To Sue or Not

[tednlou2]

I've mentioned several times how I was given 4 days of Atripla in the hospital without my knowlege.  I found out, because they also outed my status.  A nurse came in and said what meds she was giving me.  My brother and his partner who are a chiropractor and OBGYN doc knew what the drug was for.  They asked me why I was being given HIV meds--I hadn't told them I was poz. 

Since then, I've learned it was very irresponsible to start HIV meds with no plan to continue them.  I also learned that Atripla is the one med I'm resistant to now.  Everyone who knows my status keeps telling me I should sue the hospital for this--not to mention outing me.  I say the hospital just made a mistake and didn't mean to do harm.  I feel like I would be creating bad karma to sue.  I got better from the pneumonia after all. 

They reply saying hospitals are in it for profit and companies won't change unless they have to pay out money.  They say if they cut my leg off, I would sue without question.  They say they have forever taken Atripla out of my treatment options and it may come down that I may have needed that option.  I say I'm not even on meds yet and who knows whether I would need Atripla.  And, with a history of depression and anxiety, I may have not done well on it.  Plus, sueing would create more stress probably.  And, I could have been resistant to Atripla to begin with.  However, many HIV experts have told me it was probably the hospital that caused the resistance.  They said Atripla has a low genetic barrier or something like that and is one of the easiest drugs to get resistant.

So, I'm just wondering what you guys think.  Am I being "too naive and a push-over"?  Should I just be thankful I got better and let it go as a mistake?  Or, are they right that hospitals are corporations now and only respond to lawsuits to make changes?  By the way, it would probably hard to sue anyway.  Often, you have to show how you have been affected right now by the mistake.  They would argue I'm not on meds yet and I have other options.   

[Fondoo]

 I say forget about it and focus on being peaceful and happy.

[Nestor]

Unless there's something I'm not taking into consideration, that's a pretty big mistake: the first thing everybody knows about HIV meds is that you can't start taking them and then just stop.  For the hospital to have done that is outrageous.  And what point would there be of giving Atripla just for four days and then stopping?  

But a few questions here: 1. Did they give you a choice before they started giving you Atripla?  2. Did they inform you before you starting taking it or after?  3. Did they recommend that you continue after the four days?  3b. What kind of numbers did you have at that time? (I ask this because, if you had shockingly low t-cells, giving you atripla might have been the right thing, but then they should have recommended that you continue it.  4. What kind of condition were you in in general at that time?  

I'm usually against suing; at least once in my life I've been wronged so horribly that I thought, and all of my friends thought, that I could and should sue.  I didn't because I thought the whole process would bring more negative energy into my life than any possible benefit could be worth.  But in this case it isn't just about you; it's about making sure this kind of thing doesn't happen again to other people.  

[Inchlingblue]

This is the kind of situation that if it's presented right by the right lawyer, they would likely make an offer to settle.

No matter what, it's negligent for them to have given you Atripla for 4 days with no intention of informing you so that you would stay on it or go off it correctly.

Because the meds in Atripla have different half lives, it's easy to become resistant to Sustiva if you just go off it like that. The way to go off it properly is to continue just the Truvada for a certain number of days and even then there are no guarantees there will be no resistance.

HIV meds are not ever to be prescribed for just  a few days, even PEP is prescribed for 28 days minimum.

Nothing wrong if you decide to sue, just don't let it get to you emotionally etc. Only do it if you can approach it in a calm rational manner. And, yes, it's important to point this out so that it does not happen to other people.

[GNYC09]

I would sue if you're now resistant to one or more of the drugs in Atripla due to the hospital's actions.  That said, I've never heard of a stress-free lawsuit.  Be prepared for that.
I wish you good luck.

[Hellraiser]

If they didn't educate you about the hiv infection and the atripla they were at fault for your strain now being resistant to that medicine.  The doctor who was attending to you at the hospital should have explained that you were positive and they placed you on atripla which if you stop taking can cause the virus to become resistant to it.  They should have known better than to do what they did.

[skeebo1969]

   Would 4 days be enough to become resistant if you suddenly stopped?  I was under the impression that resistance came about by missing doses repeatedly, thus allowing your strain to mutate.  Is it the same if you stop the Atripla immediately?  Not disputing your situation at all, I just would like to be corrected if my thinking is wrong.  I wonder if that would be the hospital's argument as well.  Did they do a genotype test before they administered the Atripla?  If you don't know you can go to the hospital and for a minimum fee get your records on exactly what they did.

   If you go to an ASO perhaps they can advise you of a lawyer who is familiar with some of the factors concerning HIV treatment.  If not, the pessimist in me, I would think they might just turn you down. Definitely do your research and if you get turned down by one lawyer it doesn't mean you don't necessarily have a case.

[leatherman]

Did you already have an ID doc?
did your hospital refer you to an ID doc?
Did an ID doc see you while you in the hospital?

It sounds you, or your representative, was told they were administering Atripla to you (you state this in your story). It would have been up to you to continue medication after leaving the hospital.
 
(ps I would wait to sue until you find out if you've got a cold or having pnuemonia again before suing the hospital . LOL)

[Dennis]

   Would 4 days be enough to become resistant if you suddenly stopped?  I was under the impression that resistance came about by missing doses repeatedly, thus allowing your strain to mutate.  Is it the same if you stop the Atripla immediately?  

I have heard the same thing from my doc. I had to go without my meds for short period and was worried about resistance. He told me as long as I stopped all meds at once resistance wouldn't be an issue. Luckily, he was right. I'm on Norvir, Truvada, and Reyataz. Would the resistance issue be different with Atripla?

[Hellraiser]

I'm no expert but as I understand it:  when you go on the medication it prevents the virus from replicating.  When you get off of the medicine the virus has now been exposed to it and mutates into a form that the medication is not effective against.  I'm not sure why the quantity or the time frame would matter.  Anyone able to illuminate the issue for us?

[chguy78]

To prove negligence you need to show a duty, a breach of that duty, causation and damages.  Causation could be difficult to prove because there are sustiva-resistant strains out there (I have one) and without that genotype beforehand, a jury could find that it's more likely than not that you had one and it wasn't caused by the drugs being administered to you for that short amount of time. 

Then there are the damages.  What monetary damages have you incurred if the jury does find causation? Are all treatments unavailable to you now?  Probably not.  There are many treatments out there just as good as Atripla, right?  Maybe not as cheap since you'll have to buy two or three prescriptions each month now.  But remember, it's about money.  It sucks that you can't take Atripla - but were you monetarily damaged.  Some states have the punitive damages tied directly to compensatory damages, too, so without that you can't get the punitive damages.  Pain and suffering is sometimes just limited to physical and not mental anguish.  Just depends.

Regarding the breach of confidentiality.  I have no idea.

It never hurts to talk to an attorney in your state, though.  A lot have free consultations for this type of case.

[Miss Philicia]

To prove negligence you need to show a duty, a breach of that duty, causation and damages.  Causation could be difficult to prove because there are sustiva-resistant strains out there (I have one) and without that genotype beforehand, a jury could find that it's more likely than not that you had one and it wasn't caused by the drugs being administered to you for that short amount of time. 

exactly

[Inchlingblue]

I have heard the same thing from my doc. I had to go without my meds for short period and was worried about resistance. He told me as long as I stopped all meds at once resistance wouldn't be an issue. Luckily, he was right. I'm on Norvir, Truvada, and Reyataz. Would the resistance issue be different with Atripla?

Yes it's different with Atripla, as explained in my post above.

What Skeebo is saying is something else at any rate. He is saying that maybe being on Atripla for only four days is not enough time to then become resistant if you stop. I'm pretty sure that 4 days is enough for resistance to develop if one were to stop, especially if the person has a viral load as opposed to being undetectable.

