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Pediatric endocrinologist's failure to conduct simple test on young girl results in delayed diagnosis of hepatotoxicity

Type of Injury: Death
Type of Case: Medical Malpractice
Settlement Amount: $675,000.00

(Failure to Properly Monitor and Timely Discontinue Use of Propylthiouracil (“PTU”)). This lawsuit results from an injury sustained by F-16 in the course of Dr. Richard Levy (pediatric endocrinologist), and her subsequent death on December 14, 2005. In April 2001, Plaintiff presented to Thomas Huggett, M.D. from the Circle Family HealthCare Network with a history of weight loss, exophthalmus (bulging of the eyes), and family history of thyroid problems. Dr. Huggett, presuming hyperthyroidism, requested Plaintiff be seen by Dr. Levy, a pediatric endocrinologist. On April 23, 2001, Plaintiff presented to Dr. Levy. In May 2001, Dr. Levy, with the aid of laboratory results, diagnosed Plaintiff with hyperthyroidism and Graves’ disease and prescribed her PTU 150 mg TID (three times per day). Prior to Plaintiff being prescribed and taking PTU, Dr. Levy had not obtained a base-line liver function test. In June 2001, Plaintiff was feeling better and her skin was lightening. On September 20, 2001, Dr. Levy decreased Plaintiff’s PTU dosage from 150 mg TID to 125 mg TID. Between April 23, 2001 and November 15, 2001, Dr. Levy did not order any liver function tests. Also, during that same period time, some blood labs (non-liver function tests) were completed by Dr. Levy did not obtain those results.

On November 5, 2001, Plaintiff or a member of her family reported, via telephone, to Dr. Levy that she was not feeling well. No other history was obtained by Dr. Levy or his staff. On November 12, 2001, Dr. Levy received a phone call from Plaintiff’s mother advising that Plaintiff’s eyes have been yellow for one week. Thereafter, Dr. Levy decreased Plaintiff’s PTU dosage from 125 mg TID to 50 mg TID. On November 15, 2001, Plaintiff presented to Dr. Levy with jaundice (yellow eyes for one week) and he ordered that PTU be stopped immediately. One of the known adverse reactions to PTU is severe drug-induced hepatotoxicity. That hepatotoxicity is more prevalent among females being prescribed PTU than males.

On November 21st Plaintiff was seen by Dr. Brian Edelstein (pediatric hepatologist) at University of Illinois Medical Center at Chicago. Dr. Edelstein’s differential diagnosis, subject to liver biopsy, was PTU toxicity. On November 23rd Dr. Edelstein performed a liver biopsy, which showed extensive hepatocyte necrosis involving over 50% of her liver, diffuse cholestasis, and marked bile duct proliferation. All features were consistent with submassive hepatic necrosis as a result of toxicity from the PTU.

On December 25th, Plaintiff underwent a liver transplant. A few years later, Plaintiff began experiencing symptoms consistent with the transplanted liver being rejected. She is placed on the transplant list, but dies before having a second transplant.

Plaintiff contended that Dr. Levy’s failure to obtain an appropriate history for Plaintiff following the telephone message on November 5, 2001 was a breach of the standard of care, which lessened the opportunity for treatment and the effectiveness of subsequent treatment. Further, when Dr. Levy became aware of the possibility of jaundice on November 12, 2001, but failed to stop the use of PTU and obtain appropriate tests constituted a breach of the standard of care.

Defendant contends that the standard of care was not breached. Further, the standard did not require either baseline or periodic liver function tests because PTU has an idiosyncratic drug reaction. Further, Dr. Levy acted appropriately in decreasing the dosage on November 12th and, then, discontinuing it on November 15th. Based upon Dr. Levy's examination and liver function testing performed on November 15th, and the effect on the liver when hepatotoxicity results from the use of PTU, the patient's liver failure and need for a transplant would not have been avoided had Dr. Levy stopped the PTU on November 5th or 12th had symptoms of liver dysfunction been present on either of those dates.

Injuries: On December 14, 2005, 21-year old Plaintiff died as a result of pneumonia and sepsis, secondary to the liver failure. Plaintiff was survived by her mother and two sisters.

Specials: Medicals: N/A Lost Income: N/A Occupation: N/A

What Each Defendant Paid: Richard A. Levy, MD ($675,000). Humana Health Plan, Inc. ($93,441.08) (lien waived).

Insurance Company: ISMIS insured Richard A. Levy, MD. Managed Care Indemnity, Inc. insured Humana Health Plan, Inc.

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