Methadone-Related Death and Hospitalization as Medical Malpractice

[angry_husband]

In January of 2006 my wife suffered a minor back injury that prompted her to seek some help from a local doctor. This doctor examined her, sent her to the hospital for CAT scans /MRI and *determined* she had nerve damage. He then set out on prescribing her up to 30 strong Percocets weekly. After a month of her visits it became apparent by the same faces seen weekly, the majority of his patients were on the same type of treatment. It was evident that this Dr. was basically a legal drug dealer. He ordered a random x-ray or had my wife wear a heart monitor home for 24 hours from time to time to cover his ass. I am not too sure how much recourse I could get going after this jerk. My main inclusion of this Dr. in this story is to set the background.

During the first 90 days of weekly visits with this Dr. my wife started to get addicted to this medicine. So much so that she would be out her of prescription days before her next weekly refill visit. By the end of March /start of April she was officially an opiate addict. In April of 2006 he then started her on Oxycontin. From April to June '06 she was on both the Oxycontin and Percocet. During this time her health was up and down and she was having irregular periods so she attributed this to the medicine. Well, in early June we found out she was around 3 months pregnant with a due date of mid /late December '06. We informed the Dr. and at the point he fired her as a patient! My wife flipped out on him and we both demanded he consulted with an OBGYN. He folded and prescribed her 20 codeine with Tylenol and told her to take a hike, in no certain terms.

Since my wife was left high and dry, we had no alternative but to seek rehabilitation for her. The thing is, when you are pregnant and are addicted to pain killers, you cannot quit "cold turkey" for risk of miscarriage. The only medically advised option, short of an abortion, is to get on Methadone Maintenance Treatment (MMT). We do not believe in abortion as we have 5 children we are raising already. We wanted another child.

We found a 7 day inpatient induction program that started my wife out on a moderate dosage of methadone that was tailored specifically for a pregnant patient. She completed the program and then the owness was on us to find a MMT clinic to handle the daily treatment.

We found a clinic that would take her. This clinic made her get a blood test and inducted her quickly. She was on maintenance of 60mgs per day the first initial week. During this time my wife was getting proper prenatal care and she was keeping up with her daily MMT visits.

Here is where it gets complicated. The general consensus with the Dr.’s at this clinic stated that a pregnant patient will probably be on a higher dosage as gestational issues will alter the effective dosage for the patient. They claimed that MMT is safe for a baby. This clinic’s dosage policy at the time was that if any patient wanted an increase all they had to do was ask the lady at the counter handing out the daily dose for an increase. This is not standard policy. Most, if not all, clinics within this region required dosage increases to be authorized by a doctor. Well, since the doctors said MMT was safe for a baby, and my wife was feeling the need to increase her dose, she was on over 220mgs per day by the end of August ’06. This is when tragedy struck. She went into pre-term labor and was rushed to the critical care unit of one of the best hospitals in the country. After a 3 day struggle, she lost the baby. There was no ruling as to the final determination, but a couple nurses mentioned that they could not believe she was on such a high dosage of Methadone. I believe my wife’s OBGYN also told her that was the reason why she lost the baby.

After this trauma, my wife went back to the clinic and was dropped back down to 100mgs per day. Over the course of the next 30 days she asked for dosage increases, un be known too me, and by the end of October she was back up to 220mgs a day. All the while she was asking for increases she never had to confer with a Dr.. Here is where tragedy struck again. One morning after her dosage we came home and she fainted and she was sweating profusely. I rushed her to the hospital and they placed her in the cardiac care unit. If I waited much longer she would have been dead. What if I wasn’t home that day? She developed a near fatal heart arrhythmia that required an invasive pace maker to be installed in her heart. Once again, she was on a high dosage of Methadone. The doctors tapered her down 120mgs over 4 days and she was fine and they sent her home.

