Drug Case Study
Case Synopsis: Plaintiff, a 45-year-old woman with a 39-year history of asthma, alleged that her primary physician prescribed excessive amounts of the steroid medication, prednisone, resulting in aseptic necrosis (destruction) of her hip joints. Because of aseptic necrosis, plaintiff required hip replacement surgery. Plaintiff’s primary care expert opined that plaintiff had become steroid dependent.
Analysis: Review of the case revealed that plaintiff’s primary care expert report exaggerated the amount of steroids prescribed for plaintiff by defendant. When plaintiff’s deposition statements (about her primary physician’s prescriptions for steroids) were compared with her primary care expert’s statements, the analysis demonstrated that plaintiff described defendant’s prescriptions for steroids (prednisone) as shorter, and less frequent than stated by plaintiff’s expert.
Plaintiff’s primary care expert agreed that steroids were appropriate for use in the treatment of asthmatic bronchitis under certain conditions. Review of medical records revealed that defendant treated plaintiff with short courses of prednisone. It was further noted that plaintiff stated in her deposition that the prednisone gave her “relief” for her chest and lungs within 10 to 15 minutes.
Review of plaintiff’s employment records revealed that she had been cautioned about alcohol intake in close proximity to reporting to work and operating heavy equipment. Plaintiff’s pharmacology expert stated in his report, “Alcohol abuse and systemic steroid treatment are the most identifiable risk factors associated with aseptic necrosis of the hips”. Plaintiff’s pharmacology expert made no reference, however, to plaintiff’s use of alcohol. Motor vehicle records revealed multiple citations for driving under the influence of alcohol. Plaintiff admitted in deposition to “heavy” consumption of alcohol.
Based upon clear evidence of plaintiff’s heavy use of alcohol, medical records that revealed appropriate short courses of prednisone, and expert’s report that alcohol is a major causative factor in aseptic necrosis, it was concluded that plaintiff’s aseptic necrosis of the hips was not a result of prednisone, but due to regular and excessive use of alcohol.
Result: Case settled favorable for defendant physician.