Is this malpractice?

[justus]

What is the name of your state? OR

I am sorry if this gets long, I'll try to make it as short as possible.

About a month or so ago I was prescribed Wellbutrin SR. I had previously been on Wellbutrin XL (last year), for mild post partum depression. I had been off of my meds for quite a few months but my husband and I started having a hard time and things got difficult for me again so I called my doctor and asked to be put back on some anti-depressants. I went to the pharmacy to pick up my wellbutrin and my prescription insurance had changed and my insurance no longer covered Wellbutrin XL but would cover SR. So I called my doctor's office and spoke with the PA (physician's assistant). She said no problem, they'd just call in the SR. The dosage on the XL was 300mg per day. The SR was 200mg, 2 times per day for a total of 400 mg per day. I started having side effects within a few days. I called and spoke with the PA again and told them I wasn't able to sleep, it had given me severe insomnia. She said to take the last pill by 2 or 3 pm, which helped with the sleeping. I had started having other issues, I was gittery, sweatting all of the time, it was like being on some great drugs that make you able to go and go and go. I called and told them again and they said that they were side effects and they should subside.

Two weeks ago today I had an episode, where I thought I had fainted. All I remember is being downstairs in my home and wanting to go upstairs to my room. I don't remember actually going up there, but I did. I woke up to my husband standing in the door way asking me what was wrong and if I needed any help. I had absolutely no idea what he was talking about so I asked him. He said that my face was bleeding and my glasses were completely mangled. Sure enough, he wasn't lying. I had absolutely no idea what had happened, we were all completely puzzled. My husband said I was snoring when he walked in, but I hadn't been asleep. So the following Tuesday I went in and saw the PA and told them about this incident and that I'd been horribly tired, and about the other side effects that I mentioned above. They tested me for some things but all of my labs came back fine....we knew this by last Thursday.

Last Thursday, I loaded myself and my 3 small children (ages 4, 2 and 1) up and we went to visit my grandparents. By the end of the weekend, our whole family was, there...me, my husband, my kids, my parents and all of my siblings. We rented a hotel and were packing up to leave on Sunday. The kids were being good, there was no fighting or anything that would cause extra stress. The last thing I remember doing was walking to the sink in our hotel room to take my meds for the morning. The next thing I remember after that is waking up to paramedics, firemen, policemen, my parents, my brother and my husband standing over me. Needless to say I was hysterical. My family filled me in later because I had absolutely no memory of anything. My husband and my brother were standing in the door waiting for us to be ready to leave (we'd already loaded all of our things in our cars). My husband said he looked at me and asked if I was about ready to leave. He said I just stared in the mirror and didn't answer him so he asked me again. He said after he asked the second time my head started to turn towards him then started jerking and I fell to the floor in convulsions. They said my eyes were open the whole time. My dad said that my jaw locked, my face turned a blue/grey color, the whites of my eyes turned yellow and the colors started turning grey and I started foaming around the mouth. He said that was the scariest thing he's ever gone through as a parent. My family had absolutely NO idea what was going on and they didn't know if I was going to die or what. They called 911 and the emergency personnel arrived pretty quickly. Shortly after they got there I started to come out of it. Obviously they toook me to the ER, where the paramedics and the ER doctor said that it was the Wellbutrin that caused the seizures. My husband later told me that I made the same noise on Sunday that he'd heard me making about a week or so prior so we're assuming that was a seizure as well.

I have been put on an anti-seizure medicine and obviously taken off of the Wellbutrin. My dad called my primary care doctor on Monday morning to tell him what he witnessed and he told my dad that there was no way it could have been a seizure because I didn't lose control of my bowel or bladder. I went to see him later that day and he came in for about 2 minutes, listened to my heart and lungs and looked in my eyes then left and has his PA talk to my husband and I. My husband took me for an MRI that same day, which came back fine, as did my CT. They put in my chart that I fainted or had a pseudoseizure. Everything that we've read says that this was a seizure, and the ER doctor and the paramedics (who were on the scene) said the same thing. I've also seen a new PCP who believes this was a seizure caused by the Wellbutrin as well. However, I am not allowed to drive until I see a neurologist and get a clear EEG and we see what to do about taking me off of the Dilantin.

