Ten Years of Telemedicine- Based Prescribing Leads to Lawsuit

A patient in Virginia experienced fatigue, brain fog, malaise, and similar symptoms. She met once with a physician in Pennsylvania and subsequently used email to continue treatment for nearly 10 years. Eight years into the relationship, the physician diagnosed her with babesiosis, a parasitic disease caused by the Babesia species.

The prescriber issued prescriptions for a combination of medications, including high doses of corticosteroids, to help with the inflammation caused by the antimicrobial medications he’d also prescribed. The prescriber recommended that she use a specific pharmacy in Pennsylvania rather than her local one. In an 8-day period, the pharmacy staff supplied her with the equivalent of 10,600 mg of prednisone, consisting of orders for both prednisone and dexamethasone. At one point during a phone consultation with the prescriber, she reported taking 137.5 mg of prednisone the previous day. He responded by telling her, “Take all the [prednisone] you need.”

The patient reported that she felt like she was dying and that she was experiencing severe pain, nausea, and difficulty sleeping. Nevertheless, the physician continued to approve the high corticosteroid doses.

At one point, she started tapering her dosage on her own, but the prescriber advised her to return to higher dosages. The patient’s husband reported to the prescriber that she had taken prednisone dosages of 910 mg, 1272 mg, and 1526 mg during a 3-day period, which he reported had left her “near comatose.”

The patient subsequently entered a hospital in Virginia to be tapered off the corticosteroids, but the physician advised the husband that he should remove her from the hospital so she could receive more steroids. She stayed there against the physician’s recommendation and subsequently entered a rehabilitation hospital.

The patient and her husband then filed a lawsuit against the physician and the pharmacy that supplied the corticosteroids. They advanced 3 legal arguments: negligence, loss of consortium, and intentional infliction of emotional distress.

The physician’s attorneys filed a motion with the court to dismiss the case for “failure to state a claim upon which relief can be granted.” They also moved to dismiss allegations of “reckless, wanton, outrageous, and grossly negligent” conduct as well as dismiss the request for award of punitive damages. The attorneys for the pharmacy also moved to dismiss the claims against it.

THE COURT’S RULING AND REASONING

The motions on behalf of both defendants were denied. The court pointed out that the prescriber “is alleged to have directed [the patient] to consume medication in dosages far exceeding normal limits, over an extended period, and while she reported severe symptoms. From such allegations a reasonable factfinder (ie, jury) could infer that he acted with reckless indifference.”

Additionally, the court pointed out that to recover for intentional infliction of emotional distress, the defendant’s conduct must be “extreme and dangerous.” Here, the allegations met that test. Finally, the pharmacy’s contention that the plaintiff did not provide information that it acted in any reckless, wanton, or outrageous manner is not a claim subject to dismissal at this pretrial stage of the proceedings.

REFERENCE

Wolking v Lindner, 23-F Supp-806 (MD Pa 2024).