It would be good to find out if they did a resistance test. It would seem to me that the point of the lawsuit is that even if it cannot be proven definitively that his Sustiva resistance is due to the fact that they gave him Atripla for four days, it is still negligent to give someone Atripla for just 4 days while they are in the hospital, this is not the way any ARV medication is supposed to be prescribed. They were negligent in the way they prescribed it and it very likely caused the resistance.

[leatherman]

I'm not sure why the quantity or the time frame would matter.

there are no hard and fast rules about resistance. Resistance usually doesn't occur until someone drops below 90-85% compliant*. It all depends on how much virus is free-floating in your system along with what level of meds. Resistance is caused when there is a lowered level of meds in your system which only kills a part of the virus in your system, while the rest of the viral load is able to mutate to not be affected by the med. Missing a dose here or there does not cause resistance most of the time; neither does only takes meds for a few days and then going completely off.


* More info
http://www.aidsmeds.com/articles/Resistance_7509.shtml

http://jac.oxfordjournals.org/cgi/content/abstract/53/5/696
Resistance to single protease inhibitor therapy occurs most frequently at moderate to high levels of adherence, resistance to non-nucleoside reverse transcriptase inhibitor therapy occurs at low to moderate levels of adherence, and resistance to ritonavir-boosted protease inhibitor therapy is most likely to occur at middle ranges of adherence

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495121/

[leatherman]

it is still negligent to give someone Atripla for just 4 days while they are in the hospital, this is not the way that medication is supposed to be prescribed. They were negligent in the way they prescribed it and it very likely caused the resistance.

a hospital will usually start you on HIV meds (especially based on high VL and low cd4 counts) to help lower your viral load and boost your immune system to prevent death while the hospital treats the immediate health issue. You always have the choice to take or not take meds in the hospital. It is up to the patient to obtain a doctor upon leaving the hospital to continue the treatment that the patient agreed to in the hospital.

[madbrain]

Did they do a genotype test before they administered the Atripla?  If you don't know you can go to the hospital and for a minimum fee get your records on exactly what they did.

I'm going to guess that they didn't, the genotype test takes a long time to get back, and this was an emergency case. Prescribing HAART was probably the right thing. Not informing the patient about the need to continue was wrong. It may or may not have caused the resistance.

[Dennis]

When you were released from the hospital you should have been given a release form to sign. This form/s should have outlined any actions to take upon being released, such as a follow up with an HIV specialist, prescriptions to take, etc.

If your release form advised you to follow up with a doctor for HIV, I would imagine this would be fairly difficult to fight.

[Inchlingblue]

a hospital will usually start you on HIV meds (especially based on high VL and low cd4 counts) to help lower your viral load and boost your immune system to prevent death while the hospital treats the immediate health issue. You always have the choice to take or not take meds in the hospital. It is up to the patient to obtain a doctor upon leaving the hospital to continue the treatment that the patient agreed to in the hospital.

If they gave him Atripla for 4 days, as he is saying, and they did not inform him that it must be continued without fail, then they did not prescribe it properly.

When you were released from the hospital you should have been given a release form to sign. This form/s should have outlined any actions to take upon being released, such as a follow up with an HIV specialist, prescriptions to take, etc.

If your release form advised you to follow up with a doctor for HIV, I would imagine this would be fairly difficult to fight.

They would have had to make it clear that Atripla must be continued without missing any doses. They can't just give someone Atripla for 4 days and not make it perfectly clear to them that they must continue. You just do not prescribe Atripla for 4 days, it's not the way that medication is supposed to be prescribed. Even if they said to follow up with an HIV doctor, that would not be enough as far as avoiding possible resistance to Sustiva.

It seems the hospital is not aware of the particular situation with Atripla and resistance if it is stopped incorrectly, there are other cocktails where this would not be as much of an issue, with Atripla it is.

There is a member here who had to go off it, and his doctor prescribed just the Truvada for about a week. This was done to avoid resistance since, as mentioned above, the drugs in Atripla have varying half-lives. This is what causes the resistance. If you stop Atripla, the Sustiva remains in your system longer once the Truvada has worn off, so it's like taking Sustiva by itself which is not enough for suppression and can likely lead to resistance. This is something the hospital should know, they might continue to do this with other people and it is wrong, plain and simple.

[RapidRod]

If they gave him Atripla for 4 days, as he is saying, and they did not inform him that it must be continued without fail, then they did not prescribe it properly.

They would have had to make it clear that Atripla must be continued without missing any doses. They can't just give someone Atripla for 4 days and not make it perfectly clear to them that they must continue. You just do not prescribe Atripla for 4 days, it's not the way that medication is supposed to be prescribed. Even if they said to follow up with an HIV doctor, that would not be enough as far as avoiding possible resistance to Sustiva.

It seems the hospital is not aware of the particular situation with Atripla and resistance if it is stopped incorrectly, there are other cocktails where this would not be as much of an issue, with Atripla it is.

There is a member here who had to go off it, and his doctor prescribed just the Truvada for about a week. This was done to avoid resistance since, as mentioned above, the drugs in Atripla have varying half-lives. This is what causes the resistance. If you stop Atripla, the Sustiva remains in your system longer once the Truvada has worn off, so it's like taking Sustiva by itself which is not enough for suppression and can likely lead to resistance. This is something the hospital should know, they might continue to do this with other people and it is wrong, plain and simple.

If his discharge paper says follow up with your doctor and he doesn't, that is his negligence.

[Inchlingblue]

If his discharge paper says follow up with your doctor and he doesn't, that is his negligence.

There is a proper way to stop Atripla once you have started (especially if you have a viral load), and it entails continuing with Truvada for a certain number of days. They would have had to make that clear above and beyond saying to follow up with a doctor. They would have had to give him a Rx for Atripla or for a week's worth of Truvada.

A person can make an appointment to follow up with a doctor and that could take several days or even longer. This is not a matter of only following up with a doctor but rather of not missing even a single dose of a medication that they started him on, especially since he was not yet undetectable. It's two different things.

[Nashvegas]

With a history of depression and anxiety, I certainly would not want to take Atripla (or, more specifically, Sustiva), and no doctor worth his salt should, in this day and age, prescribe Atripla for someone with that medical history.  From reading your original post, it also seems to me that you, personally, are NOT hell-bent on pursuing a lawsuit, and it's others who are pressuring you to do so.  Under the circumstances, I say let it go and move on.  You've got better ways to spend your time than pursuing a lawsuit in which it would be difficult to prove damages.  I'm a lawyer, and I wouldn't take on your case.   And, even if you found a lawyer willing to take on the case, most hospitals would NOT quickly roll over on this one and pay you a big fat settlement, in my experience.  Which means that you'd be in for an extended period of high anxiety and stress.  It just ain't worth it, in my opinion...   

[RapidRod]

Atripla doses cannot be missed, they would have had to make that clear above and beyond saying to follow up with a doctor. A person can make an appointment to follow up with a doctor and that could take several days or even longer. This is not a matter of only following up with a doctor but rather of not missing even a single dose of a medication that they started him on. It's two different things.

Now how does that put the resposibility on the hospital if he can't get into his doctor? That is not the hospitals problem.

[leatherman]

Atripla doses cannot be missed

do u happen to have some link to a report that specifically discusses missing doses of atripla? instead of the reports about general adherence issues

no doctor worth his salt should, in this day and age, prescribe Atripla for someone with that medical history. 

I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

[Nashvegas]

I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

Understood.  My point is that, losing the ability to take Atripla is not necessarily much of a loss for someone who would not normally be prescribed Atripla by their personal physician in any event.  It goes to whether the original poster can establish any damages for his inability to take Atripla. 