We feel like this PCP and his PA should have even given some consideration to the fact that I could have been having a bad reaction to this medication, especially once all of my labs came back fine and I'd had that first incident where I didn't remember anything. But as it stands now they are saying that it wasn't even a seizure, that I just fainted and it had nothing to do with the medicine, etc. So as of now I'm stuck not being able to fulfill my duties as a stay at home mom, by being able to even take my daughter to school. She is supposed to start her second year of preschool next week and now that I can't drive we have no way to get her there or home, so we're just kind of SOL until I get my driving privledges back.

I guess we're wondering if any of this constitutes malpractice. We all feel like they're just saying that it wasn't what it was to cover their butts so we don't think about suing. And we're all having a hard time figuring out why the dose was so high for mild depression.

Sorry this is so long but any thoughts would be appreciated!!

 

[SPR]

My dad called my primary care doctor on Monday morning to tell him what he witnessed and he told my dad that there was no way it could have been a seizure because I didn't lose control of my bowel or bladder.

umm, this is false. Lack of incontinence is NOT an accurate way to diagnose a siezure. Can your husband/paramedics describe your activity during this period?

Believe it or not, proving malpractice can be difficult. You have to prove that the physician did something that directly harmed you. Neglect may be a better word here.

Telling someone they had a pseudoseizure is pretty much telling them that they faked it. I don't know how else to describe it, either you had one or you didn't.

Now, onto the important part. It sounds like what was happening is that your dose is too high. Most of the studies done indicated that eizures were most common in patients who had too high of a dose. Based off of what you said early on in the post, I was already getting the idea that your dose was too high. These meds take time to take effect, so this is why it did not hit you earlier.

 

[justus]

From what we can tell I had a tonic-clonic seizure and from everything I've read on those you don't have to lose control of your facilities in order for it to be that.

I know, and everyone that was there knows beyond a shadow of a doubt that this wasn't faked. I have 100% no recollection of anything past taking my pills until I woke up with the emergency personnel in our hotel room.

I was thinking that the dose must have been too high as well. I guess where we're having major issues is that I went in having issues that are side effects of this medicine and that wasn't even discussed.. Unfortunately for me I didn't know that they were signs of a doseage that was too high.

I guess my husband and I are wondering if this would be worth contacting an attorney about. I just think about how much worse it could have been. I could have been driving with my children in the car, I could have been home alone with them, I could have been carrying the baby down the stairs. The doctor and the PA are absolutely NOT sorry or even willing to say that it was too high of a dose, which is what every other doctor I've seen has said. And needless to say I am very reluctant to go back on ANY antidepressants at this time....or ever, for that matter.

We basically feel like they should take some responsibility for messing up.

 

[SPR]

I hate saying this because I am in the medical field myself, but, due to a physician's office/staff not listening to your complaints, you ended up having seizures, temp. losing your license etc. If you showed no losses or injuries, I would say no, but since you have, IMO, you have a change to show that the physician was ngelcting your health, MAYBE malpractice.

If you told them the same thing that you just posted, they should have easily seen that your dose was too high, but they didn't. IMO, prescribing a med that they are not 100% up to date on with side effects and over dose precautions, then they should be held responsible. People rely on Doctors to be educated on certain things and to trust their judgement. Sometimes a sound decision is not so cut and dry, but alot of the times they should be taking steps to protect themselves AND the patient and perhaps this time they have not.

My wife is a physician, and sometimes they criticize that she is too conservative at times with diagnostic procedures, but deep down, my wife cares about patients and if something happens, it is hautning her for weeks. She is very thorough, especially so for an ER doc. She has actually saved a few lives by being conservative when other physicians are ready to just send a patient home.

