California – Family Medicine – 13-Year-Old Patient Treated With Over 70 Medications For Lyme Disease

A family practitioner began treating a 13-year-old patient in 2006.  In February 2006, the patient’s mother filled out a Lyme Disease Questionnaire in which she stated that the patient had tested positive for Babesia and Bartonella in November 2005.  The family practitioner’s medical records did not include any positive laboratory results for Babesia or Bartonella.

The family practitioner’s notes from 1/17/2007 showed an assessment of Lyme and Bartonella.  However, there was no evidence that the family practitioner conducted any laboratory tests prior to making such diagnoses.  IgG and IgM Western Blots, conducted on 5/31/2007, were both negative for Lyme disease. Subsequent IgG and IgM Western blots conducted on January 2008, February 2009, and July 2010 were again all negative for Lyme disease.  A Bartonella FISH test, conducted in October 2010, was also negative.

The patient continued to see the family practitioner on approximately a monthly basis through at least March 2012.  During this time, the family practitioner prescribed numerous IV and oral antibiotics, in various combinations, including IV doxycycline, IV Invanz, IV Rocephin, IV Zithromax, IV cefuroxime, rifampin, minocycline, Avelox, Septra, Moxatag, nystatin, Tindamax, penicillin, and Zyvox.  The patient was also treated with numerous homeopathic remedies, including IV glutathione, IV Freamine, and numerous supplements, anti-microbials, and detoxification remedies. There was no evidence that the family practitioner obtained informed consent to treat the patient with IV glutathione or IV Freamine.

On 2/9/2012, the patient was admitted to the hospital with fever and chills.  She was diagnosed as having sepsis due to a Hickman catheter infection, which had been in place for 4.5 years.  According to the emergency room physician, the patient’s mother presented a medication list that identified over 70 medications and homeopathic remedies, including IV cefuroxime, IV glutathione, and IV Freamine, as well as oral penicillin, and Zyvox.  The Hickman catheter was removed, and the patient was discharged from the hospital on 2/12/2012.

The family practitioner’s overall conduct, acts, and omissions with regard to the patient constitute unprofessional conduct through gross negligence and repeated acts of negligence and incompetence.  More specifically, the family practitioner was guilty of unprofessional conduct with regards to the patient as follows: he continued to prescribe multiple courses of antibiotics for over a five-year period, even though there were no signs of improvement; he failed to obtain informed consent regarding treatment with IV glutathione and IV Freamine; and he failed to routinely assess and document the patient’s vital signs.

The Medical Board of California ordered that the family practitioner be publicly reprimanded and attend 65 hours of an education course.

State: California

Date: November 2013

Specialty: Family Medicine, Internal Medicine

Symptom: Fever

Diagnosis: Sepsis

Medical Error: Improper medication management, Failure of communication with patient or patient relations, Failure to properly monitor patient

Significant Outcome: N/A

Case Rating: 2

Link to Original Case File: Download PDF

← Back to the search results