Opinions Please: Medical Professionals Responsibility

  • Posted by a hidden member.
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    Jul 28, 2010 1:22 AM GMT
    I'm very curious as to what others think of this. Please bear with me because it is somewhat long.

    As many of you know, my mother died suddenly in April. She died from a bacterial infection called cloistridium difficile. From the time she had symptoms, which were mainly diarrhea and nausea to her death was about 6 days. We took her to the hospital on the 5th day because we were afraid that she was getting dehydrated. Once in the hospital, she was quickly diagnosed and every attempt was made to save her life. Unfortunately, by that time she was septic and only about 50% of people who become septic survive. For people in the health care industry, C. difficile is commonly known. In fact, this preventable infection kills 300 Americans every day.

    Most C. difficile infections are precipitated by taking antibiotics and some antibiotics are known to cause it. My mother had taken clyndamycin folloiwng a root canal about two weeks before she got sick.

    I have learned all of this since my mother died because we are starting a foundation to raise awareness among the public. Because of her age (56), the medical examiners office requested to do an autopsy and we consented because we wanted to know what happened and thought maybe it will be a case doctors could learn from. Her manner of death was ruled "therapeutic complications" and I spoke to the pathologist today to have some questions answered.

    Here's what I want your opinions on:

    While I do not think my mother's dentist meant her any harm, he prescribed an antibiotic that is widely known to cause these infections. In so doing, he DID NOT tell her that this was a possible complication of taking them. If he had, she would have sought medical attention when she first became ill, instead of - as she told me and my brother - assuming she caught a bug from the kids at school. (She was a Kindergarten teacher.)

    So, I asked the pathologist, were their contributing factors? (Her family doctor had prescribed an anti-diarrheal, which we thought might have made the infection worse.) She said no. I asked if the case was being reported to the CDC. She said "no." These cases are fairly common. We see 10-20 of them each month."

    So, her dentist gave her a drug that is causing a complication that is killing 300 people every day and he never warned her about it. Now, legally, I'm not sure what we can do or should do. We couldn't find the paperwork from her prescription, so we don't know if there were any associate warnings in the fine print.

    Regardless, do you think that health care professional have a responsibility to tell patients the possible bad outcomes from what they are prescribing?

    Beyond, what is written in 8 point font (which Mom couldn't read without glasses), do you think that a doctor should tell you or any other patient, "he drug I'm prescribing causes this complication which can be very serious. If you have X symptom, go to the hospital?"

    If her dentist had done this, she might still be alive.

    So, what do you think?




  • Posted by a hidden member.
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    Jul 28, 2010 1:48 AM GMT
    Something somewhat similar happened to me with my father. He had an operation for liver disease. We were never told of possible complications that could result from the operation. Basically, he could lose his mind (to put it colloquially). It wouldn't happen immediately but would happen gradually (though fairly quickly).

    So when it started to happen, we had no idea why or what was causing it.

    It's possible that the doctor had told my father just how risky the operation was. In any case, no one had told us how risky it was or about the possible complications. I'm sure my father knew that any time you have major surgery at 74, it's risky. (Btw, the surgery was optional, but my father had been in discomfort for some time. But what he had was not life threatening, just uncomfortable.)

    Anyway, yes, in a case like what happened with your mother, there's something very wrong that the doctor was not required to tell your mother of the risks.
  • GQjock

    Posts: 11649

    Jul 28, 2010 1:50 AM GMT
    This is a tough one
    I know that the loss of your Mom is very difficult esp when it comes after something as Mundane as a root canal
    When it comes to medical outcomes and complications
    review looks at standards of practice
    Does a practitioner have to tell every patient all the possible outcomes or side effects of a drug or antibiotic
    If the possibility is a good one absolutely he or she in all good conscience should
    But a doctor cannot list every possible effect for every drug ....
    Now antibiotic induced C difficile inflammation of the bowel does occur and even if the dentist had told your Mom beforehand it Very rarely leads to serious infection But
    and this is a big But
    if your Mom had some underlying disease or was compromised in her health or immunity in anyway
    Then there is a problem
  • Webster666

    Posts: 9217

    Jul 28, 2010 2:07 AM GMT
    I feel that you should be directing these questions to an attorney who is an expert in handling medical malpractice cases.

