Is this malpractice?

[butterscotch]

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

I suggest you do some reading on how to obtain relevant information when a patient requests assistance with a potential medical malpractice question. You have a pattern of discrediting others who attempt to help someone requesting information.

 

[panzertanker]

Emergency medicine. I know what "pseudo" means.

No you don't, b/c you said:

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

Pseudoseizures CAN be faked, but a dx of pseudoseizure is not the same as telling someone "you are faking it".
That was my point.
http://www.nlm.nih.gov/medlineplus/seizures.html

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.

Yes, but not what you said. You said telling someone that they had a pseudoseizure was telling them that they faked it. BIG difference.

The word "real" is part of the stumbling block.

 

[ellencee]

My dear compadres--I do not intentionally include responses by pz and rmet in my generally inclusive answers. If I disagree with either, at least if I disagree with any degree of concern, I do it by PM.

Butterscotch (a flavor I detest)--I have never helf'd anyone and I'm not starting now. thanks, though...

EC

 

[butterscotch]

My dear compadres--I do not intentionally include responses by pz and rmet in my generally inclusive answers. If I disagree with either, at least if I disagree with any degree of concern, I do it by PM.

Butterscotch (a flavor I detest)--I have never helf'd anyone and I'm not starting now. thanks, though...

EC

Ellen, you are a credit to your profession. I admire you. I have read many of your informative answers. I am sure that you are very very happy in your work.

PS. How did the WAXING of your perineum turn out? What a professional person you are!

 

[rmet4nzkx]

OP has a case, but against whom and how much can be blamed on OP? I can see the problem a medmal attorney is going to have, for everytime they point a finger at a professional, they will respond by pointing at another so all will have to be sued, the insurance company who denied her Rx for Wellbutrin XL, the OB/GYN for not refering her to a psychiatrist to r/o PCD instead of PPD, the PCP/PA, pharmacist, the ER docs for not refering her to either a neurologist or psychiatrist for follow up after the first seizure or "loss of time" episode, the more sued, the more it costs to sue, experts, depos, etc. They will go back before OP was born looking for things to blame it on her, head injuries, eating disorders, what woman in this country hasn't hit their head sometime or been on a diet either one of which could in time lower the seizure threshold? The problem was isolated yet OP continued to take the medication without consulting the pharmacist.

 

[rmet4nzkx]

My dear compadres--I do not intentionally include responses by pz and rmet in my generally inclusive answers. If I disagree with either, at least if I disagree with any degree of concern, I do it by PM.

Butterscotch (a flavor I detest)--I have never helf'd anyone and I'm not starting now. thanks, though...

EC

OK, this time lol have a good holiday weekend

 

[justus]

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? No
Did the pharmacist or you call the doctor to get the Rx changed to the SR formulation? I had gone to the pharmacy to pick up the XL, they told me it was 50 something (which was the whole cost of the prescription) and said my insurance didn't cover it and to call them. I called my insurance and they said that they would cover generic Wellbutrin SR. I called my dr's office, spoke with the PA and explained to her what the insurance company said. She said, "No problem, they are the same thing the only difference is one is taken once a day and one is taken twice." and that she'd call the pharmacy and have it switched.
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? No I haven't, but am going to refill my other prescriptions tonight and planned on asking them if they can give me something showing my prescription history from them.
When you picked up the fill for Wellbutrin SR did you consult with the pharmacist?Yes. I specifically asked if I needed to wean on to the medication and he said, "No, the doctor's office didn't give any instructions for that so just start taking it." I asked again and he again said no just to start taking it.
Is this the same pharmacy the filled your previous Rx for Wellbutrin XL? Yes, I believe so.
What other Rx or OTC do you take? I take Ortho Tricyclin Lo, Metformin (1000mg/day) and 2 flinstones vitamins and getting ready to start BP meds
Have you ever had an adverse reaction to medication? No
Please get a copy of your medical records re this Rx from the doctor's office. I am picking up a copy of my chart on Tuesday
Your bp is higher now that you are off the Wellbutrin?My BP was fine until after what we now believe was my first seizure. Since it's been taken several times and has been consistantly high, and was the highest immediately following the last seizure. My new PCP felt that it's been high enough to treat it.
What was your BP subsequent to the seizures? Not sure if you mean right after or over all after but I think it was answered in the previous answer**************.the readings have been 140-150's over high 90's to low 100's.
Were you given instructions re titration on the SR formula before you reached the therapeutic dose? See above but no
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.

What I was given were the 200mg tablets, and instructed to take one 2 times per day for a total of 400mg per day. I hopep I answered all of your questions. Thank you for all of your time!