 

[justus]

To be quite honest, this particular physician used to be the same way. That is why I have been seeing him for 12 years, as has my whole entire family. Unfortunately it's looking like this particular doctor is looking at losing 5 patients because of this one incident. We don't feel like we can trust him or his staff anymore. To be quite honest if they had taken responsibility and even maybe said they were sorry for the mistake we wouldn't even be considering this. But now we feel like they're just covering their butts because they made a mistake instead of owning up to it.

Thanks for your input, it's greatly appreciated.

 

[panzertanker]

Telling someone they had a pseudoseizure is pretty much telling them that they faked it. I don't know how else to describe it, either you had one or you didn't.

So my patients with pseudo aneurysms and pseudo cerebri are "faking it" too???
What area of the medical field are you in?

The word "pseudo" refers to a "mimicking" of the symptoms/signs or findings of the diagnosis of the same name. They are in no way/shape/form "fake".

Now, onto the important part. It sounds like what was happening is that your dose is too high. Most of the studies done indicated that eizures were most common in patients who had too high of a dose. Based off of what you said early on in the post, I was already getting the idea that your dose was too high. These meds take time to take effect, so this is why it did not hit you earlier.

Quite possible, but Wellbutrin SR has an indication up to 400mg/day, and therefore it is not malpractice to have a seizure when dosed appropriately.

OP:
You are upset, understandable.
You want an apology. I understand why, and if you were my pt I would give you one. However, you doctor/PA did not do anything wrong, so they do not OWE you an apology. (as I stated, it is the caring, compassionate thing to do, but not required)
As you have already done, I would seek another provider and move on with your life. You have no cause for malpractice based on your post.

 

[rmet4nzkx]

I have to leave for a while and will return later, I have a few questions.
What is your normal blood pressure?
In your MVA in 2004, did you suffer spinal, head or whiplash injury?
Do you have any history of head injury?
While on the Wellbutrin XL/SR did you experience increased libido?
Do you smoke?
Do you have any eating disorders?

 

[butterscotch]

I think you received inadequate care.
But I wonder if you would answer some questions about your physician(s).

You had your third child and following this you had symptoms of depression. Who diagnosed this?

After diagnosis was made you received a prescription for Wellbutrin sustained release (SR) and took it twice daily for how long?

Wellbutrin (SR) was helpful, but you stopped taking the meds? Why?

The second time you started taking it you received extended release (XL) and took one a day?

I am asking because psychiatrist make a diagnosis of depression and obgyn make referrals to psychiatrists.

Family practice physician may write refills once a patient has been stable on those medications. In instances where the FP doctors write changes in those medications they monitor their patients very closely.

The care you received was not standand practice and you should not have continued the medication following the episode of your pseudo- seizure. Wellbutrin is discontinued immediately as seizures are the first warning of possible complications in using this antidepressant. This medication works in a way that stimulates reuptake of certain neurotransmitters causing a seizure different from grandmal seizure, petite mal seizures.

I'll add to Panzetakers list:
Non-Hogkins lymphoma is not the white blood cell described in Hodgkins Lymphoma. Other than Hodgkins Lymphoma, there are at least 90 other cancerous white blood cells and those then cause non Hodgkins. These are not "pseudo" Hodgkins lymphoma, nor does the patient will them to be different from the Hodgkins white blood cells.

Lay persons should not try to interpret names of diseases if they aren't willing to do their homework. Teach your children well.

Please respond to the questions you have been requested to answer in order to determine product liability, negligence and injury.

 

[justus]

I have to leave for a while and will return later, I have a few questions.
What is your normal blood pressure? My normal BP is in the 120-130's over 70's. The last couple of weeks however it's been severely elevated (140's over high 90's)
In your MVA in 2004, did you suffer spinal, head or whiplash injury? No - I hurt my lower back
Do you have any history of head injury? No
While on the Wellbutrin XL/SR did you experience increased libido? I don't really think so
Do you smoke?No
Do you have any eating disorders?NO

I hope that answers everything.