    The obvious response is, of course, the dentist had an obligation to provide the patient with warnings of any possible side effects from taking the antibiotic.

    ALSO, the pharmacist who provided the prescription had the same obligation.

    If I were in you place, I'd be consulting an attorney.
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    Jul 28, 2010 2:19 AM GMT
    Clindamycin is a very effective drug against many types of oral flora, and it has an important role in treating communally acquired MRSA. It is not the only type of antibiotic, other common antibiotics such as ampicillin, amoxicillin,and cephalosporins, as well as a host of quinolones such as Cipro can lead to the pseudomembranous colitis which developed in your mother.

    Diarrhea is a common side effect of drugs, especially when taking any type of antibiotic. Overall the benefits of anitbiotics overrule the chances of development of CDF. The bacteria was already present in your mother. The dentist probably has lots of other patients that he prescribes clindamycin to that don't develop complications. In fact, the majority of the cases are not caused by anitbiotics. Also, most victims of CDF arise from nursing homes and hospitals. Your mother was of a young age, and probably without a compromised immune system.

    Any self-respecting health provider is expected to impart in their patients the side effects of prescription drugs. Particularly if they subsist for several days with as frequent occurrence of diarrhea as is seen in CDF patients. Two weeks had passed, generally the normal time that CDF symptoms exhibit are within 3-4 days. From past experience, clindamycin bottle does not come with side effects listed on it, however, it may have been different in your mother's case. The pharmacist or dentist would normally have printed out a sheet from the FDA listing the side effects of the medicine.

    As others said, please contact an attorney.
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    Jul 28, 2010 2:25 AM GMT
    Webster666 saidI feel that you should be directing these questions to an attorney who is an expert in handling medical malpractice cases.

    The obvious response is, of course, the dentist had an obligation to provide the patient with warnings of any possible side effects from taking the antibiotic.

    ALSO, the pharmacist who provided the prescription had the same obligation.

    If I were in you place, I'd be consulting an attorney.


    We are but as GQ alluded to the issue is "standard of care." I.e., what I've been told by the attorney is that if it's standard practice for a doctor to not warn a patient about such a serious side effect, than a doctor won't be considered negligent.

    I'm more curious if, given that we spend more on health care than any country and think we have the best, other RJers think this is an acceptable "standard." Because, even putting aside my mother's case, I do not think it is. I think it's completely reprehensible.

    If you want nightmares, read "Our Daily Meds" it's all about how drugs have taken over medicine and no one wants to take responsibility for the bad outcomes.
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    Jul 28, 2010 2:29 AM GMT
    carmineastoria saidClindamycin is a very effective drug against many types of oral flora, and it has an important role in treating communally acquired MRSA. It is not the only type of antibiotic, other common antibiotics such as ampicillin, amoxicillin,and cephalosporins, as well as a host of quinolones such as Cipro can lead to the pseudomembranous colitis which developed in your mother.

    Diarrhea is a common side effect of drugs, especially when taking any type of antibiotic. Overall the benefits of anitbiotics overrule the chances of development of CDF. The bacteria was already present in your mother. The dentist probably has lots of other patients that he prescribes clindamycin to that don't develop complications. In fact, the majority of the cases are not caused by anitbiotics. Also, most victims of CDF arise from nursing homes and hospitals. Your mother was of a young age, and probably without a compromised immune system.

    Any self-respecting health provider is expected to impart in their patients the side effects of prescription drugs. Particularly if they subsist for several days with as frequent occurrence of diarrhea as is seen in CDF patients. Two weeks had passed, generally the normal time that CDF symptoms exhibit are within 3-4 days. From past experience, clindamycin bottle does not come with side effects listed on it, however, it may have been different in your mother's case. The pharmacist or dentist would normally have printed out a sheet from the FDA listing the side effects of the medicine.

