Malpractice?

Overheal

Okay, assume this is a hypothetical connundrum; a riddle, if you prefer:

a 50 year old woman. well, late 40's; 48 or 49.

14 years ago, suffers from Post Natal depression, and is prescribed Xanax. Some people will recognise it as being abused narcotically, but thats not what im getting at.

the drug, Alprazolam (Xanax) is not rated for medication beyond 8 weeks. And she has been getting constant prescription renewals from her GP for 14 years.

According to wikipedia, theres also a chance the drug can secrete when breast feeding. Afaik, the daughter is perfectly healthy though... afaik.

Now, woman has begun Menopause; and while this has no real reaction with Xanax in itself, she decided to abruptly halt her medication 4 days ago. Im yet unsure whether this was under GP advice or not - I would hope not. She explains she would have to be taking a new menopausal medication (i dont know which) and felt herself that she didnt want to continue taking Xanax, or at least mixing it with additional drugs.

during the 4 day period, we observed:

Drowsiness
Hallucinations (thats a long story)
Agitation
Hostility
Light Headedness
Fainting
Disorientation
Speech and Memory failure
Impaired Coordination
Restlessness
Excess Sweating

I dont' know too much about menopause either but I wager their sharing symptoms a bit at the moment.

Now, she went this morning to go get a new prescription after it became blatantly apparent what had gone wrong..

but what I want to know is, be there grounds for gross malpractice, for prescribing the drugs for 14 years?

I'm assuming for the moment she was not advised to stop her medication. And, by her own admission, the GP has been gradually supplying her with less Xanax - where once it was the case she could take up to seven a day she is now prescribed 2. Still, it souldnt take... y'know, 13 years to ween someone off post-natal depression meds.

and oh yeah - celebrating my 1000th post and 1 year anniversary with Boards.ie! we love you!

johnnyskeleton

The standard for medical negligence is whether the treatment is so unusual that no other doctor, acting with reasonable care, would have done the same thing. So, although the prescription is not rated beyond 8 weeks, it might be a fairly common practice to prescribe it for longer. The exception to this is where it is blatantly obvious to everyone that the treatment was not safe (e.g. performing surgery blindfold while drunk, or treating a patient without even meeting them or reading their charts).

The second issue is that it is not enough to show that she was taking a drug for longer than necessary, that she withdrew too abruptly, or that it reacted badly with menopause/menopause medication; it must also be shown that this was on the advice of the medical practitioner in question (who acted in a manner which no other medical pratitioner of equal skill would have acted) and that the treatment directly caused the injuries complained of.

So, in effect, this is the legal test. I couldn't possibly apply it to the facts, as that would require the opinion of a medical pratitioner.

Tom Young

Is that the Bolam test?

Or is it a conjugated Bolam + Bolitho + Dunne v. National Maternity Hospital & Reg Jackson = Irish Standard?

Rhonda9000

No, it's a real world story being called a hypothetical situation :-)

The medical negligence test outlined by JS seems like straightforward Dunne v. Nat. Mat. Hosp. ?

johnnyskeleton

Tom Young wrote:

Is that the Bolam test?

Or is it a conjugated Bolam + Bolitho + Dunne v. National Maternity Hospital & Reg Jackson = Irish Standard?

It's the johnnyskeleton formula, with a nod towards Dunne. The other cases concern the extent to which a doctor should disclose risks prior to a treatment, which might be a secondary issue in this thread. As to that, while it's unfortunate, I think a doctor only needs to advise as to the risks involved with use of a treatment over a forseeable period. That the suggested 8 weeks was extended to 14 years seems to be an issue of common (or garden) medical negligence rather than lack of disclosure.