[Inchlingblue]

Now how does that put the resposibility on the hospital if he can't get into his doctor? That is not the hospitals problem.

That's not what I wrote. You misread it.

[Inchlingblue]

do u happen to have some link to a report that specifically discusses missing doses of atripla? instead of the reports about general adherence issues
I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

I'm not talking about missing doses of Atripla. This is not a case of missing doses of Atripla. In fact there was a FOTO study that determined Atripla can be taken "Five Days On Two Days Off."

This is not about "missing" a dose or two. It's about starting Atripla and then stopping it. There is a difference. I already explained it above, so it's tiring to repeat it, it has to do with the fact that the drugs in Atripla have varying half-lives.

As mentioned above, one of the members here, buffaloboy, stopped Atripla and his doctor kept him on just the Truvada for about a week, this was done in order to minimize chances of becoming resistant to Sustiva.

If you stop 3 medications that have the same or very similar half lives then they are all out of your system at about the same time and that's fine, not likely to develop resistance.

With Atripla, the half life of Sustiva is longer than those of the two drugs in Truvada so if you just stop taking Atripla, the Truvada wears off sooner and you still have Sustiva in your system by itself for a period of time and this is when resistance can develop, it's comparable to taking Sustiva monotherapy.

Stopping effective HIV treatment usually leads to fairly quick (2 weeks) rebound in virus and dropping CD4 count. That can lead to a variety of symptoms in some patients (possibly muscle pain) as well as risk for resistance in case of Atripla. I recommend seeing your HIV specialist for an evaluation and see if you can go to a clinic with ADAP/Ryan White funding to see if you qualify for drug assistance. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Current/Q199190.html

Stopping Atripla runs the risk of developing resistance particularly to the efavirenz with its long half life (persistence in blood). The risk for both AIDS and non-AIDS HIV related events (such as heart disease and cancer) increases after stopping HIV medication. I would suggest trying to discuss with a case manager at a Ryan White site nearby to examine your insurance/funding options. The ideal way to stop Atripla still needs to be determined but some experts recommend taking a boosted PI for several weeks after stopping as one approach. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Archive/Treatment/Q193745.html


If the hospital put him on Atripla it was their responsibility to inform him about this, not just give a general instruction to "follow up with your doctor," which is not enough in this particular case.

[RapidRod]

That's not what I wrote. You misread it.

Your information is incorrect. I was taken off Atripla for a month because of incompatibility with my other medications and then I was put back on Atripla and it didn't cause an issue.

[Inchlingblue]

Your information is incorrect. I was taken off Atripla for a month because of incompatibility with my other medications and then I was put back on Atripla and it didn't cause an issue.

My information is not incorrect, please read above, with links from thebody.com.

Resistance does not always happen, you were lucky. Also, whether a person has a viral load or not is a factor. If a person is undetectable when they stop then there is less of a chance of resistance.

[RapidRod]

I'm not talking about missing doses of Atripla. This is not a case of missing doses of Atripla. In fact there was a FOTO study that determined Atripla can be taken "Five Days On Two Days Off."

This is not about "missing" a dose or two. It's about starting Atripla and then stopping it. There is a difference. I already explained it above, so it's tiring to repeat it, it has to do with the fact that the drugs in Atripla have varying half-lives.

As mentioned above, one of the members here, buffaloboy, stopped Atripla and his doctor kept him on just the Truvada for about a week, this was done in order to minimize chances of becoming resistant to Sustiva.

If you stop 3 medications that have the same or very similar half lives then they are all out of your system at about the same time and that's fine, not likely to develop resistance.

With Atripla, the half life of Sustiva is longer than those of the two drugs in Truvada so if you just stop taking Atripla, the Truvada wears off sooner and you still have Sustiva in your system by itself for a period of time and this is when resistance can develop, it's comparable to taking Sustiva monotherapy.

Stopping effective HIV treatment usually leads to fairly quick (2 weeks) rebound in virus and dropping CD4 count. That can lead to a variety of symptoms in some patients (possibly muscle pain) as well as risk for resistance in case of Atripla. I recommend seeing your HIV specialist for an evaluation and see if you can go to a clinic with ADAP/Ryan White funding to see if you qualify for drug assistance. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Current/Q199190.html

Stopping Atripla runs the risk of developing resistance particularly to the efavirenz with its long half life (persistence in blood). The risk for both AIDS and non-AIDS HIV related events (such as heart disease and cancer) increases after stopping HIV medication. I would suggest trying to discuss with a case manager at a Ryan White site nearby to examine your insurance/funding options. The ideal way to stop Atripla still needs to be determined but some experts recommend taking a boosted PI for several weeks after stopping as one approach. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Archive/Treatment/Q193745.html


If the hospital put him on Atripla it was their responsibility to inform him about this, not just give a general instruction to "follow up with your doctor," which is not enough in this particular case.

Give me a break. You going to blame a hospital for someone that doesn't take their medications correctly? The orginal poster doesn't have a suit.

[Hellraiser]

It's not that he didn't take their medication correctly.

They didn't inform him that stopping the medication could potentially cause the virus to become resistant.
They didn't inform him that he should make a doctor's visit asap with an ID in order to continue Atripla.
They didn't give him any Atripla or a prescrption in order to continue taking it once he left the hospital.

I don't know whether it's suit worthy, but I'd sure as hell wanna have a word with the doctor who took away one of my treatment options.

[Inchlingblue]

Give me a break. You going to blame a hospital for someone that doesn't take their medications correctly? The orginal poster doesn't have a suit.

If they explained it to him, then maybe you are right. But if they were not absolutely clear that he needs to continue Atripla without stopping once he leaves the hospital (and, as Hellraiser mentioned, give him a prescription for it) then it would seem he does have a case.

At any rate, I'm not a lawyer, are you? His best bet is to talk to a lawyer who is familiar with medical malpractice and with HIV in particular and they can advise him.

In any lawsuit you have to prove "loss" and his "loss" here is that he cannot ever take Sustiva or many other NNRTIs. This is not a major loss but it is a loss nonetheless and a price tag can be placed on that loss.

[John2038]

I also learned that Atripla is the one med I'm resistant to now.

Was the blood draw for the genotype made before you started Atripla ? Was it made by the same hospital ?

A 4 day prescription is common in the EU for a PEP in the 48h following a risk exposure, typically by an MD at the emergency unit . Before the end of this 4 days regimen, the "patient" have to see a virologist in order to decide whether or not the PEP should be continued until the day 28, or changed (side effects, labs) or discontinued if after a reevaluation of the risk it appears to be too low to justify continuing a PEP.

I am wondering so if you haven't get prescribed a PEP.

Best Wishes

John

[Miss Philicia]

The bottom line here is that tednlou2 has a rather acute case of anxiety disorder, one that seems to pre-date his HIV diagnosis and which has, understandably, worsened greatly post-diagnosis.  Yet it seems we have a cadre of lawsuit cheerleaders-in-residence that wish for this guy to ramp up his state of already acute stress and anxiety with what would inevitably be more of the same.  The only people here who seem to recognize this are tednlou2 himself in his opening post, and NashVegas.

This is a support group, not a debating society. I don't see how it's supportive to encourage a board member to engage in something that will only worsen his mental health.

[David_CA]

I say forget about it and focus on being peaceful and happy.

I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

I was in the hospital for 8 days a little over 3 years ago with a nasty case of PCP pneumonia.  I had not started meds yet.  The second day I was there, I started Atripla.  It was actually the 3 base drugs in Atripla, but it's the same thing.  Nobody asked me about psychological issues, etc.  I'd had genotype and phenotype tests when I was first diagnosed (about 8 months prior) with no resistance, but I don't know if that was relayed to the hospital.  

