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11-18-2008, 02:39 PM
| | Junior Member | | Join Date: Nov 2008
Posts: 8
| | | Practitioner now refuses to give life sustaining medication
Washington State
Patient without a thyroid gland and has hypopituitarism (non-functioning putuitary gland).
Has been taking thyroid replacement and methyl-prednisoLone and is healthy at this time.
Patient's practitioner of many years, fully aware of these conditions, and willingly prescribing medications for these conditions has suddenly (and without any warning) refused to prescribe anymore thyroid replacement. His reasoning was that the patient's TSH was "0". A non-functioning pituitary gland can not produce TSH, and this practitioner is fully aware of that, and was reminded of that. The soonest this patient can see another practioner is longer than this patient can survive without thyroid replacement.
Are there any laws against this? The practitioner is a ARNP (nurse practitioner).What is the name of your state (only U.S. law)? |
11-18-2008, 04:03 PM
| | Senior Member | | Join Date: Feb 2006 Location: Philadelphia, PA
Posts: 11,722
| | | Have you spoken with the NP's supervising physician? |
11-18-2008, 04:46 PM
| | Junior Member | | Join Date: Nov 2008
Posts: 8
| | | The NP operates his own clinic.
As far as we are aware, there is no supervising physician. |
11-18-2008, 07:00 PM
| | Member | | Join Date: Jun 2007 Location: flying city
Posts: 830
| | Quote:
Originally Posted by k9gang  Washington State
Patient without a thyroid gland and has hypopituitarism (non-functioning putuitary gland).
Has been taking thyroid replacement and methyl-prednisoLone and is healthy at this time.
Patient's practitioner of many years, fully aware of these conditions, and willingly prescribing medications for these conditions has suddenly (and without any warning) refused to prescribe anymore thyroid replacement. His reasoning was that the patient's TSH was "0". A non-functioning pituitary gland can not produce TSH, and this practitioner is fully aware of that, and was reminded of that. The soonest this patient can see another practioner is longer than this patient can survive without thyroid replacement.
Are there any laws against this? The practitioner is a ARNP (nurse practitioner).What is the name of your state (only U.S. law)? | Restated question or deja vu all over, again?
A TSH of 0 means you do not need thyroid replacement medications; the blood level of circulating thyroid hormone is too high.
What were the Free 3, Free 4, T3, and T4 values?
I have no idea why you are taking methylprednisolone; but, tapering off of the medication is usually recommended. There is new thought that it may not be necessary to taper the drug before discontinuing; but, the decision is usually based on the total daily dosage and the length of time the patient has been taking the drug.
Find another physician or practitioner for a second opinion.
It does not appear you have a valid medmal claim. You have suffered no damage and as yet, have not given sufficient evidence of an act of negligence or medical malpractice.
Somewhere, there is a physician who reviews the practitioner's records and treatment plans. Washington's State Board of Nursing governs the practice of all nurses at all levels of practice; you may report your concerns to the BON.
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lya
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11-18-2008, 07:23 PM
| | Senior Member | | Join Date: Feb 2006 Location: Philadelphia, PA
Posts: 11,722
| | | I was under the impression that a NP can't practice without a supervising physician, but those rules vary by state. |
11-18-2008, 07:30 PM
| | Member | | Join Date: Jun 2007 Location: flying city
Posts: 830
| | Quote:
Originally Posted by ecmst12 I was under the impression that a NP can't practice without a supervising physician, but those rules vary by state. | As I stated in my reply, somewhere there is a physician who reviews the work of the nurse practitioner.
It is OK for a nurse practitioner to own and operate his/her own practice; however, there must be a physician who is willing to take referral from the practitioner when the patient's needs exceed the scope of practice of the NP and be willing to review the work of the practitioner in accordance with the state's BON's regulations.
In other words, the NP who has his/her own practice does not have to have an in-house MD or have daily contact with a "supervising" physician.
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lya
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11-18-2008, 11:04 PM
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Posts: 8
| | | Lya, I'll explain more clearly...
