Parkinson’s Treatment - Off and On: A medication error

Raul, a very nice elderly man who has had Parkinson’s Disease for 15 years, had frozen in place, seemingly awake but unresponsive, for more than an hour. Such on/off states among Parkinson’s patients are quite frightening to spouses when they occur. They seem to occur when the patient’s brain lacks Dopamine, a chemical that is provided by Sinemet. Alarmed, his wife called an ambulance, which took Raul to a large, well-known medical center. He arrived at noon. Later that afternoon, his wife gave his Sinemet—the mainstay of his treatment for all these years—to the E.R. nurse, with instructions that his next pill was due at 11 pm.

Raul was finally admitted to a hospital bed on the Surgery unit at 9 pm, because no bed in an appropriate unit was available. When Raul’s adult son called Raul’s nurse at 11:40 pm to verify the nurse had indeed given him the Sinemet, the nurse said another nurse was getting it. In other words, the attending physician had to write an order for the same medicine, hopefully in the same dose, with a similar timed release, and the hospital Pharmacy would dispense it—but this had not been done, and the dose was already 40 minutes late. Without their Sinemet, patients with advanced Parkinson’s often have extreme, uncontrollable tremors affecting their whole arms and legs, as viewers of Michael J. Fox’s political advertisement in last year’s Senatorial election in Missouri saw. The nurse mentioned that Raul had been quite “restless.” As my teenager says, Duh!

The hospital’s delay in providing the Sinemet had both caused this upsetting and uncomfortable set of tremors, AND made a recurrence of the on/off state even more likely—and that was the very cause that brought him to the hospital for treatment! Excuse my cynicism, but I doubt that the hospital will withhold their bill, or delay in sending it. Raul’s Medicare should cover the bill, so my thanks to you, Reader, the American taxpayer, for paying for his care

Advice to patient advocates: If a hospital patient depends on the meds he has brought from home, call to ensure that nurses have given them to him on time.