First, the goal was to make me well.  If I had mental issues that would contraindicate Atripla, I would have been switched to another med after release from the hospital.  Upon release, I was given Rx's for Atripla and Bactrim.  There was nobody to hold my hand for either drug.  Had I not taken Atripla, I would likely have had more HIV-related illnesses.  If I didn't take the Bactrim, I think I would have PCP again.  

Bottom line, the hospital did what was required to help make me well.  After I was discharged, it was up to me.  I could have discussed meds with my ID Dr and changed them or continue like I did.  As to being outed, did you ask the nurse what the meds were or did she just blurt it out?  Either way, I wouldn't pursue any sort of legal proceedings.  

If I were in your position and felt strongly enough about it, I would contact the nurse or his/her supervisor and tell why I didn't like how it was handled.  It's done and over with; I say move on.  From some of your other posts, it sounds like you're not quite through the acceptance stage of diagnosis yet.  The sooner you get past that point, the better off you'll be.  Take care.

[Inchlingblue]

The bottom line here is that tednlou2 has a rather acute case of anxiety disorder, one that seems to pre-date his HIV diagnosis and which has, understandably, worsened greatly post-diagnosis.  Yet it seems we have a cadre of lawsuit cheerleaders-in-residence that wish for this guy to ramp up his state of already acute stress and anxiety with what would inevitably be more of the same.  The only people here who seem to recognize this are tednlou2 himself in his opening post, and NashVegas.

This is a support group, not a debating society. I don't see how it's supportive to encourage a board member to engage in something that will only worsen his mental health.

I'm not endorsing that he sue one way or the other but I do think it's important to see that the hospital acted wrongly here (based on the information supplied on this thread). They should be made aware so that this does not continue to happen to others.

  Upon release, I was given Rx's for Atripla and Bactrim.   

That's the important difference here: he was apparently not given an Rx for Atripla upon discharge, after they had given him 4 days worth while he was there.

[Hellraiser]

I'm not endorsing that he sue one way or the other but I do think it's important to see that the hospital acted wrongly here (based on the information supplied on this thread). They should be made aware so that this does not continue to happen to others.

I'm not going to get involved with anymore finger pointing and I'll bow out of this thread, however I agree with Inchling on this.  I felt that it was wrong (not necessarily that he should sue) of them to not "finish what they started".  However, when I got out of the hospital I was so drugged up on painkillers I have no idea what they told me.  I'm pretty sure that even though they were suspicious of HIV however they gave me no HIV specific medications only anti-biotics.  If they had denied me the use of a treatment option, I would've been very upset about it.

[David_CA]

I also learned that Atripla is the one med I'm resistant to now. 

I doubt you're resistant to all three drugs in Atripla.  I have 'partial' sensitivity to one of the components (or however it's worded), but that partial sensitivity plus maximal sensitivity to the other two makes it work for me.  I'm not saying you should take Atripla or not (by itself or with another drug); one would have to look at geno- and phenotype test results, taking any psychological issues into consideration, before making such a determination.  From what I've read about the drugs in Atripla, the hospital most likely did not cause any resistance.

[GSOgymrat]

I'm not trying to place blame here but I'm confused how the nurses gave you Atripla without your knowledge. The doctors and nurses are supposed to inform you of diagnosis and treatment as part of your rights as a patient. If they didn't do that they didn't do their job. I wouldn't sue in your situation because I just don't think it would be worth it however I would want to know why appropriate procedures were not followed.

[skeebo1969]

  I am certain this won't be drawn out like the OJ trial if he does try to pursue it.   I  think  trying to prove liability would be extremely difficult.  He may have already been resistant to it to begin with.  A lawyer would do all the legwork and we are not talking about a murder trial here.  From reading this thread, like myself, it seems a lot of  people here have an aversion to the word sue.  It congers up visions of the lady who purposely slips in the store and sues because the tile was too glossy.  With that said though I do agree, Tednlou should concentrate on self right now.  Ted, you hang in there bud..

[Miss Philicia]

Also, in terms of the "outing" I'm somewhat confused.  You reference "My brother and his partner" as opposed to his wife or girlfriend -- are you saying that your brother is gay?  You've stated previously that you yourself have a partner and he didn't leave your hospital room the entire time, so staff would have known you are gay.  If your brother came into the hospital, signed in with his gay partner, and presented himself as such to hospital staff, I'd assume it was a reasonable assumption to make that there were not secrets to be had in the room.

[Dennis]

On top of a patient's rights, a patient also has responsbilities. A couple of those responsibilities include providing accurate and complete information of their medical history as well as providing written consent or refusal to treatment and procedures requested by the treating physycian.

When I was in for PCP i was urged to take meds for HIV. I refused and also had sign a paper stating so.

In addition to hospital release papers, did the op also receive and sign a copy of the the hospitals and patients rights and responsibilites at the time of admission?

[chguy78]

Also, in terms of the "outing" I'm somewhat confused. 

I took the "outing" as referring to his testing positive for HIV not for his sexual orientation.

[Inchlingblue]

   Causation could be difficult to prove because there are sustiva-resistant strains out there (I have one) and without that genotype beforehand, a jury could find that it's more likely than not that you had one and it wasn't caused by the drugs being administered to you for that short amount of time. 

 I am certain this won't be drawn out like the OJ trial if he does try to pursue it.   I  think  trying to prove liability would be extremely difficult.  He may have already been resistant to it to begin with.  

The thing is he responded very well when they gave him Atripla for 4 days, with his viral load going down and CD4s shooting way up, which would indicate that he was not resistant to begin with.

I doubt you're resistant to all three drugs in Atripla.  

I think when he says he is resistant to Atripla he means he is resistant to Sustiva (Efavirenz); he has mentioned this in another post. Being resistant to Sustiva also means he is resistant to other drugs in that class, NNRTIs.

[skeebo1969]

The thing is he responded very well, with his viral load going down and CD4s shooting way up, which would indicate that he was not resistant to begin with.

Hmmm, that is something I definitely overlooked here.  Damn that is a real bitch then.. something that would definitely have me talking to an attorney.

[David_CA]

The thing is he responded very well when they gave him Atripla for 4 days, with his viral load going down and CD4s shooting way up, which would indicate that he was not resistant to begin with.

I think when he says he is resistant to Atripla he means he is resistant to Sustiva (Efavirenz); he has mentioned this in another post. Being resistant to Sustiva also means he is resistant to other drugs in that class, NNRTIs.

Not necessarily.  Look at my numbers... especially when I started meds.  My VL dropped and my CD4's increased.  I have some resistance to one of the meds in Atripla (I can't remember which; I'll have to look it up at home), but still my numbers improved.  Remember, it wasn't all that long ago that monotherapy was the norm; it also worked for a while before resistance became an issue.  If being on meds for 4 days and then stopping caused resistance, wouldn't almost everybody that ever stopped a particular drug be resistant to that drug? 

According to my ID Dr, there's also something, and I can't remember what it's called, either, where the wild type virus is suppressed by meds causing an intial drop in VL.  Once suppressed, other 'forms' of the virus increase due to not being resistant to the meds.  I'll have to try and find more specifics.  At any rate, it would be hard to believe and prove that 4 days of Atripla caused resistance.  Isn't this one of the reasons for both a genotype and phenotype.  http://hivdb.stanford.edu/pages/documentPage/genoPheno.html

[RapidRod]

If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.

[David_CA]

If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.

Duh, good point; I kinda forgot about that! 

[Assurbanipal]

Ted

It sounds like you are under a lot of pressure, which you really don't need. 

It might help to break it into pieces.

Are you resistant to all of Atripla (unlikely) or just the Sustiva part? 