TSH is a pituitary hormone, and the patient's pituitary gland is non-functioning due to radioiodine damage, and therefore can not produce any TSH at all - her TSH has tested at "0" for many years, including the years this NP has been her practitioner.
Since the pituitary is non-functioning, it also can not signal the adrenal glands to produce cortisol, so they must be supplemented. Low dose methyl-prednisoLone is the supplement for that, and must be taken for life because a damaged and non-functioning pituitary gland will never recover. Not supplementing will put the patient into adrenal crisis, which can be life threatening.
The non-functioning pituitary gland is not the result of too much thyroid replacement, it is the result of radioiodine damage. The Free T3 and Free T4 are within normal range, and at very good levels. The patient has never had symptoms of "too much" thyroid replacement, and is, at this time, in very good health due to being properly medicated and monitored.
The nurse practitioner was very happy with the treatment, lab results (which have not wavered much over the years from what I can see), and the health of this patient for the years he has treated her. He is aware she has no thyroid gland and is aware her pituitary is damaged and non-functioning and can not produce any TSH. He is aware that her TSH has always been "0" and has been fine with that all these years.
The points are:
#1 - Patient has no thyroid gland and requires replacement to survive, and her NP has taken her thyroid replacement away based on a "0" TSH. Human beings are not able to survive without thyroid glands and on no thyroid replacement. Taking thyroid replacement away from a person without a thyroid gland is a death sentence.
#2 - A damaged pituitary is not able to produce any TSH. The NP states the "0" TSH is due to being overmedicated on thyroid replacement, yet he knows her pituitry is damaged and can not produce any TSH, and has not produced any TSH for a number of years, including all the years he has been her practitioner.
#3 - the time it will take to get in to see another practitioner will surpass the patient's ability to survive - she'll die before she can see another practitioner.
I hope I've explained this better.  |
11-18-2008, 11:23 PM
| | Member | | Join Date: Jun 2007 Location: flying city
Posts: 830
| | | You remain confused about TSH levels. The lower the TSH level, the more thyroid hormone is in the bloodstream.
I do not need or desire your internet search based knowledge as I've been in my career for nearly 30 years; but, thank you just the same.
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lya
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May we all have a blessed new year, 2009.
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11-18-2008, 11:28 PM
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Posts: 11,722
| | | If the patient is having a medical emergency, she can go to the emergency room. |
11-19-2008, 02:01 AM
| | Junior Member | | Join Date: Nov 2008
Posts: 8
| | Quote:
Originally Posted by lya You remain confused about TSH levels. The lower the TSH level, the more thyroid hormone is in the bloodstream.
I do not need or desire your internet search based knowledge as I've been in my career for nearly 30 years; but, thank you just the same. | Yes, lya, the lower the TSH level, the more thyroid hormone is in the bloodstream "if" the pituitary gland is fully functioning. In a patient with a non-functioning pituitary, the TSH will be non-existent. If you've been "in the biz" for 30 years you should know this, or you can open up your Merck manual and look up hypopituitarism. Or I can look it up for you in one of my Mercks, if you'd like...
The patient has a non-functioning pituitary gland which can not produce TSH. The NP knows the patient's pituitary can not produce TSH, and that it does not have anything to do with thyroid replacement, and yet he discontinued her thyroid replacement based on her TSH. AND she is without a thyroid gland and can not survive without thyroid replacement.
The NP is withholding life sustaining medication to this patient for no good reason.
Having a damaged non-functioning pituitary gland is NOT a good reason to withhold her thyroid replacement and endanger her life. He pulled the rug out from under her and did not give her enough time to find an alternative. Good grief, he could have simply lowered her dose, but for god's sake why can he just take it away?
Again, is there a law in Washington State that protects patients from this sort of unethical and dangerous practice? |
11-19-2008, 10:19 AM
| | Senior Member | | Join Date: Mar 2006
Posts: 5,012
| | I know nothing about TSH, but if the statement: Quote: |
#3 - the time it will take to get in to see another practitioner will surpass the patient's ability to survive - she'll die before she can see another practitioner.
| is true, then she is dead. That's because, even if there was: Quote: |
a law in Washington State that protects patients from this sort of unethical and dangerous practice?
| it would take longer to work the case's way through the courts then it would take to find another doctor.