    As others said, please contact an attorney.


    Thanks, Carmine. As I said above, we have retained counsel. My mother was a very intelligent woman. There is no way she was warned in a meaningful way that this was possible. And I was wrong int he time line. It was about a week after she started taking antibiotics that she became ill. .
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    Jul 28, 2010 2:45 AM GMT
    Christian73 said

    We are but as GQ alluded to the issue is "standard of care." I.e., what I've been told by the attorney is that if it's standard practice for a doctor to not warn a patient about such a serious side effect, than a doctor won't be considered negligent.

    I'm more curious if, given that we spend more on health care than any country and think we have the best, other RJers think this is an acceptable "standard." Because, even putting aside my mother's case, I do not think it is. I think it's completely reprehensible.


    It is not required by law that health care practitioners provide side effects of medicines, as pharmacists are equally involved too. But most do. An antibiotic was necessary. Any antibiotic that I listed before and several others would have caused colitis.
    Did you ask the lawyer about the pharmacist? Generally, they ascribe a sheet of info about the medicine to the prescription bag.
  • Posted by a hidden member.
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    Jul 28, 2010 2:00 PM GMT
    Gosh Christian, I wish I could help.

    I'm feeling a lot of grief for you right now. I use the Merck manual, a pharmaceutical manual and online, the Mayo Clinic.

    Here: http://www.mayoclinic.com/health/pseudomembranous-colitis/DS00797/DSECTION=treatments-and-drugs

    hugs -Doug
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    Jul 29, 2010 1:59 AM GMT
    Dear Christian: Unless some of us here are professionals in this area, I'm not sure we can advise you on the medical technicalities of this issue. You might consider seeking an initial consultation with attorneys who specialize in medical malpractice cases, and advise you if you have a case or not, that they might be willing to take mainly on contingency.

    You shouldn't spend a great deal of your own money on this if a favorable outcome is not clearly indicated. The trick will be in finding competent counsel, who aren't shady "ambulance chasers."

    As I said at the time of your mother's death, you have my sympathies. No one should lose his mother when she is only 56.
  • Posted by a hidden member.
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    Jul 29, 2010 2:05 AM GMT
    First of all my sincerest condolences to you...

    I feel bad to hav to say it, but it is a legal issue, and you should contact an attorney, most of us here are in the medical field, and do not have the full scope of the legalities... it may be shocking, but its not possible for a doctor to do his job AND be an attorney at medical law... all they can do is follow common procedures as the medical field teaches them to
  • rnch

    Posts: 11524

    Jul 29, 2010 2:12 AM GMT
    20 minutes after my father, riddled with cancer, weakened from 4 months of chemotheraphy (that i felt was a total waste of time and effort) died, the hospital movers & shakers wanted to do an autopsy on him.

    "why"? i asked.

    "to see why he died" they replied.

    "will it make him any less dead if you guys carve him up like a thanksgiving turkey?" i asked.

    "of course not!" they replied. "but perhaps we can see why the drugs didn't work".

    "he's dead, for God's sake! let him be in peace, finally." i said, as i tore their release forms into many, many tiny pieces.


    i kept my composure and temper and grief intact until they foolishly started to an end run with the same routine on my emotionally shattered mother........... icon_mad.gif

  • Posted by a hidden member.
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    Jul 29, 2010 2:14 AM GMT
    First let me say how sorry I am for your loss. It must be a tough time for you.

