Bactrim for a UTI ends in death

One of the most common patient encounters ends badly with a malpractice lawsuit:

According to court documents, her doctor, Dr. P.Z. Vora, prescribed Bactrim, an antibiotic containing sulfa.
Instead of helping Rees, the drug eventually killed her.
Herfamily is now suing her Dr. Vora and Walgreens, claiming they should have known about her sulfa allergy from her medical chart.
“I’ve seen a number of cases that are bad, but this physical injury is one of the most harmful I can recall,” said Kinnard.
According to the family’s attorney, the drug reaction caused Rees’ skin to slowly peel off to the point she was unrecognizable.
She died last May.

Comments

Eddie Alexander
Disgraceful.
A tragic case where “swiss cheese” model” can be used to explain this major mishap since errors are rarely the fault of one person, as this case illustrates.
We are always hung up on PCN allergies and the overexagerrated cross-reactivity with cephalosporins (it is much less than the quoted 15%) and forget that a lot of common drugs contain sulfa such as bactrim and lasix.
With that said, the implicated physician is culpable; no excuse. End of story.
Anonymous
The woman dies in a ridiculously painful way and to Kevin the bad part is that the defendants’ malpractice carriers might have to pay some money?
Wow.
Anonymous
Wow anon 9:59….read for comprehension. All kevin did was cut and paste what was written in the link. No editorial comments. Maybe you need to look at your own biases.
Anonymous
What is this:
“One of the most common patient encounters ends badly with a malpractice lawsuit:”
If not an editorial comment? It’s not in the source doc.
Anonymous
If it was a known fact that she was allergic to sulfa and still prescribed and dispensed the medication then this would be malpractice. The patient probably had Exfoliative Dermatitis or Steven-Johnson’s Syndrome as a reation to the Sulfa and there is no way to predict who would develop this reaction if the patient has no known allergy to any medication. The drug of choice in most communities for UTI is a quinolone antibiotic rather than a Sulfa because of resistance to it. I use sulfa for most of my patients with skin abscess which is usually a community acquired MRSA.
Mike
Anonymous, you are either insane, or not a physician. It IS a common encounter. That’s all that was said. Kevin is unbiased most of the time, and there is no slant to this statement.
The case is sad.
Anonymous
Kevin is not biased. You must be a new reader.
Anonymous
Kevin’s bias is always clear. And it’s always there.
Anonymous
I used to get a fair number of UTIs.
As it turns out I also have a sulfa allergy. I found this out as I was sitting in class (college) and I looked down at my arm to see red welts developing under my skin. Since I’m also allergic to bees and the two reactions looked similar I figured I was allergic to sulfa (I had been put on Bactrim for a UTI) as I knew that many people are allergic to sulfa based drugs.
I got up in the middle of the lecture, took my things and went to the clinic. They gave me some Benadryl and kept me around until the welts went away.
And I of course never took a sulfa based drug again. I write it on every form I tell every doctor, I tell my dentist if I’m prescribed something I tell the person prescribing it “I am allergic to sulfa — there’s no sulfa in there is there?” Before I pick up the medication I ask the pharmacist (if it’s a new drug) “I have a sulfa allergy.”
Seriously, how hard is this? It’s your life. I’m sure the doctor involved feels badly that this woman is dead but that won’t bring her back to life. It won’t make the family happy. When did we make everyone passive in their care. Why didn’t the woman have some obligation to keep herself safe?
Maybe there will be a pay out but I can’t see how it’s anyone’s fault but the woman involved. It seems from RTFA that the other pharmacy knew she had a sulfa allergy so she had to have known.
The Independent Urologist
The is Stevens-Johnson Syndrome. It is an idiosyncratic reaction, not an allergy. The outcome is terrible, but not necessarily preventable or malpractice.
immune guy
Idependent urologist 1:48
Stevens Johnson syndrome is a severe manifestation of erythema multiforme.
It may be a rare occurrence to have this severe reaciton, but it is an allergic hypersensitivity reaction, and an improperly or properly prescribed sulfa drug can trigger it.
Maybe I misunderstand, and you mean to say only that the severity of the this reaction was somehow not forseeable, (even if a potentially deadlydeadly allergic reaction “ordinary” allergic reaction would be), so the doctors should be off the hook for the result that occurred from improperly prescribing this medicine.
Anonymous
If the chart says “sulfa allergy” and it was prescribed then it is an error. If the chart does not say that then someone dying of Steven Johnson syndrome is not malpractice. Is a doctor supposed to predict an outcome???
I work in ER, so most people I see are not playing with a full deck, or even half a deck. Usually the only allergy known is “Toradol”, but “demerol” will work. Someitmes patient will list “antibiotics” as an allergy and have no further clue about it. Not particularly helpful.
Anonymous
Anyone who thinks Kevin is not bias, is either new to this blog or they have absolutely no reading comprehension. Kevin is the most bias of all medical providers who blog.
Its laughable that someone can say he is not.
Anonymous
People seeking opiate highs isn’t the issue here. The woman had a documented hypersensitivity reaction to sulpha meds, was given them anyway, and she became ill (and died a nasty, painful death) because she was given this drug by doctors who ignored her chart.
I hear a somewhat lame defense that usually when doctors prescribe a drug like bactrim for a common UTI (an ordinary drug and a frequently seen illness), the patient doesn’t get sick and die, or if she has a reaction she usually doesn’t die, and that most people who react, even those who die, won’t have had Stevens Johnson syndrome.
The fact remains, any patient who has had an apparently allergic reaction to a sulpha med should not get a sulpha med to treat a UTI.
Ignoring that history was an error, an error contrary to the ordinary standard of care ( most doctors would agree that sulpha meds should not be given to a patient who had her history) and it led directly to a forseeable injury – a hypersensitivity reaction resulting in death.