Immediately upon return to the MMT clinic they enacted a new rule where ANY dosage changes, whether up or down, required a visit with the resident doctor. I was up in arms. I researched the SAMSHA guidelines in regards to dosage protocol and it clearly states that a doctor needs to be in constant monitoring of the administration of medicine as well as the general well being of the patient. This was not performed at this clinic until after my wife almost died. I lost a son in the process as well. I am angry and I want to make them pay, financially. Needless to say I have not had a good year.

Please let me know where I stand here. I would like to go after both the Dr. who started this whole mess as well as the MMT Clinic. Could I get the original Dr. for misdiagnosing my wife with nerve damage which ultimately got her hooked to opiates? She clearly does not have nerve damage. As for the clinic, I think they were negligent in my wife’s treatment by not having a doctor supervise the dosage administration. This negligence resulted in the death of my unborn child and a near life trauma with my wife’s near fatal cardiac arrhythmia.

I do not know if this matters at all but my wife and I are in our early 30’s. We have (5) children ranging in ages 1 – 8. We do not have criminal records and no history of drug abuse. We are not poor and we live in a single family house. I am an engineer. The reason I mention this is that I know when it comes to going after these people (from what I read) background of the suing party plays a heavy role.

I appreciate any information and /or advice anyone can provide. It has been (7) months since the loss of my unborn child and 6 months since I almost lost my wife. I was trying to get on with my life the past (7) months and I am now coming to terms with the grief. I want to sue these bastards for all they got. No one informed me what was going on with her treatment and my wife was going under their recommendations. They screwed with my life badly. I am ready to fight.

[Mr. Knowitall]

During the first 90 days of weekly visits with this Dr. my wife started to get addicted to this medicine. So much so that she would be out her of prescription days before her next weekly refill visit. By the end of March /start of April she was officially an opiate addict.

What do you mean by "officially an opiate addict"? Officially, as in medically diagnosed? By whom?

This clinic’s dosage policy at the time was that if any patient wanted an increase all they had to do was ask the lady at the counter handing out the daily dose for an increase. This is not standard policy.

That's beyond unusual. I've never heard of such a thing.

She went into pre-term labor and was rushed to the critical care unit of one of the best hospitals in the country. After a 3 day struggle, she lost the baby. There was no ruling as to the final determination, but a couple nurses mentioned that they could not believe she was on such a high dosage of Methadone. I believe my wife’s OBGYN also told her that was the reason why she lost the baby.

This is problematic, medically speaking, as you will find that there are many babies born to mothers who take 200+ mg of methadone on a daily basis. Typically the babies have to spend time in the NICU for observation, and possibly a double withdrawal (one short-term withdrawal shortly after birth, and a second withdrawal as much as several weeks later due to methadone's long half-life in infants). But with medical management of the withdrawal, that of itself shouldn't be fatal.

To turn this into a medical malpractice case by the methadone provider, you would need a medical determination that methadone caused the death. If you consult a malpractice lawyer, the lawyer would likely have the medical records reviewed by a lawyer or legal nurse to see if there is a potential case.

She developed a near fatal heart arrhythmia that required an invasive pace maker to be installed in her heart. Once again, she was on a high dosage of Methadone. The doctors tapered her down 120mgs over 4 days and she was fine and they sent her home.

Her doctors likely shared an opinion as to how she developed the arrythmia - did their theories relate to the methadone dose?

If you don't feel like answering these questions, or they seem to prying, at the end of this discussion we are likely to end up at a point where we have to tell you to have your wife's medical records reviewed by a medical malpractice lawyer to see if a case can be made.

[angry_husband]

I sincerely appreciate you taking the time to reply to this. I know it is very long winded and too be honest, telling it through this forum was the first time I have verbalized the whole thing to someone outside of my family circle. That in itself was very theraputic. The fact it was taken seriously is further validation that I need to explore my options.

I am going to answer your comments in the order they were posted..

