7
Fitzgerald Health Education Associates, Inc., April 2015 fhea.com
Avoiding Malpractice: A Case Analysis
CASE
A patient was seeing two nurse practitioners at the
same clinic: a family NP and a psychiatric NP. The psy-
chiatric NP prescribed lamotrigine for the patient's de-
pression. One week later the patient visited the family
NP for evaluation and management of hypertension.
Two weeks later the patient visited the family NP again,
with a complaint of body aches. The family NP pre-
scribed an antibiotic. One week later the patient tele-
phoned the family NP and complained of a skin rash.
The family NP believed the rash was related to a medica-
tion. She reviewed the list of medications the patient
was taking, which included lamotrigine, but didn't asso-
ciate lamotrigine with the rash. The patient finished the
antibiotic, continued to take lamotrigine, and continued
to have the skin rash. She visited the family NP a few
days after completing the course of antibiotics. The fam-
ily NP prescribed a steroid for inflammation. ( The case
report did not disclose what type of inflammation it was
or whether a topical or systemic corticosteroid was pre-
scribed.) She also referred the patient to a dermatolo-
gist, who told the patient to discontinue the lamotrigine
immediately. Two days later the patient was diagnosed
with Stevens-Johnson syndrome and hospitalized. The
condition progressed to toxic epidermal necrolysis. The
patient was hospitalized for three weeks.
The patient sued the family NP for failing to diagnose
and treat Stevens-Johnson syndrome. The family NP testi-
fied that she believed she was not responsible for the ad-
verse effects of medications prescribed by others. A jury,
and later the Missouri Court of Appeals, found that testi-
mony damning. The Court said the family NP was aware
the patient was on lamotrigine and that standard refer-
ence materials available to her would have alerted her to
Failure to Recognize Adverse Effect of
Medication
Carolyn Buppert, NP, JD
Figures 1 & 2: A 1-year-old child with Stevens-Johnson
syndrome.
Photo
credit:
CDC,
Courtesy
of
Allen
W.
Mathies,
MD
Photo
credit:
CDC,
Courtesy
of
Allen
W.
Mathies,
MD
Continued on page 9