I know its scary that an ordinary patient encounter, common illness, common treatment, and most of all, the common error of not paying enough attention to drug allergy history, could result in this unusual, catastropic result.
Try to remeber that it can the next time you feel like declaring a person’s allergy to NSAIDS must be imaginary.
Anonymous
“Try to remeber that it can the next time you feel like declaring a person’s allergy to NSAIDS must be imaginary”
Spoken by someone who clearly has never worked one minute in an ER.
PS: The rest of your rant is a statement of the obvious to anybody who has a semester of med school under their belt. The question is whether the sul”f”a allery was clearly documented or not. If so..end of story. Neither you, I, or the rest of the internet know the answer to that one.
Anonymous
Hon, “Sulpha” is a correct spelling, in many places preferred to “sulfa.”
I think you are the one ranting. You have my sympathy for your cynical views on allergy to NSAIDS, I’m sure you come by them honsestly. However, many persons lacking half a semester of med school do not realize that the medicine they are precribed will be dangerous to them if it has a different name than the original offender.
Should this patient failure excuse failure to maintain records and read them?
My rant, er, point, is that the rarity of the severe reaction in this patient is not a mitigating factor, so long as it is a forseeable consequence of the error committed.
Anonymous
Hon, it is sul”ph”a in British English and sul”f”a in American English. Given, that the rest of your rant is written in American Emglish I suspect you live on this side of the pond. But we digress. I am not the anon who made the original comment about a “toradol” allergy but only demerol works for me. BUT, I too have heard that same line dozens of times in certain patient populations. As you have never practiced medicine in an ER, I don’t expect you know that is what we in the biz call a “red flag”. About the patient’s death, again, you, I, nor anybody on the internet really knows what happened here. Maybe it was written all over the chart and the doc screwed up. Maybe it was writen nowhere on the chart and the pateint denied the allergy. The simple fact is nobody here knows….Correct? That is unless you are some type of internet mind-reader. If so could you tell me if GW was lying about those weapons of mass destruction?
Anonymous
No doubt my mid-atlantic accent would confound speculations on my heritage, as well as my occasional use of “s” instead of “z” and the odd extra “u”.
Even an infrequent reader of this blog, let alone the poor souls forced to treat all comers, is familiar with red flags of drug-seekers who appear in the ER. Those discussions always chap my hide, but I’m guessing the reason it was brought up in this context is that the writer believes non-”red flag” patients less frequently announce their allergies, or if they do, they might not be specific enough to warn off a physician.
Being psychic, or rather, reading the alleged complaint, it seems the patient’s chart contained evidence of a prior hypersensitivity reaction to a sulpha med. There are many reasons this might not have come to the bactrim-prescribing physicians attention…not my real point, although I’m sure many interesting discussions could be had on how facilities can make sure physicians have complete drug histories, etc.
My point is really that the rarity of Stevens-Johnson syndrome is not a mitigating factor in the award of damages.
Anonymous
And my point is none of us in cyberspace know whether it was documented or not. Additionally, did the prescribing doctor have access to the medical chart? I regularly don’t and have to ask the patient their allergies (which I do anyways). Heck, half the time people’s medical chart isn’t available (after hours in the clinic, another hospital, etc).
From the article:
“Her family is now suing her Dr. Vora and Walgreens, claiming they should have known about her sulfa allergy from her medical chart.
Now we would assume it was documented in the chart based on that statement. But remember the two people involved in writing/quoted from in this article are A: the lawyer (hardly an unbiased source).2: the journalist. Based on my expericne with journalists writing medical related stories, they only get it right about half the time.
MY POINT: Is you don’t know what happened anymore than I do.
MY OTHER POINT: Be an acitve consumer in your own health care. What does this mean? Have a list of the following memorized or written down
1: your medication list
2: your allergies
3: your medical problems.
Anonymous
What does “mid-Atlantic” mean? Are you Madonna?
The above ER physician is correct in his(doubtful her) assessment of the incompetence of most patients. Less than 5% of patients over 60 have available for even scheduled appointments the three things he has listed. And if I had a nickel for every time I heard, “it’s in the chart”,….
There is alot of bullshit and old information in the chart. Why would we want your medications from 1999? Additionally, it is the rare clinic/ER that uses the same EMR. If you want to risk your life asuming someone has information on you fine, but realize that you are responsible and to blame for your laziness. The poor ER doctors are juggling the best they can.
Any bias Kevin has is from being a practicing physician. Every general internist who reads this automatically sides with 99% of what he says. Mostly because it is the truth.
b
Susana
Urinary Track Infections are a nuisance, but you can stop them naturally without the use of antibiotics. Use preventive measures daily by drinking plenty of water, consume cranberry juice, take warm baths but don’t use bubble baths only use a cup of baking soda. Also limit your intake of coffee and soda. These simple measures are a natural preventive and effective way to keep those UTI’s out of your body!
If it is too late and the UTI already invaded your body, here’s a safe and natural way to rid the germs. There are many natural herbs that are extremely effective in the treatment and prevention of UTI’s. Some of these have been used for centuries and many have been subjected to clinical trials that prove their effectiveness.
Find out more below:
http://naturalsupply.blogspot.com/2007/05/natural-ways-to-stop-constant-and.html

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