Legal Background

Dr G sought the counsel of the defense attorney provided by his insurance company. He explained what had happened and provided the patient’s medical records for the attorney’s experts to review.

“The plaintiff is alleging that you were negligent in your treatment of him, and specifically that you were negligent in prescribing mefloquine, which is contraindicated in people who have had depression. Were you the physician who originally treated him for depression or was that before you were caring for this patient?” asked the attorney.

“I treated him for depression,” said Dr G. “It was several years ago – during college – but I was the treating physician and I did prescribe antidepressants.”

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“The plaintiff is also alleging that you didn’t warn him that there was a potential for a psychiatric event…,” he said to the physician

“No, I didn’t give him any specific warnings about the medication,” admitted Dr G.

The attorney asked his expert physician to review the medical records. The expert was critical of both Dr G’s choice of medication, and of his failure to warn the patient. The expert noted that during prophylactic use of mefloquine, psychiatric symptoms such as confusion, acute anxiety, restlessness, and depression are often a precursor of a more serious event and an indication that the medication should be discontinued immediately. Dr G had to admit that he had not warned the patient to be alert to these signs.

The attorney advised Dr G to settle the case, which he did. The case was settled out of court for $700,000.

Protecting Yourself

When writing a prescription for a patient, it’s important to review the patient’s prior medical history – particularly when it is a patient who doesn’t come in regularly. Allergies, other conditions, medications which could cause interactions, diseases that could be exacerbated by certain medications, must all be taken into consideration when writing a new prescription, particularly for a drug that you don’t prescribe regularly.

Dr G made 3 mistakes here. His first was his choice of medication, and the fact that he neglected to take the patient’s history of depression into consideration. His second was that antimalarials were not something he prescribed often, and so he should have reviewed the options and the prescribing information to ensure that he was making the best choice for this patient. His third mistake was not educating the patient about the potential for an adverse effect, and warning the patient that if he noticed certain symptoms (anxiety, confusion, depression) he should stop taking the medication and alert the physician. Knowledge is power – make sure that both you and your patients have it.