If it is just Sustiva, with your history, you are probably not a good candidate to take it anyway.  And as one of the other posters pointed out, it will be difficult for you to show that you were harmed by becoming resistant to a drug that you shouldn't take anyway.

If you are under a lot of pressure from your family and friends though it might make sense for you to talk to your ASO and see if they could refer you to a lawyer so you get an "official" response as to whether you have a case -- seems unlikely though.

But sometimes getting an official answer that something won't work is the easiest way to get it off the list of things to worry about.

Hope you get over the cold soon -- have some chicken soup :-)

A

[Inchlingblue]

Not necessarily.  Look at my numbers... especially when I started meds.  My VL dropped and my CD4's increased.  I have some resistance to one of the meds in Atripla (I can't remember which; I'll have to look it up at home), but still my numbers improved.  Remember, it wasn't all that long ago that monotherapy was the norm; it also worked for a while before resistance became an issue.  If being on meds for 4 days and then stopping caused resistance, wouldn't almost everybody that ever stopped a particular drug be resistant to that drug?  

According to my ID Dr, there's also something, and I can't remember what it's called, either, where the wild type virus is suppressed by meds causing an intial drop in VL.  Once suppressed, other 'forms' of the virus increase due to not being resistant to the meds.  I'll have to try and find more specifics.  At any rate, it would be hard to believe and prove that 4 days of Atripla caused resistance.  Isn't this one of the reasons for both a genotype and phenotype.  http://hivdb.stanford.edu/pages/documentPage/genoPheno.html

If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.

Duh, good point; I kinda forgot about that!  

Atripla stopping protocol

Joel E. Gallant, M.D., M.P.H.

Question:

Posted on Dec 30, 2009
Hi Dr. Gallant, A friend of mine, treatment naive, started atripla a couple of weeks ago. However, he got a rash all over his body and, 11 days after having started meds,   his hiv doctor told him to stop atripla altogether and to come back for a new combo in 1 month. I was under the impression that in the case of having to stop an efavirenz based combo it was recommended either to immediately start the new combo or at least continue with the nrti backbone of the treatment for a couple of weeks in order to avoid being in an efavirenz effective monotherapy, due to its long half-life, with the corresponding risk of developing resistance to it. I told my friend to consult that aspect with his doctor, but have yet to hear from him about it, and wanted to confirm whether my concerns were well founded. Thanks a lot and happy new year!

Response:

On Dec 30, 2009 Joel E. Gallant, M.D., M.P.H. replied:
This is not how I'd do it. It's very clear that stopping Atripla can result in NNRTI resistance, especially if the viral load is not suppressed at the time of interruption.

The first thing to remember is that it's rarely necessary to stop efavirenz because of a rash, which almost always goes away on its own with continued use of the drug. Second, if someone DOES have to stop Atripla because of a rash, then it's obvious that the efavirenz is the culprit, and all that's necessary is to switch from efavirenz to something else. You can do this without interrupting therapy: simply switch from Atripla to Truvada plus either Prezista/Norvir, Reyataz/Norvir, or Isentress, for example. That way, there's no risk of resistance.

Your friend should get a genotype to see whether he now has the K103N mutation

LINK:

http://www.hopkins-hivguide.org/q_a/patient/antiretroviral_therapy/treatment_interruption/atripla_stopping_protocol.html?contentInstanceId=510872&siteId=7151

It is wrong for a hospital to give a patient Atripla for just 4 days and not explain to them that they must continue and give them a Rx for doing so, period. This is not debatable or a matter of opinion, it is a fact. If the patient were not able to continue with Atripla (for financial or other reasons), they could give him a Rx for about a week's worth of Truvada, this would lessen the chances of acquiring Sustiva resistance.

Whether or not he should sue is a different question. I do think it's important, as already mentioned, to bring attention to this sort of thing in order to keep it from happening to others in the future. This whole issue points to the lack of HIV/AIDS knowledge among many health care practitioners.

[RapidRod]

Then you are saying no one should take nPEP? There is NO difference in what he has done for only 4 days and those that take nPEP for 28 days.

[Assurbanipal]

Then you are saying no one should take nPEP? There is NO difference in what he has done for only 4 days and those that take nPEP for 28 days.

Are you joking?  There is an enormous difference. 

When PEP works (whether or not it is "n"on-occupational PEP), the virus is killed off before it has a chance to establish itself.  There is no virus left in the body to reproduce. 

Resistance occurs when there is virus in the body attempting to reproduce.  HIV produces a lot of variant(mutant) copies of itself when reproducing -- otherwise inferior copies that are resistant to a drug can be favored if the virus is reproducing and the drug kills off the otherwise healthier strains.  The reason for 3 drug HAART is that the other active drugs kill off virus that mutates to be resistant to one drug.

But if someone has no active reproducing virus when the drug is discontinued, there is no chance of developing resistance -- if you no longer have an HIV infection, you will not develop resistance.

Giving Atripla to someone with an established infection and then ending it all at once more or less guarantees that they will be on effective monotherapy for several weeks, because an established HIV infection lingers in a number of places in the body.  So it is always there trying to reproduce.  While effective monotherapy doesn't guarantee resistance, but it is unwise if there is an alternative.

Finally, nPEP is not necessarily based on Atripla -- and the differential wear off time is primarily an Atripla problem.



Sorry for the highjack Ted

[RapidRod]

Are you joking?  There is an enormous difference. 

When PEP works (whether or not it is "n"on-occupational PEP), the virus is killed off before it has a chance to establish itself.  There is no virus left in the body to reproduce. 

Resistance occurs when there is virus in the body attempting to reproduce.  HIV produces a lot of variant(mutant) copies of itself when reproducing -- otherwise inferior copies that are resistant to a drug can be favored if the virus is reproducing and the drug kills off the otherwise healthier strains.  The reason for 3 drug HAART is that the other active drugs kill off virus that mutates to be resistant to one drug.

But if someone has no active reproducing virus when the drug is discontinued, there is no chance of developing resistance -- if you no longer have an HIV infection, you will not develop resistance.

Giving Atripla to someone with an established infection and then ending it all at once more or less guarantees that they will be on effective monotherapy for several weeks, because an established HIV infection lingers in a number of places in the body.  So it is always there trying to reproduce.  While effective monotherapy doesn't guarantee resistance, but it is unwise if there is an alternative.

Finally, nPEP is not necessarily based on Atripla -- and the differential wear off time is primarily an Atripla problem.



Sorry for the highjack Ted

No I wasn't joking nor the use of Atripla for 4 days cause a resistence.

[Inchlingblue]

No I wasn't joking nor the use of Atripla for 4 days cause a resistence.

What does that even mean? It doesn't make any sense.

I hope that people who come to this thread for information they might need about Atripla and how one can develop resistance to Sustiva if it's not stopped properly don't get confused with your posts, which make no sense.

[tednlou2]

First, I want to thank everyone for all the posts and opinions.  As I said, everyone who knows keeps pushing me to see a lawer, so I wanted to talk to you guys.  I want to clear up some things--and some things I've learned since posting.

I went back through the hospital reports.  They didn't even have me on Atripla like I thought.  They just had me on Sustiva--which makes them even more irresponsible.  I was thinking Atripla, because I was told I wouldn't be able to take Atripla because I resistant to it.  Looking back at the papers, they only gave me the Sustiva component, which makes them even more negligent.  

I was never told I was being given HIV meds.  I found out when my brother and his partner recognized the name of the drug.  My brother is gay as well--just 2 boys for my mom and both gay...lol.  When I said outed, I meant HIV status.  The hospital should have told me about the HIV meds.  There was basically no contact.  My attending doc would come in around midnight and wake me up every night.  If ya didn't get info then, you had to wait another 24 hours.  Not a good situation.    