Even with an attempt an an emergency injunction, the rule is "substantially likely to succeed on the merits" and I don't see it here. You'd have to get an attorney, he has to spend time in research and filing the lawsuit and you would have to gather the facts necessary to reach that hurdle.
As someone else said, go to the emergency room and stop trying to second guess the NP. Sheesh, the law is not designed to make people do what is easy for the one initiating a lawsuit. I suspect, if there is a law and if the facts fit, it would take years before the NP was told what to do. Now, if damages do occur and if it is found to be a abandoning of a patient, then you'd have a suit. Not before. (Again, nothing I say or know if there is some problem here. I just speak to the legal problem of slavery.)
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11-19-2008, 10:48 AM
| | Senior Member | | Join Date: Feb 2006 Location: Philadelphia, PA
Posts: 11,722
| | | The patient needs to make an appointment with a REAL DOCTOR, preferably an endocrineologist, to evaluate her condition. If she experiences a medical emergency while awaiting this appointment, she can go to the ER.
I have done some reading and can't find anything that indicates short term untreated hypothyroidism is a life threatening condition. What exactly do you think is going to kill the patient in a few weeks or even months? |
11-19-2008, 11:54 AM
| | Senior Member | | Join Date: Jul 2006 Location: by the bay
Posts: 1,506
| | Quote:
Originally Posted by ecmst12 The patient needs to make an appointment with a REAL DOCTOR, preferably an endocrineologist, to evaluate her condition. If she experiences a medical emergency while awaiting this appointment, she can go to the ER.
I have done some reading and can't find anything that indicates short term untreated hypothyroidism is a life threatening condition. What exactly do you think is going to kill the patient in a few weeks or even months? |
Agreed, on both points. One can be without their thyroid replacement for quite a while before exhibiting symptoms that would be considered "life threatening" . If patient continues to seek treatment from an NP, that NP should be under the supervision of a Board Certified Endocrinologist.
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11-19-2008, 01:50 PM
| | Junior Member | | Join Date: Nov 2008
Posts: 8
| | Quote:
Originally Posted by ecmst12 The patient needs to make an appointment with a REAL DOCTOR, preferably an endocrineologist, to evaluate her condition. If she experiences a medical emergency while awaiting this appointment, she can go to the ER.
I have done some reading and can't find anything that indicates short term untreated hypothyroidism is a life threatening condition. What exactly do you think is going to kill the patient in a few weeks or even months? | The patient already has an appointment with another practitioner in December, although I am trying to get her in to see my naturopath when he returns from vacation in a few days.
She is without a thyroid gland. She stated to me the last time she was without medication it turned into a medical emergency on day number five (the NP is apparently aware of this). She has told me a close friend of hers in another state, also without a thyroid gland, succumbed on day number ten without thyroid replacement.
I am not here to seek information about any lawsuit, I am here to seek information about any rules, regulations, or laws against practitioners endangering patients like this. |
11-19-2008, 02:13 PM
| | Senior Member | | Join Date: Jul 2006 Location: by the bay
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| | Quote:
Originally Posted by k9gang The patient already has an appointment with another practitioner in December, although I am trying to get her in to see my naturopath when he returns from vacation in a few days.
She is without a thyroid gland. She stated to me the last time she was without medication it turned into a medical emergency on day number five (the NP is apparently aware of this). She has told me a close friend of hers in another state, also without a thyroid gland, succumbed on day number ten without thyroid replacement.
I am not here to seek information about any lawsuit, I am here to seek information about any rules, regulations, or laws against practitioners endangering patients like this. |
Prescribing unnecessary medication that could worsen the patient's condition, or cause other medical problems would be endangering the patient. Also, expecting a "naturopath" to practice beyond their scope of expertise, education, or licensure, is also endangering the patient.
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