My friend (X), was referred to a Neuro-Psychiatrist (Z) post brain injury w/ the goal of admission to a more comprehensive rehab facility since X had already failed the day program X was in. Z saw X once a month ongoing. Third month - Z prescribed anti-depressant (Venlafaxine Hcl). Fourth month - Z complains X is regressing, stresses need for comprehensive rehab, says Z will advocate for X (I have Z's clinic notes). I tell Z that I am looking all over the U.S. Fifth month - I gain entrance for X in a top notch facility. Insurance contacts Z, and then informs me that Z would not support X. I call Z - no response. I call Z's sec. and ask what exactly our next appt. is for?? Z leaves a message on my machine (he has my mobile #?? ) that he will not see X again. Five months wasted with Z.

Q = Can Z prescribe an anti-depressant and then legally abandon X?

Q = Does Z owe a duty to perform as promised and as described in Z's clinic notes, i.e. advocate for X rgd rehab program?

First of all, as a prior med-mal researcher, it is easer if you just give names rather than X or Z.

Venlafaxine Hcl is Effexor XR which is prescribed in specific dosages beginning at 37.5mg and increased from there.

To research this problem better I would need to know the dx (diagnoses) of the pt (patient) as well as the mg of the meds prescribed.

What is your relationship to the patient? How did you obtain records, and how comprehensive are the records that you do have access to?

All of this I would need to know to go further in depth.

This was my profession for over 10 years and at this point all the info you have given so far is too cloudy to be able to give a direct answer.

Are you in the states? If so, I need to know which one so I can refer to the specific laws of the state.

Sorry I was not much help at this point, but med-mal is a very tricky area when laws are concerned, especially psychiatry.

Janine

Thank you J_9,

A) I cannot disclose names at this time. As a former law student (long time ago) "X" & "Y" are fine for this hypothetical.

B) Effexor pharmacology is known & protocol understood - it's the law, Fed & State which I need help with as I am imobile.

C) Diagnosis: Mycobacteria Meningeoencephalitis. X is finished all meds and culture reveals no remaining mycobacteria. X has suffered severe brain damage because of initial misdiagnosis (a whole different issue and being pursued), however, Z's behavior may reflect defense by negligent Dr's of aforementioned. Prognosis: Severe retardation - global slowdown due to diffuse infarcts, hydrocephalus, anoxia, etc. Medication: Z prescribed 75mg Effexor daily for X for possible depression, to curb emotionality, for reduced lethargy, and to stabilize X for day program rehab.

D) Xand Z are both Maryland residents - (MD venue, MD law unless Fed trumps).

I understand how med-mal is very "tricky" and also how Maryland is a very Dr. "friendly" venue. Add the all too times mystical, but mostly personal, interpretation of a patient and their history by a Psych and you have the recipe for modern voodoo.

Regardless, I simply want to know if Z can prescribe Venlaxafine and then decline to follow-up on a patient which was already started on said drug? Drug literature states caution and extreem care, etc, etc. but is this criminal or civil? What are the Dr's responsibility to follw drug mfg's guidelines? If not followed is it simply and issue of ethics to bring before physicians review board or criminal for states atty, or civil for us to get atty?

Thanks again.

Okay, I was not asking to disclose actual names. If you were a law student you understand that it is easier to follow when using the word patient and the word doctor instead of X & Y. Just easier for the layperson to follow when reading transcripts, etc.

Without reading actual doctors notes and nurses notes this is really hard for me. Remember I am not a doctor or an attorney, these are strictly opinions that are coming from only one side of the story, yours.

I cannot, with exact certainty, tell you whether you have a case without the file directly in front of me, but here goes what I know from what you say.

In the Doctors notes does it say anywhere where doc refused to follow up with patient, and if so, there must be a reason.

Effexor XR can be prescribed in most states today by a GP. This drug does not necessarily require strict follow up once maintenace level has been achieved. Many people receive maintenance level and go back to GP once every 6 months for follow up and new RX.

You say PT was Dx with Mycobacteria meningeoencephalitisand initial misdiagnosis. I am wondering if there was a DX of Pneumocystis carinii or possibly Histoplasmosis.

My experience comes from Michigan and Tennessee, so I am not familiar with MD, but would like to help as much as possible.

Again, I would like to reiterate that without looking directly at the medical records I cannot, in good faith, state for sure if you do indeed have a case.

Here is some further info about the micobacterium which you state was initially misdiagnosed.