I had 2 different ID docs come see me in the hospital.  They were in the room for like 2 mins and gone--guess to pick up the pay and leave.  Both of them should have noticed this mistake and talked to me about the meds.  These 2 got paid to see me and would know better than anyone how to prescribe HIV meds.  I guess they would.  I was reading most ID docs are clueless about HIV.  You really need an HIV expert.  I know there are many awesome docs.  There are the others who do just want to get paid.  I was billed for a doc who came in while I was asleep.  

When I left, I was not given prescription for HIV meds.  I was given an appt date to see my HIV doc, but that was like 3-4 weeks out.  I didn't know much about HIV at that time--certainly didn't know about resistance issues.  I didn't know stopping would cause an issue.  

My CD4 in the hospital was 171.  The one thing the ID doc did say was to ignore that number and it would bounce back.  I think my attending doc thought he knew what he was doing with the HIV med.  He was very nice and it is hard for me to be angry at him.  I did get better and got out alive.  I think the CD4 scared him and he thought he was doing what was right.  My partner says he was like most docs--didn't want to ask for help/guidance.  I did send a letter to the president/director of the hospital about the situation and that they need to do things to prevent it.  I asked him to reply--just to know he got it.  He never replied.  It may be they are afraid of a lawsuit and doesn't want to say anything that may be used against them.  It does piss me off that he would never respond.  Maybe he didn't get my letter.  

It sounds like most of you would possibly sue.  I do feel hospitals have become like major corporations and only make changes if sued.  I will keep ya updated on what I do.  I'm sure the 2 year time-frame applies here on filing suit.  This is a big chain of hospitals.  I honestly would rather gotten a reply to my letter informing me they discussed this with all docs and nurses than to get $1.  Leatherman, you're right.  You must have read I'm having my first cold since that time.  I guess I should make sure it is just a simple cold before suing..lol.  It would be awkward to end up back there and the doc know I'm suing him.  I think I would go to different hospital this time.  

[tednlou2]

One more thing---As far as I've been able to tell, the hospital didn't do any genotype, phenotype, or whatever testing.  They didn't do a viral load either.  It would have been helpful to know viral load.

From talking to several HIV docs including Dr. Gallant and Dr. Young on their websites, 4 days of Atripla or just the Sustiva is enough to get resistant.  The Sustiva or something obviously worked.  When I did the first bloodwork 3-4 weeks later, my CD4 was over 1,000 and vl just 400.  So, the Sustiva did something-- which is surprising with just the one drug being used.  I'm going to try to get in touch with my attending doc to clear up some things.  Hopefully, he'll talk to me. 

[Miss Philicia]

When I did the first bloodwork 3-4 weeks later, my CD4 was over 1,000 and vl just 400.  So, the Sustiva did something

Can we even say that considering you've not been on any HIV med for almost a year yet maintain those numbers?  Or am I missing something?

[RapidRod]

What does that even mean? It doesn't make any sense.

I hope that people who come to this thread for information they might need about Atripla and how one can develop resistance to Sustiva if it's not stopped properly don't get confused with your posts, which make no sense.

I hope they don't get paranoid from your incorrect information.

[Dennis]

One thing I'm confused about is why you didn't ask any questions regarding any medication that was given to you while in the hospital? I realize everyone isn't as vocal as I am, but I find it odd that someone wouldn't ask questions about what medications were being dispensed prior to swallowing it. I would imagine this question would be asked of any opposing attorney. Remember, you have rights and responsibilities in regards to your care as well as the hospital.

Also, given your history of depression, would Atripla have been a first consideration in treatment for you? One could argue there are other options as well as others down the pipeline. So what actual loss have you incurred? Also, would you be able to prove the hospital was negligent beyond a reasonable doubt?

O.k. So I've been watching too much CSI Miami and The Good Wife. 

If your main objective is to bring attention to this error to the hospital so it doesn't occur to others, than perhaps a visit to the patient advocacy coordinator at the hospital would be in order.

[Miss Philicia]

It's very strange.  Doubly so because his partner was there with him the entire time, so neither of them questioned the various doctors and staff.

[tednlou2]

Miss P, the reason I said the Sustiva must have done something is because it put my CD4 over 1,000 and vl at just 400.  Granted, my last CD4 of 811 is great and not that big a change.  My last vl was 27,000--up from 400.  The Sustiva was trying to get it undetectable is what I'm saying. 

As I've said in previous post, I realize my numbers are good and I realize the real, immediate problems many are dealing with right now due to bad numbers.  I just wanted to say that again.  I realize, right now, I don't have much to worry about.  I know many have vl's in the millions and single digit CD4's.

About not asking questions:  Even though I had suspected I had HIV for several years, it still was devestating news.  I think we both were in a daze.  My partner was facing being poz, too.  He got tested and luckily was neg.  As I said, my attending doc would come in at midnight.  He was always in a hurry.  The 2 ID docs were really in a hurry.  They were in and out within 2 mins. 

As I said in first post, I have not been in favor of suing.  I realize I would probably lose.  I would like them to make changes, so it doesn't happen again.  Maybe a real HIV doc needs to come in for care when this happens.  Maybe they need more focused care when someone is told they are poz or given cancer diagnosis.  This is what I was trying to discuss by letter with the president of the hospital.

I just wanted to know what you guys thought.  I respect your opinions.  And, the dialog is often educational.

[Dennis]

As I said, my attending doc would come in at midnight.  He was always in a hurry.  The 2 ID docs were really in a hurry.  They were in and out within 2 mins.

Understandable. However, if you ever find yourself in the hospital again (and I truly hope you don't), realize that you are the customer (for lack of a better word). You are paying these doctors and you deserve to have all your questions and concerns answered. If that means having a family member chase the physician down the hall than that's what you do. And if that doesn't work, than you request to speak to a hospital administrator.

If the doctor didn't do his job while making his rounds; and that includes addressing any and all questions and concerns you have before he leaves, than I would definitely dispute his charges for those days when you receive the bill.

[tednlou2]

Dennis, thanks for the info.  Maybe I do need to look back at those charges.  And, I know we'd be more assertive if I should end up in the hospital again.

While I'm on here....I updated all my labs and even changed my pic.  I noticed it didn't update all my labs and my pic is blank.  I don't know what's up. 

[Inchlingblue]

I hope they don't get paranoid from your incorrect information.

LOL

Why would anyone get paranoid? Again, this makes no sense.

At any rate, all my information has been backed up by world-renowned HIV experts, with links included.

[Matty the Damned]

Yes yes Inch, you and Roddles both have enormous pensus. We're all terribly impressed.

Nao, back to the issue at hand, Ted's complaint.

Ted, have you considered the hosptial's internal disputes resolution procedures?

MtD

[tednlou2]

MtD,

I will look into that.  I probably should call the president and see if he got my letter.  I called before sending to get correct name, address, etc.  But, I will look into going around the president to other people within the hospital.

[Matty the Damned]

Yup.

First steps. You can lawyer up now, but it may be this can be resolved by availing yourself of the relevant complaints process within the institution in question.

Failing to do this will only prejudice any legal action you might take down the track.

MtD

[Inchlingblue]

Yes yes Inch, you and Roddles both have enormous pensus. We're all terribly impressed.

Nao, back to the issue at hand, Ted's complaint.

Ted, have you considered the hosptial's internal disputes resolution procedures?

MtD

MtD: The only reason I persisted in responding is not because I want some sort of pissing contest but because he's giving out false information. The thread speaks for itself at this point but it would not have had his false statements regarding Atripla and resistance remained unchallenged.

And the subject matter of the back and forth is germane to the OP and his post, so it's in keeping with the "issue at hand."