 

[justus]

I think you received inadequate care.
But I wonder if you would answer some questions about your physician(s).

You had your third child and following this you had symptoms of depression. Who diagnosed this?

After diagnosis was made you received a prescription for Wellbutrin sustained release (SR) and took it twice daily for how long?

Wellbutrin (SR) was helpful, but you stopped taking the meds? Why?

The second time you started taking it you received extended release (XL) and took one a day?

I am asking because psychiatrist make a diagnosis of depression and obgyn make referrals to psychiatrists.

Family practice physician may write refills once a patient has been stable on those medications. In instances where the FP doctors write changes in those medications they monitor their patients very closely.

The care you received was not standand practice and you should not have continued the medication following the episode of your pseudo- seizure. Wellbutrin is discontinued immediately as seizures are the first warning of possible complications in using this antidepressant. This medication works in a way that stimulates reuptake of certain neurotransmitters.

Please respond to the questions you have been requested to answer in order to determine product liability, negligence and injury.

My OB/GYN's office started me on Wellbutrin XL last year. I took it for a few months and saw a counselor. I felt better so I went off and discontinued the counselor. I called my PCP's office this year, in July because I was having a difficult time. They called in a prescription of Wellbutrin XL. I went to pick it up and I guess my insurance changed because they no longer covered wellbutrin XL but would cover the SR. So they called the pharmacy and changed it to SR. So the end of July of this year was the first time I took Wellbutrin SR. They started me at the 400mg, dose right away. I looked at the prescription date on the bottle and it was 7/28 of this year. So I was on the Wellbutrin SR for about 3 weeks before the first seizure and 4 1/2 before the 2nd.

I discontinued the Wellbutrin SR this last Sunday, per the ER physicians.

Thank you all for your time.

 

[ellencee]

What is the name of your state? OR

I am sorry if this gets long, I'll try to make it as short as possible.

About a month or so ago I was prescribed Wellbutrin SR. I had previously been on Wellbutrin XL (last year), for mild post partum depression. I had been off of my meds for quite a few months but my husband and I started having a hard time and things got difficult for me again so I called my doctor and asked to be put back on some anti-depressants. I went to the pharmacy to pick up my wellbutrin and my prescription insurance had changed and my insurance no longer covered Wellbutrin XL but would cover SR. So I called my doctor's office and spoke with the PA (physician's assistant). She said no problem, they'd just call in the SR. The dosage on the XL was 300mg per day. The SR was 200mg, 2 times per day for a total of 400 mg per day. I started having side effects within a few days. I called and spoke with the PA again and told them I wasn't able to sleep, it had given me severe insomnia. She said to take the last pill by 2 or 3 pm, which helped with the sleeping. I had started having other issues, I was gittery, sweatting all of the time, it was like being on some great drugs that make you able to go and go and go. I called and told them again and they said that they were side effects and they should subside.

Two weeks ago today I had an episode, where I thought I had fainted. All I remember is being downstairs in my home and wanting to go upstairs to my room. I don't remember actually going up there, but I did. I woke up to my husband standing in the door way asking me what was wrong and if I needed any help. I had absolutely no idea what he was talking about so I asked him. He said that my face was bleeding and my glasses were completely mangled. Sure enough, he wasn't lying. I had absolutely no idea what had happened, we were all completely puzzled. My husband said I was snoring when he walked in, but I hadn't been asleep. So the following Tuesday I went in and saw the PA and told them about this incident and that I'd been horribly tired, and about the other side effects that I mentioned above. They tested me for some things but all of my labs came back fine....we knew this by last Thursday.