"Officially an opiate addict" - She was never was officailly diagnosed as such during those early months. I labled her that by going off of the determination of what a drug addict is. http://encarta.msn.com/dictionary_/addiction.html

"Dosage policy from the nurses.." - This is verifiable by anyone at the clinic PRIOR to my wife almost dying. When she came back to the clinic they changed the policy ACROSS THE BOARD. It was strange. When she came back to the clinic they changed the policy because of her almost dying.

"Heart arrhytmia.." - The doctors in the cardiac care unit dropped her back to 120mgs of Methadone in an attempt to stop the heart problem. They explicity sent changes to the MMT clinic that she is to not go above 120mgs. So yes, I am vey sure it is documented that Methadone was the cause of her hospitalization.

So if all the medical documentation backs up the allegations to methadone as being the root cause for these problems, does it look like we have the making of a case? The fact the MMT did damage control right after she almost died, is that something that is in our favor?

[Mr. Knowitall]

"Officially an opiate addict" - She was never was officailly diagnosed as such during those early months. I labled her that by going off of the determination of what a drug addict is. http://encarta.msn.com/dictionary_/addiction.html

True or not, I would venture that the doctor will defend by arguing that she was an addict when she came into his practice who lied about her symptoms to get pain pills. There's a probability that she did lie to him at times in order to get her medication increased or to get "replacement" pills she had taken but claimed to have lost, as almost all addicts do that.

"Dosage policy from the nurses.." - This is verifiable by anyone at the clinic PRIOR to my wife almost dying. When she came back to the clinic they changed the policy ACROSS THE BOARD. It was strange. When she came back to the clinic they changed the policy because of her almost dying.

As I said before, I've never heard of a clinic with such a policy, which seems both outrageous and reckless.

"Heart arrhytmia.." - The doctors in the cardiac care unit dropped her back to 120mgs of Methadone in an attempt to stop the heart problem. They explicity sent changes to the MMT clinic that she is to not go above 120mgs. So yes, I am vey sure it is documented that Methadone was the cause of her hospitalization.

The fact that they wished to limit her methadone dosage after they implanted a pacemaker does not mean, of itself, that they believe that her methadone usage caused the condition which required the pacemaker. That's the big question.

So if all the medical documentation backs up the allegations to methadone as being the root cause for these problems, does it look like we have the making of a case? The fact the MMT did damage control right after she almost died, is that something that is in our favor?

You may have a case. Doctors are not responsible for every bad outcome which results from the use of a medication. There are thousands of people on similar doses of methadone who don't develop heart problems, and I'm not personally aware of any cases where an arrythmia has been shown to develop from methadone use alone.

[angry_husband]

I agree about your comment about the back doctor who *I believe* was instrumental in getting my wife into this whole damned mess. It would be a tough situation to fight that one.

Again, I really appreciate your insight into this matter. I do have a couple more questions that I would like to ask you if you wouldn't mind answering...

1. What area of all of the this tragedy is the most strongest for litigation? The death of my unborn son? The heart arrythmia? Or both?

2. The MMT clinic is located in one state and the hospital where both incidences occured are located in are in another. This would fall under jurisdiction where the MMT clinic is located, correct? From what I read the jurisdiction of the MMT clinic does not have any monetary limitations on mal suits. The other is capped at a certain amount.

3. Assuming I do I have a semblance of a case, what would you recommend for monetary recourse? From the 10,000ft. view, would the nature of this case be one where it looks like a slam dunk for maximum payout or a low ball out of court settlement?

3. The daily methadone increases handled by the nurse then changed to only Dr. approved for the whole clinic AFTER my wife almost croaked, is this in itself incriminating /damning on their part? If so, does this look like their achilles heel in terms of out of court settlement? I would think the federal governing board who monitors MMT clinics would seriously scold or threaten their licensure for something of this magnitude.

I understand that to fully determine this situation would involve a mal lawyer really scrutinizing the medical records and spending some time hands on with this case. I just would like to get the thinking process of where the strong points of this case are and find what direction the mal lawyer is going to take to determine the avenue of attack.