    Here's my opinion: It is not malpractice for a dentist to prescribe an antibiotic after a root canal. Prescription medications have inherent risks. Product information pamplets are attached to the medication when dispensed at the pharmacy with potential harmful side effects. It is the responsibility of the consumer to read the pamphlets and contact the pharmacist or physician if any side effects occur. IMO the dentist followed accepted industry standardards in providing care to this patient.
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    Jul 29, 2010 2:24 AM GMT
    I'm a prescribing medical professional. I'm aware of the potential of clindamycin to promote an environment in the gut that ALLOWS but does not CAUSE clostridium dificile overgrowth. Most humans have C. diff in their colon but it is kept in check by 'good bacteria'. Certain antibiotics are more likely to reduce the population of good bacteria that keep C. diff in check and allow C. diff to become a dominant and pathological bacterial population. Because it is a spore-forming bacterium, it is exceedingly difficult to eradicate once it predominates. I generally avoid prescribing clindamycin if I can. Having said that, there are lots of people who take clindamycin without adverse drug events (ADEs).

    It is unrealistic to expect MDs, PAs and NPs to know all side effects of all medications. It is the responsibility of the patient to read the package insert and warnings provided by the pharmacist with medications. I work diligently to know ADEs of most of the drugs I prescribe, however, I can't know them all. That is a responsibilty that should be shared among the prescriber, the pharmacist and the patient.

    I am extremely sorry for your loss.
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    Jul 29, 2010 6:42 AM GMT
    My sincere sympathy to you on the loss of your mother. She was a young woman from my perspective.

    I lost my first lover when he was 33 to an overdose of antibiotics in the hospital causing bone marrow suppression so I understand your grief as it can happen very quickly.

    If you read reports from agencies that keep track of deaths caused by avoidable medical mistakes you may be astonished at the number that occur on a yearly bases.

    Even over the counter drugs can be lethal. If you have been reading about the FDA and drug companies lately you know that many approved drugs have been taken of the market for safety and side affect reasons not stated when the drug was approved. If the fines paid by the large drug companies lately are any indication this may be a bigger problem than we think.

    I never assume the doctors understand or even know about drug side effects on the drugs they prescribe. Much of what they know comes form colleagues and drug salesman and not from their own studying of the trails.

    I know you are angry as I was and it took years for me to get over being angry at the doctors that treated my lover but before you fix blame make sure you know what really happened.


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    Jul 31, 2010 6:51 AM GMT
    Hi Chrisitan73:

    Foremost, my deepest sympathy for your loss and your family, I lost my Uncle two years to a simple pacemaker operation that turned horrific for all of us.

    First like everyone else has said you already have an attorney working for you and giving you the best advise. Additionally, having gone through root canal infection this year and placed in Clindamycin with no ill effect, because I am allergic to penicillin…I would just like to comment on a few items.

    Within your statement:

    While I do not think my mother's dentist meant her any harm, he prescribed an antibiotic that is widely known to cause these infections. In so doing, he DID NOT tell her that this was a possible complication of taking them. If he had, she would have sought medical attention when she first became ill, instead of - as she told me and my brother - assuming she caught a bug from the kids at school. (She was a Kindergarten teacher.)

    Antibiotics like Clindamycin have gone through a rigorous clinical trial and application to be approved by FDA in lieu of submission by pharmaceutical application who first applied for a New Drug Application (NDA) and then the FDA approving the drug on the market based on the clinical trial data presented to the FDA. Clinical trials are extremely controlled in what efficacy and treatment is being sought for…not after the product hits the market with the interaction of other medications are sometimes Serious Adverse Events reported SAE to the FDA via Medwatch reporting. In this instance, MDs, PAs, etc. are required to alert the FDA of any Serious Adverse Events (SAE's) reported…if in fact the medication is causing SAE’s then the label of the medication is reviewed and in some instances the label is strengthen of additional side-effects, and in some instances we have seen the medication being pulled out of the market. It is not a fail safe mechanism, but compared to other countries in the world who follow is the best we have.

    The FDA has a site for black label medications, if we look at Clindamycin:
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm194129.htm, it received a warning in November 2009, but it warns of ALL ANTIBACTERIAL medications associated with CDAD – not just Clindamycin- Additional it observes a careful medical history shown be known of the patient.

    Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
    • If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. Clostridium difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. Clostridium difficile, and surgical evaluation should be instituted as clinically indicated.