Last Thursday, I loaded myself and my 3 small children (ages 4, 2 and 1) up and we went to visit my grandparents. By the end of the weekend, our whole family was, there...me, my husband, my kids, my parents and all of my siblings. We rented a hotel and were packing up to leave on Sunday. The kids were being good, there was no fighting or anything that would cause extra stress. The last thing I remember doing was walking to the sink in our hotel room to take my meds for the morning. The next thing I remember after that is waking up to paramedics, firemen, policemen, my parents, my brother and my husband standing over me. Needless to say I was hysterical. My family filled me in later because I had absolutely no memory of anything. My husband and my brother were standing in the door waiting for us to be ready to leave (we'd already loaded all of our things in our cars). My husband said he looked at me and asked if I was about ready to leave. He said I just stared in the mirror and didn't answer him so he asked me again. He said after he asked the second time my head started to turn towards him then started jerking and I fell to the floor in convulsions. They said my eyes were open the whole time. My dad said that my jaw locked, my face turned a blue/grey color, the whites of my eyes turned yellow and the colors started turning grey and I started foaming around the mouth. He said that was the scariest thing he's ever gone through as a parent. My family had absolutely NO idea what was going on and they didn't know if I was going to die or what. They called 911 and the emergency personnel arrived pretty quickly. Shortly after they got there I started to come out of it. Obviously they toook me to the ER, where the paramedics and the ER doctor said that it was the Wellbutrin that caused the seizures. My husband later told me that I made the same noise on Sunday that he'd heard me making about a week or so prior so we're assuming that was a seizure as well.

I have been put on an anti-seizure medicine and obviously taken off of the Wellbutrin. My dad called my primary care doctor on Monday morning to tell him what he witnessed and he told my dad that there was no way it could have been a seizure because I didn't lose control of my bowel or bladder. I went to see him later that day and he came in for about 2 minutes, listened to my heart and lungs and looked in my eyes then left and has his PA talk to my husband and I. My husband took me for an MRI that same day, which came back fine, as did my CT. They put in my chart that I fainted or had a pseudoseizure. Everything that we've read says that this was a seizure, and the ER doctor and the paramedics (who were on the scene) said the same thing. I've also seen a new PCP who believes this was a seizure caused by the Wellbutrin as well. However, I am not allowed to drive until I see a neurologist and get a clear EEG and we see what to do about taking me off of the Dilantin.

We feel like this PCP and his PA should have even given some consideration to the fact that I could have been having a bad reaction to this medication, especially once all of my labs came back fine and I'd had that first incident where I didn't remember anything. But as it stands now they are saying that it wasn't even a seizure, that I just fainted and it had nothing to do with the medicine, etc. So as of now I'm stuck not being able to fulfill my duties as a stay at home mom, by being able to even take my daughter to school. She is supposed to start her second year of preschool next week and now that I can't drive we have no way to get her there or home, so we're just kind of SOL until I get my driving privledges back.

I guess we're wondering if any of this constitutes malpractice. We all feel like they're just saying that it wasn't what it was to cover their butts so we don't think about suing. And we're all having a hard time figuring out why the dose was so high for mild depression.

Sorry this is so long but any thoughts would be appreciated!!

I don't know the extent of your depression or the other contributing factors and I don't want to or need to know in order to answer your question.

If you were intially prescribed 200 mg twice daily, then the initial dosage was incorrect, which is professional negligence in prescribing the correct dosage. Wellbutrin, whether plain, XL, or SR, is implemented in stages. Initial dosages are small (example, 100 mg twice daily). After two weeks, the dosage is increased (100 mg three times daily). The REASON dosage is started low and increased is to evaluate whether or not the patient can take Welbutrin without developing significant CNS (central nervous system) side-effects.

This was not done, according to the info in the original post. As a direct result of failure to properly prescribe Welbutrin and to properly evaluate the significance of the side-effect, which do not require positive findings on any diagnostic test (bloodwork, CT, MRI, etc.) and to act (taper off and stop the medication), it appears that the OP suffered significant damages as a direct result of medical malpractice.

Consult with an attorney in your area.

As for everyone else, OP included, do some reading on seizures.

EC

 

[SPR]

So my patients with pseudo aneurysms and pseudo cerebri are "faking it" too???
What area of the medical field are you in?

The word "pseudo" refers to a "mimicking" of the symptoms/signs or findings of the diagnosis of the same name. They are in no way/shape/form "fake".