[Matty the Damned]

MtD: The only reason I persisted in responding is not because I want some sort of pissing contest but because he's giving out false information. The thread speaks for itself at this point but it would not have had his false statements regarding Atripla and resistance remained unchallenged.

Listen babe,

I appreciate your position but I've been around long enough to know dick measuring when I see it. If you and Roddles wanna wave your massive gonads at each other that's great, but take it elsewhere. PM, another thread - wherever.

This thread is about Ted and his issue.

Why don't we focus on that?

MtD

[Inchlingblue]

MtD: The only reason I persisted in responding is not because I want some sort of pissing contest but because he's giving out false information. The thread speaks for itself at this point but it would not have had his false statements regarding Atripla and resistance remained unchallenged.

Listen babe,

I appreciate your position but I've been around long enough to know dick measuring when I see it. If you and Roddles wanna wave your massive gonads at each other that's great, but take it elsewhere. PM, another thread - wherever.

This thread is about Ted and his issue.

Why don't we focus on that?

MtD

Excuse me, but discussing whether stopping Atripla can cause resistance is very much in keeping with the subject of this thread. The discussion is very much a part of Ted and his issue.

What you are doing, by trying to moderate this, is not.

[Matty the Damned]

The issue at hand is should Ted sue the hospital or not.

Check the title of the OP.

It seems he has received a less than appropriate standard of care and he should indeed pursue further action. My advice to Ted is that he should investigate what options the health care service he attended has to resolve this matter.

If those options don't pan out, then he might want to lawyer up and avail himself of his legal rights.

Well intentioned as you are Inch, this extended hair pulling about Atripla resistance seems both undue and tangential to the matter before us.

With that said, my advice to Ted remains the same - check out your options with the health care provider first. If they don't work out - call the shysters.

Regards,

MtD

[chguy78]

One thing I'm confused about is why you didn't ask any questions regarding any medication that was given to you while in the hospital? I realize everyone isn't as vocal as I am, but I find it odd that someone wouldn't ask questions about what medications were being dispensed prior to swallowing it.

What would a reasonable person do in this situation?: I'm in the hospital for an emergency; I was just told that I have HIV; a doctor, someone from whom you are supposed to rely on for advice and counsel, gives you a drug to take because of your dire situation.  Do I not take it and go online to investigate whether it will cause resistance (have I even heard about "resistance" at this point?) only to be confronted with contradictory information like has been on this thread?  In this situation, I would find it difficult to say it was contributorily negligent to take medicine given to you by an ID specialist.

Also, would you be able to prove the hospital was negligent beyond a reasonable doubt?

Negligence usually needs to be proved by a preponderance of the evidence ("more likely than not" or 51% likely) or, rarely, by clear and convincing evidence

[mecch]

If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.

nPEP for 28 days cant cause resistance if it works there is no virus left duh.
I assume you are speaking about where it does not work.  So then the HIV infection that is established would be resistant? And you are saying not. 
Interesting.  Has that actually been researched?

[Assurbanipal]

Ted

While you probably will need to go through the hospital appeals process, I'd check out legal advice first, were I in your shoes. 

I differ from the esteemed damned one here, but sometimes, in the US at least, companies have been known to use those appeals processes to get people to make statements that could later come back to haunt them in court.  It wouldn't hurt to see if there is free legal assistance through your ASO and to talk to them, before you go back to the hosppital.

A

[Matty the Damned]

Matty the Damned is always open to reasonable correction. Particularly when it comes from the A.

You should heed his sage counsel.

MtD

[Dennis]

What would a reasonable person do in this situation?: I'm in the hospital for an emergency; I was just told that I have HIV; a doctor, someone from whom you are supposed to rely on for advice and counsel, gives you a drug to take because of your dire situation.  Do I not take it and go online to investigate whether it will cause resistance (have I even heard about "resistance" at this point?) only to be confronted with contradictory information like has been on this thread?  In this situation, I would find it difficult to say it was contributorily negligent to take medicine given to you by an ID specialist.

Negligence usually needs to be proved by a preponderance of the evidence ("more likely than not" or 51% likely) or, rarely, by clear and convincing evidence

The OP mentioned he didn't find out he was given Sustiva until AFTER the fact. This is what I find odd. The fact that someone would place a pill into their mouth without any questioning as to what is being dispensed to them. The op also mentions he was surrounded by friends and family, two of which are in the medical community and somewhat familiar with HIV medications. So, he did have access to someone to advocate on his behalf.

If I had not asked questions about what medication was being administered to me while I was in the hospital than I also would have been placed on HIV meds without my authorization. I excercised my responsiblity as a patient to ask questions regarding my own healthcare and then excercised my right to refuse such treatment.

The op also admits here that he may not have faired well on Atripla due to his history of depression. So what would the actual loss be? Especially when there are other meds available with others in the pipeline.

I can't help but believe that the national patient's bill of rights along with the hospitals own patient's rights and responsibilities which are signed at the time of admission would play somewhat of a role during a case of this type. Let's be honest, a patients rights and responsibilities are put into place to protect the hospital and it's staff as much as it is to protect the patient.

I'm not saying the op is completely to blame. However, I do believe he didn't fully take advantage of his rights and responsibilities as a patient. So couldn't a court of law find negligence on behalf of both parties?

I presume you agree the op wouldn't be able to prove negligence beyond a preponderance of the evidence since you stated you wouldn't take on his case.

EDITED...Please disregard that last paragraph. After reviewing the thread I realize it was another member who was an atorney as well as stated he wouldn't take on the case. Sorry!

I'm obviously not an attorney, so I find your feedback to this thread rather interesting.

[Inchlingblue]

The issue at hand is should Ted sue the hospital or not.

Check the title of the OP.

It seems he has received a less than appropriate standard of care and he should indeed pursue further action. My advice to Ted is that he should investigate what options the health care service he attended has to resolve this matter.

If those options don't pan out, then he might want to lawyer up and avail himself of his legal rights.

Well intentioned as you are Inch, this extended hair pulling about Atripla resistance seems both undue and tangential to the matter before us.

With that said, my advice to Ted remains the same - check out your options with the health care provider first. If they don't work out - call the shysters.

Regards,

MtD

A less appropriate standard of care that happens to hinge on whether it was correct procedure to have given him Atripla for four days, likely causing resistance to Sustiva. (Later corrected by the OP to say it was Sustiva alone and not Atripla that he was given). The question was should he or should he not sue for that specific reason, it has very much to do with the matters at hand.

It's puzzling why you're (inappropriately) trying to "moderate" this.

[chguy78]

The OP mentioned he didn't find out he was given Sustiva until AFTER the fact. This is what I find odd. The fact that someone would place a pill into their mouth without any questioning as to what is being dispensed to them.

You make great points and ones that any defense attorney would make; I was just playing devil's advocate to a degree.

I'm not saying the op is completely to blame. However, I do believe he didn't fully take advantage of his rights and responsibilities as a patient. So couldn't a court of law find negligence on behalf of both parties?

Yeap, depending on the jurisdiction (only in a very few now) a plaintiff could receive NO remedy if he is negligent in any way (1%).  Most, however, use comparative negligence (or some variation of it) to apportion fault (25% to 75%) and would make an award accordingly.

I presume you agree the op wouldn't be able to prove negligence beyond a preponderance of the evidence since you stated you wouldn't take on his case.

I wouldn't take it because I only know enough about medical malpractice law to post on forums    I always recommend someone who has a concern to consult with an experienced med mal attorney for a consultation - many will give free consultations on a matter such as this.

[Moffie65]

Ted,

Sorry for the unsubstantiated post, quoted by Ass.  below, I am not qualified to give an opinion in this thread obviously, so to see what this post was, please read his verdict which follows below.