 

[justus]

OP has a case, but against whom and how much can be blamed on OP? I can see the problem a medmal attorney is going to have, for everytime they point a finger at a professional, they will respond by pointing at another so all will have to be sued, the insurance company who denied her Rx for Wellbutrin XL, the OB/GYN for not refering her to a psychiatrist to r/o PCD instead of PPD, the PCP/PA, pharmacist, the ER docs for not refering her to either a neurologist or psychiatrist for follow up after the first seizure or "loss of time" episode, the more sued, the more it costs to sue, experts, depos, etc. They will go back before OP was born looking for things to blame it on her, head injuries, eating disorders, what woman in this country hasn't hit their head sometime or been on a diet either one of which could in time lower the seizure threshold? The problem was isolated yet OP continued to take the medication without consulting the pharmacist.

Actually just to clarify....I did not go to the ER after the first episode. However, I went in the following Tuesday and saw the PA in my doctor's office, and told her about that episode. I told her I didn't know what happened but whatever it was gave me cuts on my face and my glasses were mangled. It wasn't until after this last seizure that my husband realized that I was making the same noises then that he heard me making that day two weeks ago when I had the first episode. Unfortunately he came in at the end and didn't see me because I was on the floor between our bed and the wall (which isn't visible from our doorway where he was). I absolutely 100% think that with that episode and the other problems I described to the PA, and having labs for other things that came back perfectly fine, they should have given some more thought to what could be causing it instead of telling me to see an ENT for the ringing in my ears. If they had this last episode may not have happened because they might have cut back or eliminated my Wellbutrin.

My OB/GYN did originally send me to a psychiatrist, and I did go. Things got better, as they tend to do with PPD and I discontinued treatement. I went quite a few months with no meds and no problems either.

 

[butterscotch]

justus,

I encourage you not to take advice about the dosages you received as a claim for malpractice. No one can do that other than a physician. And any professional person in the medical field knows that.

Also, I don't believe a physician who works in an emergency room has ever written a prescription for Wellbutin would continue to be covered by the underwriters for malpractice.


Rmet will help you identify where there might be concern. From what you have said, I think may be able to question the prescription for Wellbutin as negligence. And it sounds that in your case there is a breech in the standards of practice but it would be inapproprate for you to post that information on a public website. As soon as you do you have lost any possible right to confidentiality. I hope you are able to find help.

 

[ellencee]

Ellen, you are a credit to your profession. I admire you. I have read many of your informative answers. I am sure that you are very very happy in your work.

PS. How did the WAXING of your perineum turn out? What a professional person you are!:D

Surely, you know I copied and pasted it from an article circulating via email?!
EC

 

[rmet4nzkx]

Please update us as you can answer the other quetions, key of which will be who made the error withthe Rx for 400 mg instead of 300 mg of SR. The PA/PCP does seem to have some responsibility at least in not noticing the Rx was wrong and in not D/C the Rx. The pharmacist should have checked the amounts between the old Rx and the now amount if the same pharmacy filled both Rx for XL & SR. PA should have titrated up since it was a split dose anyway. Referal to psychiatrist by OB for 1st Rx was ok, referal to ENT was also appropriate there are forms of vertigo that can cause similar problems. Before you start on a BP Rx wait till you are off the Wellbutrin for a while and also take bp readings out of the doctor's office, keep a log and be tested for orthostatic hypotension, you don't want to treat white coat hypertension and create a new problem, so perhaps wait and get cleared by the neurologist. What is your Rx, Metformin for PCOS or Adult onset diabetes. The change in blood sugar levels could be contributing to your experience. Are you eating a hi protein diet? While the 400 mg Wellbutrin was incorrect I think it is more complex than that.

 

[justus]

The Metformin is for PCOS. I have been tested several times for diabetes and the tests have always come back negative. They tested my sugars in the ambulance on the way to the ER and my sugar was in the 80's....86 if I remember correctly. And yes, I do eat a pretty high protein diet.

I am going tonight to get a refill on my metformin and my BCP's and am going to speak to the pharamacist and get a print out of all of my meds that they have filled for me and I think that will give some more answers.

Thanks again!

 

[rmet4nzkx]

The Metformin is for PCOS. I have been tested several times for diabetes and the tests have always come back negative. They tested my sugars in the ambulance on the way to the ER and my sugar was in the 80's....86 if I remember correctly. And yes, I do eat a pretty high protein diet.

I am going tonight to get a refill on my metformin and my BCP's and am going to speak to the pharamacist and get a print out of all of my meds that they have filled for me and I think that will give some more answers.

Thanks again!

I am talking not just the print out of all our Rx but the actual script or phone log to determin the source of the error.

 

[rmet4nzkx]

Based on the records you recently obtained from the PA/PCP there was a deviation in the standard of care in record keeping, calculating the correct dose and prescribing at a level known to lower the seizure threshhold, not considering the effect in combination with a medication known to simulate an eating disorder, a contraindicted combination, failure to consult or d/c after the first "seizure", failure to titrate up/down. Please see a med-mal attorney.