Practice Areas

Many physician and nurse experts used for screening don’t recognize potentially good plaintiff gentamicin cases

Attorneys have told us that a nurse or physician they use for case review couldn’t find standard of care violations in gentamicin poisoning cases. From our extensive experience, we knew a qualified expert would have spotted them. We suspect that the reason for this is a prejudice on the part of the nurse or physician reviewer. There is a perception in these cases that the prescribing physician was faced with a “life or death situation” and needed to bring out the “really big gun.” The reviewing expert’s analysis often ignores the newer “big gun” antibiotics that have appeared since the mid 1990's that are far less toxic than gentamicin, or the fact that gentamicin might be indicated only for empiric therapy prior to obtaining culture results.

Choose an ID Expert for initial case review

If there is no major issue of causation, (you have a firm diagnosis of gentamicin-induced ototoxicity from an expert physician well versed in balance disorders who has tested the patient), and there appears to be some merit in investigating standard of care violations, the best expert for threshold evaluation is an infectious disease specialist (ID expert) who has a good familiarity with gentamicin issues. We have found certain ID experts that have an extensive knowledge of gentamicin issues.

In appropriate circumstances, ID experts might opine that if a non-ID specialist is giving gentamicin for an extended period of time, at a high dose, or in a renally impaired patient, that physician should obtain an ID consult, or assume the standard of practice of an ID specialist.

Make an initial determination of causation

Causation is sometimes overlooked in the initial evaluation. Unless there is an undisputable casual link between the gentamicin administration and the client’s vestibular symptoms, an examination of the patient and a complete chart review by an experienced neuro-otologist or otolaryngologist specializing in balance disorders is a priority.

Additionally, any other potential causes of the vestibulopathy must be ruled out early on. Three of the many alternative possible causes of vestibulopathy are:

• A traumatic head injury about the time of the gentamicin administration.
• The client taking a diuretic without the knowledge of his physician about the time of the gentamicin administration.
• Another physician prescribing an ototoxic drug that was unknown to the defendant physician.

Just like other medical malpractice cases, if there is any conceivable explanation for your client’s symptoms, the defense will exploit it.