According to some of you, this forum cannot exist without a degree in law and medicine.

I bow to the self proclaimed professionals.

[Matty the Damned]

A less appropriate standard of care that happens to hinge on whether it was correct procedure to have given him Atripla for four days, likely causing resistance to Sustiva. (Later corrected by the OP to say it was Sustiva alone and not Atripla that he was given). The question was should he or should he not sue for that specific reason, it has very much to do with the matters at hand.

It's puzzling why you're (inappropriately) trying to "moderate" this.

Puzzled as you might choose to be, the pertinent issue here (as I have stated previously) is a question of the general standard care offered to Ted.

That, I fancy, has been addressed as far as this forum is able to address such things.

You suggest I am attempting to moderate this discusssion. I reject the premise of your assertion and I am not inclined to engage you further with regard to this matter in a public setting.

You are always welcome to email me if you wish to further this exchange. You will find my email address in my profile.

MtD

[Inchlingblue]

A less appropriate standard of care that happens to hinge on whether it was correct procedure to have given him Atripla for four days, likely causing resistance to Sustiva. (Later corrected by the OP to say it was Sustiva alone and not Atripla that he was given). The question was should he or should he not sue for that specific reason, it has very much to do with the matters at hand.

It's puzzling why you're (inappropriately) trying to "moderate" this.

Puzzled as you might choose to be, the pertinent issue here (as I have stated previously) is a question of the general standard care offered to Ted.

That, I fancy, has been addressed as far as this forum is able to address such things.

You suggest I am attempting to moderate this discusssion. I reject the premise of your assertion and I am not inclined to engage you further with regard to this matter in a public setting.

You are always welcome to email me if you wish to further this exchange. You will find my email address in my profile.

MtD

Do you have any idea how thoroughly unpleasant you come across? Not just on this thread but in general? I suppose not. But maybe you do, what with that "Hyena - Nature's Asshole" banner, is this a hint of what people should expect from you and your posts?

Ted: I'm sorry for, at this point, hijacking the thread, it won't happen again.

[Matty the Damned]

Do you have any idea how thoroughly unpleasant you come across? Not just on this thread but in general? I suppose not. But maybe you do, what with that "Hyena - Nature's Asshole" banner, is this a hint of what people should expect from you and your posts?

"You are always welcome to email me if you wish to further this exchange. You will find my email address in my profile."

MtD
(Who hopes Inch will drop him a line)

[David_CA]

(Who hopes Inch will drop him a line)

LOL  I always thought it was Itchingblue instead of Inchlingblue.  Damned dyslexia!

[Assurbanipal]

Ted,

I just read this thread, and I would like to bring up some things that nobody has mentioned yet.  

First off, when you put something in your mouth, especially a drug, without asking all the questions that should be asked about said drug, becomes your responsiblity "legally", at least as far as the Pharma is concerned.  Remember, doctor's advice ends with our placing anything in our mouths without checking first.

Secondly, and probably more important is the stress, and negative impact on your immune system, will probably cause you far more issues with your numbers than you can immagine at this point, and you might very well have to start meds sooner than later as a result.  Are you ready for two or three years of stress, because of something you might have failed to do?  Remember, Pharma, and hospitals have far more, and less scrupulous teams of attourneys, than you can probably afford.  My suggestion is to learn from it and move on.  The experience will be far more valuable in the future, as you fight this disease, than any amount of money, or satisfaction you might reap from a suit. 

If you decide that a suit is a good alternative however, check with your ASO for your states' "legal aid".  Most large universities have one as part of their legal internship.

cites please

A (finding this highly unlikely to be correct advice in the given situation -- too many plaintiffs have won too many suits to the contrary)

[skeebo1969]

LOL  I always thought it was Itchingblue instead of Inchlingblue.  Damned dyslexia!

  I think it's a movie or song, can't remember which.  David, I have it worse than you though, for some reason I get him mixed up with livedbythemoon.  I don't know why, perhaps they joined around the same time....  both good people in my book.

   Ted, have you learned much here?  I hope so, because this thread is a prime example of how your friends here at AM can really stretch something out beyond belief.  Don't fret though it all comes from a good place.  I hope you are feeling better today.

   Thomas

  

  

[Moffie65]

cites please

A (finding this highly unlikely to be correct advice in the given situation -- too many plaintiffs have won too many suits to the contrary)

Assurbanipal,
I adjusted my original post, to pay defference to your exquisite professional inquisition.  I have no business posting anything here anymore, I am neither a doctor or a lawyer.  I see that many of the newer infected have far more experience in both the law and HIV, so my opinions are obviously just noise here.

Thanks for the heads up.

[leatherman]

 I think it's a movie or song, can't remember which.

it's from a poem ("Bantams in Pine-woods" by wallace stevens ) but that's like a song,
so you get half-credit for being close.

for some reason I get him mixed up with livedbythemoon.  I don't know why, perhaps they joined around the same time....  both good people in my book.

maybe cause they both have almost the same color blue in their avatar? cookie monster vs buddha

[Rev. Moon]

David, I have it worse than you though, for some reason I get him mixed up with livedbythemoon.  I don't know why, perhaps they joined around the same time....  both good people in my book.

Interesting that you should say that, I get you and Miss Philicia mixed up all the time  .

[skeebo1969]

Interesting that you should say that, I get you and Miss Philicia mixed up all the time  .

Well if it helps I am the one with the poor sentence structure.

[David_CA]

Well if it helps I am the one with the poor sentence structure.

And the hair.

[tednlou2]

I want to thank everyone again for their thoughts.  I've read them a few times.  The arguing could get out of hand, but a good debate may bring out valuable info.

I just want to say again-- If I were to ever get sick again, I would, or someone, would be checking everything.  It is a good idea anyway, since something like 100,000 people die each year from medical mistakes.  I think it is important to remember that I was very ill with pneumonia.  I was so weak that I couldn't make it to the bathroom.  I was also on pain killers.  I just assumed all the meds were for treating the pneumonia.  I assumed they would have told us if they were going to start me on HIV meds.  I know what they say about people who assume.  My partner was just as naive.  While my brother and his partner are in the medical profession, I was not going to tell them my newly found status.  As I said, they recognize the name of the drug and asked me why I was being given HIV meds.  This is how I learned on was on HIV meds.  I didn't want to discuss it with them and was not going to get them involved in asking why I'm on HIV meds.  I didn't want them to know in the first place-- at least not then. 

As to the argument on whether 4 days would cause resistance:  Dr. Young, Dr. McGowan, Dr. Gallant, and docs in my own practice have told me 4 days could cause resistance.  So, I don't know.  I do appreciate everyone who took the time to give their opinions.  I guess I need to do some soul searching on what is right.  I'm mainly just concerned with how people are treated in hospitals after being told they are poz. 

[Ann]

Ted, don't beat yourself up about assuming the doctors were doing the right thing. If you're someone who never had to deal with a major illness before you got sick, it's perfectly natural that you would trust your doctors. I think it's probably safe to say that most of us here did the same until we had some sort of wake-up call, just like you did. I know I trusted doctors to "know best" until I ended up being coerced into a totally unnecessary c-section. Ever since then I question, question, question!

I don't know if suing would be the best course of action for you, taking into consideration your existing anxiety issues. It could turn out to be like throwing petrol on the fire. However, it would be a good thing if you tried to bring attention to this ghastly error in some other, more productive way. Good luck, you've got my support whatever course of action - or even inaction - you decide is best for you. Maybe your brother and/or his partner could help point you in the right direction, now that they know about the hiv anyway. They may be very good allies.

Ann

[tednlou2]

Thanks Ann for the kind remarks and advice.