Mycobacteria usually produces TB - which is a common ailment in people with AIDS - suppressed immune system. In those people it could also travel to the brain as encephalitis. Misdiagnosed? Maybe - it is rare except in people who are already suppressed.

Mycobacteria is called an OIP (opportunistic) which will usually only invade people who are immunodeficient for one reason or another.

Just a thought.

Thanks again J_9

Your info about the mycobacterium was exact. Yes, it is considered rare, but in reality it WAS considered rare. The global community has found a resurgence of TB. The US has seen this as well with a huge increase in TB due to immigration, HIV/AIDs, and non-compliance with DOT. Anyone who spent any amount of time outside the US, esp in S. America, S.E. Asia, and Africa stands a good chance of having been exposed. The Mantoux test is not infallible, and only detects latent infection, and will also fail if patient is immunosuppressed due to Rx, ailment, etc. or on a drug like prednisone, etc.

The story of how X ended up with the brain injury is too long for this forum. However, the physician whom started X on a Prednisone/Methotrexate combo without proper selection, pre-screening, and follow-up for opportunistic infection failed X miserably. I can only assume this physician went into self-defense mode when X became critically ill because so many strange yet 'physician friendly'/'family harmful' events occurred afterward (Wagon circling and pre-emptive strikes in anticipation of litigation).

It has been an eye opening experience of what some in the medical community here in the US are actually capable of.

Anyway, I have come to comprehend how the neuropsych in question fell in line with the prescribing physician, as well as others at hosp where X almost physically died - Nevertheless, the X I knew did in essence die that day.

Clinic notes by Z reveal a contemptuous attitude toward X and entire family by coloring events and facts in a positive way for all physicians in prior care, and then leaving feel that X is an entirely behavioral case. Too much again to go into here, but, last note says he will see X again in a month and that's it. Nothing else. Other 'hidden' notes probably reveal much more, but I can't get hold of those (yet).

I truly appreciate your help, knowledge, and time here. You obviously have a good amount of knowledge to take-up what little I had written and deliver what you have. I did have the feeling that Z acted well within the law with all done - Too smart not to, and too smart to completely underestimate me. It just amazws me how this could be done to someone as innocent and wonderful as X - and not just the immunocompromisation (is that a word?), but the misdiag, the mistreatment, and now the bail-out on rehab. It is very sad. I am weary. Life will never be well again.

I have a whole new respect for Latin justice.

Thanks again J_9 - Keep up the great work! - I'll try to take care of X the same.

Hello otherdude:

Look, I don't know myocardialo baccillis from a hemorrhoid. What I do know, is that you shouldn't give up on your case from what you hear here.

J-9 is a very cool person and knows a lot of medical stuff. But, what I know about the law is, that the person who is right, ISN'T always the person who wins. They guy who wins (especially in matters such as these), is the guy who has the better attorney. I suggest there are attorney's out there who will take this case on a contingency basis. Which means that it won't cost you (or X, or Y) a nickel, unless you win. As a matter of fact, there may be attorney's vying for the case. Shop wisely. Caveat Emptor.

excon

So sorry to hear about 'X'! And I agree with excon - don't give up.
J_9 has given you a lot of great information, and it's what you do with it that counts.
If you can press it in the issue of neglectful abandonment after initiating the rehab, do it, no matter. Even if you have to start a civil suite.
Files are full of started cases, then given up... but they don't make the news or records.
My feeling on this is that the doctor does, one way or the other, need to be taught a lesson, and who is better able to do it at this point. I feel he should have referred the patient to another physician, and not just ignored your efforts to contact him.

Good Luck, and please keep us posted.

http://smileys.smileycentral.com/cat/15/15_9_16.gifDoctors are not Gods! They are just as human as everyone else, and prone to make a mistake... or two...

I do know that in the mental health field, there is a professional accepted treatment, but that is not fully used or excepted by many within the field.

Many will want or teach various methods of healing or medication not accepted by the majority of others, who also don't always agree with each other either.

Many will go with one medication, others another, some will not agree with any medication but look for other treatment. For those that can make it without a more close environment, most will work with them on an outpatient treatment.

The doctor could have course feel that if they were searching for and found another location for care, that stopped their client patient commitment.
Also the doctor may have felt that was not what the patient really needed, so the patient finding other treatment not recommended by him, the doctor would have ended the care at that point.

Not saying the doctor was right ( but saying that you most likely could get 3 doctors to swear in court he was wrong, he would get 4 to swear he was right in his treatment) Esp in mental health, the line of correct and not correct is often not known for sure because of varoius opinions on how to treat, or even what is really wrong.