FYI - The pace-maker used was an external one. They taped it to her chest and the electric wire was fished from her artery under her collar bone into her heart, directly. This was not open heart surgery or anything. Once the methdone was tapered down over 3 days they removed the pacemaker and sent her home on the 5th day. I wanted to clarify that, if it matters. My wife did have heart complications when she was younger, so anything having to do with her heart makes it a bigger deal than if she never had heart complications before. Her heart condition was always mentioned during any intake with any clinic or doctors office.

[Mr. Knowitall]

1. What area of all of the this tragedy is the most strongest for litigation? The death of my unborn son? The heart arrythmia? Or both?

For the reasons you note in your last paragraph, it's hard to give any meaningful response to that. In some senses, both the original doctor and the methadone clinic may have liability in relation to your wife's addiction and the necessity for treatment of that addiction, assuming it started with a misdiagnos and inappropriate prescription practices and was escalated by the methadone clinic's inappropriate client-initiated increases in dosage.

Unless you have a medical opinion that the methadone contributed in some way to the death of your unborn son, and that the death would not have happened at a lower dose, I unfortunately don't think you'll be able to build a case. As you have noted, methadone is the medical standard for treatment of opiate and opioid dependent pregnant mothers, so the provision of methadone of itself is not malpractice. But there may have been contraindications to the dose which, with proper medical practices, would have been detected and, if they played a role in what happened, perhaps there's a case to be made.

For the arrythmia, again there's a question of causation, and you would need a doctor to again both testify that the methadone caused the problem and that it would not have occurred at a lower dose. I am not familiar with any medical study which establishes causation between methadone use and arrythmia, although I am aware that the combination of methadone with other substances (e.g., taking Oxycontin while on methadone) can have that effect.

Also, and this may sound strange, if she has no permanent heart damage from the incident you will probably have a hard time finding a lawyer who would deem the case viable. The cost of bringing a malpractice case is extremely high, and absent extremely serious injury many cases of clear malpractice cannot be pursued because the cost of the lawsuit will exceed any possible recovery.

2. The MMT clinic is located in one state and the hospital where both incidences occured are located in are in another. This would fall under jurisdiction where the MMT clinic is located, correct? From what I read the jurisdiction of the MMT clinic does not have any monetary limitations on mal suits. The other is capped at a certain amount.

I would expect that you would have to pursue each possible defendant in the state where they are situated.

3. Assuming I do I have a semblance of a case, what would you recommend for monetary recourse? From the 10,000ft. view, would the nature of this case be one where it looks like a slam dunk for maximum payout or a low ball out of court settlement?

It's hard to get a lowball settlement in a malpractice case, as malpractice defense lawyers know how quickly they can run up the cost of litigation. In some states, it can cost $5,000.00 or more for a mandatory medical opinion in the form of what is called an "affidavit of merit" just to get a case filed.

[4]. The daily methadone increases handled by the nurse then changed to only Dr. approved for the whole clinic AFTER my wife almost croaked, is this in itself incriminating /damning on their part? If so, does this look like their achilles heel in terms of out of court settlement? I would think the federal governing board who monitors MMT clinics would seriously scold or threaten their licensure for something of this magnitude.

Subsequent remedial actions may be admissible to show control, but they are almost never admissible to show culpability. However, I don't think you would need to worry about that, as I don't think you would have much trouble establishing that the clinic was not observing the appropriate standard of practice when they let the nurse increase doses on request without any medical review or approval.

My first thought was that somebody at the clinic might be engaged in diversion (siphoning off methadone for illegal sale), as the system you describe would seem to circumvent many of the safeguards against diversion. Premix a bunch of 40 mg bottles, then use fictitious patient-initiated "dose increases" to account for hundreds of miligrams siphoned off for illegal sale.

I'm not going to discount the value of methadone clinics, or the benefit of methadone's being a cheap medication, but office-based administration of buprenorphine (Suboxone) seems to be a much better alternative for many (probably most) addicts.

I'm not a medical professional, but there are some who read this forum and I hope one chimes in with a more medically-oriented perspective.