    It would have been interesting to research prior to your Mother visiting the dentist if the dentist sought a complete medical history prior to proceeding with the root canal. You mentioned that her primary physician had prescribed an anti-diarrhea medication, then is suspected that your Mom was ill prior to going to the dentist with CDAD in her system already. At this point of who should be blamed for not knowing the ill effects of the medication as well as the patient being informed of counter-medications, is ill conjecture and hard to proof of negligence without having hard evidence of negligence. It would also be interesting to see if the dentist and her primary physician have been sited by the Health board on your State for other cases of negligence and of these if death has occurred.

    Getting back to the root canal, it would be interesting to see if within her medical dental records, your Mom signed a consent form for the root canal. The consent forms states and clarifies what the physician will be performing, what medications will be used in the procedures, side effects, and even complications. It also might ask what current medications you are taking.

    When I did my initial root canal I had to sign this consent form. Additionally, my dental practitioner on the form stated the possibility of serious infection, because root canals are not an all-safe procedure, and the actions that I should take as a patient if complications arose as due diligent care on the patient’s care. Additionally, he asked what allergies, medications was I taking which I did advise him at the time in view that I had come for a small out patient surgery and advise him of all the meds that I was taking and if there were any counter meds…he noted that because I was allergic to Penicillin the best choice was Clindamycin to treat the infection. He noted that he would perform the root canal, clear the infection, and capped it for a month before a crown would install since he needed to review the tooth after I came back in a month to ensure that all the infection was gone. Additionally, he stated there were no guarantee in view that the bacteria could be quite resistant to the medication he was clearing the root canals.

    I think, ultimately you and your family have to ask the purpose of pursuing this…not to be insensitive to your loss, your grief, but ultimately if the purpose is to bring justice to a negligent physician or dentist by all means, but as rightasrain has stated whoever reviews the case, will also ask about the patient’s responsibility in their own care. In the eyes, of the court and law is the facts and if the facts ultimately will show the dentist was neglient.

    Again, my sincerest sympathy for your loss.
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    Jul 31, 2010 3:16 PM GMT
    Thanks, again, to all who have responded. As I mentioned earlier, we have retained counsel and the matter is being investigated.

    But, my question here is more philosophical in the sense that if a doctor has the right to prescribe any medication to any person for any diagnosis, shouldn't they also be responsible for at least WARNING people of the potentially major side effects?
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    Jul 31, 2010 3:33 PM GMT
    Christian73 said
    But, my question here is more philosophical in the sense that if a doctor has the right to prescribe any medication to any person for any diagnosis, shouldn't they also be responsible for at least WARNING people of the potentially major side effects?


    I am sorry for your loss.

    I believe the main responsibility for warning patients of side effects and interactions lies in fact with the pharmacist. This is what they are trained for.

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    Jul 31, 2010 3:43 PM GMT
    My mother had this same problem after getting antibiotics. Because she's been in chemotherapy for more than a year and leery of ANY minor change to her body, and my sister and brother are very attentive to medical issues, she went back to the hospital at the first sign of symptoms and recovered well.

    She was told of the complications from the antibiotics after she was admitted to the hospital, not when she was prescribed them. What saved her was how hyper-reactive we are to any change in her medical condition, because she's always on the verge of something. A healthy person (your mom) normally isn't concerned, and you wouldn't be either.

    I hope you can raise awareness. I want to see much better information given to patients. Three-hundred deaths a day is an epidemic, I think.

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    Jul 31, 2010 4:09 PM GMT
    viveutvivas said
    Christian73 said
    But, my question here is more philosophical in the sense that if a doctor has the right to prescribe any medication to any person for any diagnosis, shouldn't they also be responsible for at least WARNING people of the potentially major side effects?


    I am sorry for your loss.

    I believe the main responsibility for warning patients of side effects and interactions lies in fact with the pharmacist. This is what they are trained for.



    Thanks, I agree with you, but in practice it's not really the case.