July 27.

The results for the bloodwork taken the first week of August, after the change in dosage on July 27, and obtained after repeated calls to the neurologist's office during the second week of August, showed E----'s Depakote level to be 6.4 and within normal parameters. Again it was blatantly apparent that neither the neurologist nor any subordinates had bothered to look at those results until a family member's final call of inquiry stressed the need to clarify whether the status of one of the patients under the neurologist's care would still be considered "toxic." in the neurologist's opinion.

(III)

The family believes that the negligence and malfeasance of her two physicians has led to side effects that are wholly incongruous with any of the previous symptoms and ailments associated with hemiplegic migraines. And they are not showing signs of relenting; if anything, there is a very real concern that they are getting worse.

Until July 27, things were back and forth with E----'s recovery. She was nowhere near ready to return to work, but the hemiplegic migraine symptoms never returned either, and she was, with considerable difficulty, able to eventually go out on short errands a few times a week. She was allowed to graduate and receive her diploma in late June (having been dropped from the last class required due to her hospital visit in April), and, though she was fairly immobile for a few days afterward, she got through the ceremony walking slowly, or with the help of others, or with a wheelchair. July was equally back and forth, and then her joint pain became extremely pronounced by the end of July. So much so that getting off the couch or bed to use the restroom was now a lengthy and painful process.

As of this writing (late August, 2007), the joint pain has rendered her unable to do hardly any walking, her hair is falling out in the shower in clumps, and her overall circulation appears to be severely compromised. The family considers this to be the result of something (or, perhaps, somethings) that were indeed toxic in their application, as E---- has been displaying side effects similar in nature to being poisoned for just over a month now.

For all the problems E---- has had in the past, they have since dissipated; there have been no more migraines, no stroke-like symptoms and fibromyalgia that affect only one half of her body, etc. Instead, her entire body has become incapacitated while her mind has healed and is quite clear, and that has never happened; indeed, with her previous condition, whenever any event has occurred it has always been neurological in its onset and the pressure remained omnipresent in her head while the physiological symptoms would manifest themselves on her right side and, eventually, begin to dissipate in time.

She is presently at home, unable to return to work or commence school, and in chronic pain during waking hours.

(IV)

An upcoming appointment with a rheumatologist has been scheduled, as well as a pain management specialist, both by way of E----'s last visit to her primary physician, who, unless the neurologist has informed him, is still unaware of his incorrect prescription writing regarding the drug Depakote. I accompanied E---- on this most recent trip to her doctor where lab reports had come back saying her joint pain wasn't arthritis. She said, "I hurt." He said, "I want to get you to a pain management specialist." I asked, "Given that her neurological condition's extreme symptoms present when you met her in the hospital in mid-May have subsided, replaced instead with increasing joint pain and decreasing lack of mobility, what can we do to determine the cause?" He said "I don't have all the answers" and "I'm referring you to a rheumatologist (should take about three to four weeks)" and "Is the Aleve helping?" and it devolved further from there. A few more " I wish I had all the answers" and one "I'll be on vacation for two weeks" after filling out the prescription for Oxycontin for her pain.

It is my belief that an attorney should be retained, though perhaps after a formal request to the health care provider for a new primary doctor and a new neurologist. For now, consultation is very much appreciated. We, the family, have no idea the extent of the damage done by the prescription of the wrong drug, and at levels so high. The long-term effects remain to be seen from the negligent behavior by both doctors; however, there are more than enough reasons given E----'s suffering at present for the family to consult with an attorney.

The patient has a very real fear of being dropped by her HMO, and having to face this new batch of problems without medical insurance.

Thank you in advance for your time.


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