$1M settlement for medication error, lithium toxicity

2006 Medical Malpractice Settlement Report

Medication error and failure to notice signs and lithium toxicity lead to death of 51 year-old woman

The plaintiff’s decedent was a 51-year-old mentally retarded woman who died from lithium toxicity on May 13, 2002. She had been a resident at the defendant residential home from 1992 until her death in 2002. Her past medical history was significant for profound mental retardation, rapid cyclic bipolar disorder, hypothyroidism, and early onset idiopathic Parkinsonism.

On April 13, 2002, the defendant pharmacy and pharmacist incorrectly filled the decedent’s lithium prescription, dispensing lithium carbonate 300-mg capsules instead of the prescribed lithium carbonate 150-mg capsules. This mistake resulted in plaintiff’s decedent consuming 1800-mg of lithium carbonate daily, instead of the prescribed 900-mg daily dosage, prior to her death.

On April 25, 2002, the decedent’s primary care physician (also a defendant) examined her for complaints of a three-day history of diarrhea, a classic symptom of lithium toxicity. The defendant PCP noted that the decedent had no evidence of clinical dehydration and recommended an increase in her fluid intake and regular diet. The PCP also instructed the caregivers at the defendant residential home to follow-up with him if the decedent exhibited signs of decreased oral intake, a change in activity level which he specified as lethargy, or worsening symptoms. Over the next several days, the decedent continued to experience diarrhea and was not eating well, however, these facts were apparently not communicated to the PCP.

On April 30, 2002, the decedent was again examined by the defendant PCP. There was no notation regarding the complaints of diarrhea for which he saw the patient five days earlier, nor did he note that her symptoms had improved or resolved. The PCP did note a slight increase in tone upon examining the decedent, but made no determination regarding the cause of this increased tone. Increased muscle tone, or rigidity, is a symptom of lithium toxicity. The PCP ordered blood tests during this visit, but neglected to order a lithium level.

In review of the documents and interviews obtained prior to and during litigation, it was clear that the residential staff had indicated and noted that the decedent was demonstrating unsteadiness, gait disturbances, lethargy, and weakness approximately one-month before she died. This time frame included the two visits to the PCP, however, none of these signs or symptoms were noted by the PCP or prompted him to question the patient’s lithium levels.

On May 2, 2002, the decedent was still experiencing diarrhea. The residential home was informed by the decedent’s day program that she was not allowed to return until she was medically cleared to do so. Also on May 2, 2002, a nurse at the residential home called the patient’s psychiatrist to report the patient’s symptoms. At that time the defendant psychiatrist gave orders to discontinue the patient’s morning dose of Zyprexa 2.5-mg due to her "unsteadiness and lethargy. " Unsteadiness and lethargy are classic symptoms of lithium toxicity, however, the psychiatrist failed to recognize these important symptoms and order a stat lithium level. She also failed to give orders to bring the decedent to a physician for an immediate physical exam.

On May 8, 2002, one of the residential home employees documented that the decedent was unstable, could hardly move, and was very weak and helpless. It does not appear that this was reported to any supervisor.

On May 10, 2002, the decedent again visited her PCP’s office for the purpose of an x-ray. It does not appear that the PCP personally examined the decedent and no other staff member noted her seriously deteriorating condition during the visit. Subsequent treating physicians from the hospital where the decedent was taken and eventually died indicated that the patient was obtunded for one week before her admission, had generalized weakness and lethargy for one-month before her admission, and that a history of five to seven days of dehydration would be compatible with her condition on admission to the hospital.

On May 11, 2002, the decedent’s parents visited her at the residential home and insisted that she be taken to the hospital for evaluation. She was sent to the hospital and was noted as having been obtunded for one week and suffering from general weakness. She was admitted with severe hyponatremia, hyperkalemia, and volume depletion. Her lithium level was noted to be 6.8 mEq/L, a critically high value. Lithium levels between 0.6 and 1.2 mEq/L are considered to be within the normal, non-toxic range. The next day she was noted to have persistent severe dehydration with metabolic derangement and hypotension, as well as acute renal failure, a known consequence and sign of lithium toxicity. The patient died on May 13, 2002.

Litigation continues in this matter with the PCP and psychiatrist stating that the symptoms the decedent was exhibiting were not relayed to them by the residential staff. The PCP contends that the patient’s symptoms on the dates he saw here were not suggestive of lithium toxicity and it is not his responsibility to monitor that medication as he was not the individual who prescribed the medication. The psychiatrist who prescribed the medication contends that she was not told of weakness and lethargy despite her signed telephone communication stating these as the symptoms and reason for altering other medications.

The case was settled for One Million Dollars ($1,000,000) during litigation with the pharmacy, pharmacist and residential home defendants. The case remains ongoing against the PCP and psychiatrist.

Lubin & Meyer attorneys represented the plaintiff in this medication error lawsuit.

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