Emergency medicine. I know what "pseudo" means.

The examples you are giving are a totally different pathology. In a pseudo seizure, the patient doesn't actually know they are faking it. It's more of a psyhcological thing. So, again, either you had a "real" seizure, or you didn't.

With pseudo aneurysms and pseudo cerebri, you have a totally different diagnosis once you realize that the person doesn't actually have a bleed etc.

 

[rmet4nzkx]

Thank you for answering my questions, now I have a few more but believe I can help pinpoint the problem for you and you will need to do a little research.
Did you have a written Rx for the Wellbutrin XL on your first attempt to fill the Rx?
Did the pharmacist or you call the doctor to get the Rx changed to the SR formulation?
What color were your Wellbutrin SR Tabs, blue, purple or light pink?
Have you returned to the Pharmacy to get a copy of both the Rx?
When you picked up the fill for Wellbutrin SR did you consult with the pharmacist?
Is this the same pharmacy the filled your previous Rx for Wellbutrin XL?
What other Rx or OTC do you take?
Have you ever had an adverse reaction to medication?
Please get a copy of your medical records re this Rx from the doctor's office.
Your bp is higher now that you are off the Wellbutrin?
What was your BP subsequent to the seizures?
Were you given instructions re titration on the SR formula before you reached the therapeutic dose?
Fact: Incontinence MAY be a clinical sign of a seizure but not all seizures result in incontinence, lack of incontinence may help rule out more serious/chronic seizure disorders.

The difference between the SR and XL formulations is the rate of release, XL being the new and improved Rx is pushed for it's convenience of once a day dosing and a dosage limitation intended to avoid seizures more frequently found in doses greater than 400 mg per day, this higher dose may be required for some patients. When given a choice your insurance may choose to substitute (with the doctor's approval) the older less expensive formulation, sometimes you can get a waiver to the formulary however you do not want to do that now. Apparently what happened is that the formulary doesn't cover the XL which comes in 150 & 300 mg tabs, whereas the SR comes in 100, 150 & 200 mg tabs, You were known to benefit without side effect from the 300 mg dose which should have converted to Wellbutrin SR 150 mg (purple) BID not Wellbutrin SR 200 mg (light pink) BID.

 

[rmet4nzkx]

I don't know the extent of your depression or the other contributing factors and I don't want to or need to know in order to answer your question.

If you were intially prescribed 200 mg twice daily, then the initial dosage was incorrect, which is professional negligence in prescribing the correct dosage. Wellbutrin, whether plain, XL, or SR, is implemented in stages. Initial dosages are small (example, 100 mg twice daily). After two weeks, the dosage is increased (100 mg three times daily). The REASON dosage is started low and increased is to evaluate whether or not the patient can take Welbutrin without developing significant CNS (central nervous system) side-effects.

This was not done, according to the info in the original post. As a direct result of failure to properly prescribe Welbutrin and to properly evaluate the significance of the side-effect, which do not require positive findings on any diagnostic test (bloodwork, CT, MRI, etc.) and to act (taper off and stop the medication), it appears that the OP suffered significant damages as a direct result of medical malpractice.

Consult with an attorney in your area.

As for everyone else, OP included, do some reading on seizures.

EC

Ellen,
With all due respect, I asked the questions I did to rule out other factors that might have lowered her seizure threshold, the incorrect conversion from XL to SR dosage is obvious, who is responsible is not. I had to leave so waited to address the issue of the dosage. Neuroscience is my speciality and I have contributed to publications on psychopharmacology so I know all about Wellbutrin.

 

[panzertanker]

If you were intially prescribed 200 mg twice daily, then the initial dosage was incorrect, which is professional negligence in prescribing the correct dosage.
This was not done, according to the info in the original post.

EC

Yup, I missed that. I breezed through and read that she had changed from Wellbutrin XL 300/day to Wellbutrin SR 400/day.

OP: If you were started on the SR 400/day, Ellen is correct, see a lawyer. If not, my original post stands.