Lithium Toxity

California
My husband has taken Lithium for his Bipolar illness for over 30 years without incident. He also has diabetes and chronic Arthritis.
Last Oct. he asked his Doctor for something to relieve some of the pain in his shoulder. He is under a P.A. but of course there is a medical doctor who oversees what is prescribed. The P.A. presribed Naproxen 500 MG for the pain. He was already taken several medications including zestril. He kept getting sicker and sicker and in Jan of this of year ended up in ICU with Toxity 2.6 Lithium level. He had irregular heart beat, severe tremors and water,potassium and kidney effects. He was released after 3 days . Most of the bad tremors stopped but he now has tremors in his leg. He was taken completely off Lithium and because he was off for several days before he could be put back Zyprexa and Depocote he had a Manic episode and was manic for 2 weeks. He now has slight kidney failure something he didn't have before. He has resently had to have heart stint put in and will need another because his kidney doctor didn't want to stress his kidneys so he must now go a second time. He is on SSI and all his medical is covered with Medi-cal. Hes afraid to ask anyone about this because he thinks that the doctors won't treat him if he looks into this.This could be permanate damage to his kidneys and if it is may shorten his life. I would not have known that Naproxen & Zestril can not be taken with Lithium unlessl a nurse, who was trying to confort me about my husbands tremors gave me a write up on Lithium Toxity and in there it said you can take those meds. We are on a very megar income and this is causing us undo hardship. What do you advise if anything? The PA said she was sorry but shes just a PA not a doctor and one of the doctors told me they can't keep up with all the medicines. We have to go 86 miles out of town now for his specialist. I don't want to seem ungrateful because we do have medical but that doen't cover the extra expenses. Thank so much, Sandy

[ellencee]

skb53
I hope I'll be able to answer with some credibility. As I was answering this post, the phone rang so answered the phone and when the call ended, I put a load of clothes in the dryer. Then, I couldn't find the phone and I couldn't hear it beep when I pushed page. Finally, I did hear the muffled beep coming from inside the dryer! Now, I'm feeling way to stupid to answer your post, but here goes.....

The PA had a responsibility to know the actions and interactions of each medication he, or she, prescribed. The MD is responsible for monitoring the work of the PA and is responsible for checking the PA's orders for accuracy and appropriate treatment.

Of course, somewhere there is a pharmacist that dispensed the medications concurrently. (hopefully he's not in my dryer!) If the same pharmacist or pharmacy filled these prescriptions, then the pharmacist and, or pharmacy had a duty to 'catch' the medications that should not be given together and to notify the MD and to withhold the filling of the prescriptions until such time as he talked with the MD and explained the situation to your husband.

If what you have posted holds to be an accurate accounting of the events and the damages to your husband are from the drug interactions, then you may want to give serious consideration to speaking with a medmal attorney in your area.

Your husband's being on Medicare or Medicaid or both will not impact his right to recover damages. Some of the monetary award may be spent to reimburse Medicare, Medicaid, or both, for the costs of treatments that were due to the negligent act(s), but those costs will not come from money awarded to him for his suffering and injuries.

Even if your husband has what appears to be a valid claim of malpractice, he must have an attorney willing to take his case and progress it to trial or settlement. Most medmal attorneys offer free consultation appointments. I hope that you and your husband will take advantage of one of these appointments and speak directly to a medmal attorney.

Best wishes,
EC

Ellensee is right about the medicines and the responsibilities of the PA, the doctor and the pharmacist.
Go see a lawyer, but do not hope for too much. Your husband's medical history will play a large part in any trial and lawyers will think about that hard and long before they accept your case. Juries are not sympathetic to those with a mental illness. Also you will find experts coming out of the walls saying the kidney trouble, the heart trouble and the surgery all contributed to his current problems. To account for that, those same experts for the defense will say the heart trouble pre-dated the medicine troubl, and the kidney failure resulted from the necessary heart stents.
Cases like yours do represent medical malpractice. Make no mistake about that. But complicated cases and cases involving long term illnesses are lost more often than won. That is what a lawyer will think about first. Sorry, to tell you this. But while I insist you should see a lawyer (at least five or six), you may find that you have no lawsuit.
In that case, ask for one of the lawyers to help you file an "in pro per" lawsuit. That way you make a public record of the blunders. In the future if another lawyer has a similar case against that set of doctors he can get information from you that will help him.

Thank you for your reply. The kidney failure was caused after the IUC stay for the Lithium Toxity. The Pa he was under had given him a Lithium level at that time and as usual it was normal she didn't check him again until he ended up in the hospital. His kidney function was also normal at that time. His local doctor arranged a visit to a Nephrologist in Eureka because his kidneys weren't working correctly after the hospital stay. he had not been diagnosed with a heart problem at that time. He had as a standard of care when he first started at this Doctor in October 2002 been given a EEG because he was Diabetic that showed nothing. They also had given him another test at the hospital here , I don't know the name of it but he said he saw on a screen his heart with vibrant colors shooting through it, again nothing showed as unusal, In fact the Tech who preformed the test questioned why they wanted the test him since he hadn't had a heart attack or even chest pain. the last test they had ordered for him was a stress test and he ended up in the hospital ICU with the toxity before he could take it and we canceled it until he was out and felt better. That test was rescheduled for the last of March and that is the test that showed he had heart problems. His doctor quickly scheduled him with a heart specialist. His kidney doctor also was making the case that he could have had this happen from all his ills but in the end when he found out that Bob didn't have kidney problems before the toxity, he said, "Well I guess it was the Naproxen and Zestril that caused it". I don't know whether his heart problem were from the Toxity or not. But I do know the kidney failure is. I don't even like the word "Sue"! But, we are on a fixed income of $757.00 a month and now we must travel to Eureka ,86 mile one way ,to his specialist's in a truck that's tranny is going out. As long as he's on SSI his medical is covered but if I work for every Two dollars I make they take one of his off and he cannot lose his medical . Sorry , my frustration is showing. Thank you so very much for your time.Really it was appreciated. Sincerely, Sandy Bomar

I am glad you gave me further information. Humboldt County is probably the worst county in California to file a malpractice lawsuit. Well, next to Trinity County, I guess.
Your case sounds better now. I think if you can't afford a trip to either San Francisco (the best) or Oakland, then go to the closest library and go through the yellow pages for malpractice lawyers in both cities. Phone a few and talk to them. (Use what you wrote for these pages as you guide while you talk to them) If you are lucky one of the lawyers will send his investigator up to talk to you. Then you will be on your way for some help.
It sounds to me as if the heart surgery started the kidney failure. Even if he was having kidney problems before the surgery, the heart surgery would have caused micro-emboli that triggered the failure. That is a fairly common result of open heart (chest) surgery. Maybe if you find a lawyer he can show that the drug mess started all of this. It still will be a tough fight. But I can assure you the first thing the lawyer will do is to bring your case down to the Bay Area. Then you will have a fighting chance. If he does bring it down to the Bay Area, you may not have to travel until and unless you go to trial.
You have nothing but the cost of telephone calls to lose. So, try it. The lawyer will see that your husband's SSI is protected. Go for it.
I hope I didn't discourage you too much in the beginning.