TN man with wife's kidney blames Vanderbilt for organ decline

[okarol]

TN man with wife's kidney blames Vanderbilt for organ decline
Medication was changed; Vanderbilt says no mistakes were made

Sandy Thornton looks at her husband of 35 years with the sad knowledge that the kidney she gave him is dying.

“Vanderbilt has murdered that kidney,” she said.

She blames the pill that a nephrologist from Vanderbilt University Medical Center prescribed. Vanderbilt contends that no medical mistakes occurred in the course of Dan Thornton’s treatment and that it “met or exceeded the standard of care.”

The Thorntons tried to sue, but they ran into barriers. So they went beyond the courts. They filed complaints with Medicare, the United Network for Organ Sharing, the Joint Commission and the Tennessee Department of Health. The Tennessee legislature has passed tort reform laws in recent years that make it more difficult to file malpractice suits.

But complaints like the ones the Thorntons just filed could also put financial penalties on hospitals. The federal government is pushing for transparency and accountability to lower health-care costs. If it determines hospitals make mistakes with Medicare and Medicaid patients, it won’t pay the hospital bills.

“Medicare considers him a million-dollar man,” Sandy Thornton said. “They have paid out nearly $1 million for our transplant and also $400,000 to keep him alive for three months.”

Obvious mistakes, such as surgeries on the wrong side of the body, are in the initial list for nonpayment, but scrutiny is expected to expand to other disputes between patients and hospitals.

The medicine at the heart of the conflict between the Thorntons and Vanderbilt was already the focus of an ongoing federal lawsuit when Dan Thornton was prescribed Rapamune. Vanderbilt switched his anti-rejection medicine to Rapamune six years after his transplant.

The lawsuit alleges that Wyeth Pharmaceuticals (now Pfizer) promoted switching patients from other anti-rejection medicines to Rapamune, when the drug is supposed to be used only by patients who start taking it immediately after their transplant surgeries.

Thornton started taking Rapamune in October 2010 — the month after the U.S. Department of Justice joined a whistle-blower suit that accused the drugmaker of illegal off-label marketing. A Vanderbilt nephrologist prescribed the drug to slow Thornton’s chronic kidney disease and to lessen the likelihood of his developing more skin cancers — a common complication for people on anti-rejection drugs.

But Thornton got sicker. The level of creatinine in his urine spiked — an indication his kidney was worsening — a week after he switched medications. By early November, he was in the hospital for dehydration. In December, he suffered a heart attack, which he says resulted from his kidney shutting down. Doctors switched him back to his original medication. By the end of 2010, he was back on dialysis.

Then in February — after all the anti-rejection drugs were out of his system — the kidney unexpectedly came back to life. Now, it’s faltering and Thornton is making plans to start dialysis again.

“They could have stopped this thing a week or two after that first reaction before I went into the hospital three times over an eight-week period,” he said. “It was a runaway train.”

He accuses the institution, which has a highly respected kidney transplant program with a 98 percent patient survival rate, of staging a cover-up.

Vanderbilt defends care
Vanderbilt, which issued a statement to The Tennessean after Thornton signed a release, said it has nothing to hide. Thornton’s medical history of high blood pressure and chronic dehydration can both cause and worsen kidney damage, Vanderbilt said.

“Although we are no longer managing his medical care, his declining kidney function is unrelated to any change from one standard anti-rejection medication to another standard anti-rejection medication,” Vanderbilt said. “Repeated efforts have been unsuccessful to help Mr. Thornton understand this temporary change in his anti-rejection medication is not related to the continued decline in the function of his kidney.”

The Thorntons say Vanderbilt’s switching back and forth between anti-rejection drugs caused the damage. Vanderbilt says the heart attack is to blame.

The labeling for Rapamune cautions that its safety has not been established for patients switching medications and also notes that increased rates of kidney rejection occurred among a certain group of patients in a clinical study. That study looked at patients who were switched from Thornton’s prior medication type to Rapamune and concluded it resulted in no kidney function benefits.

Vanderbilt said Thornton was told of the risks associated with taking Rapamune. Thornton said he was never told.

Dan and Sandy Thornton moved to Spring Hill from Florida, where they underwent successful transplant surgery in 2004 at Shands Jacksonville hospital.

Doctors gave them a good prognosis before they moved to Spring Hill a couple of years later to be closer to family.

But by 2010, his creatinine levels were rising. After Thornton was diagnosed with symptoms of renal failure by a non-Vanderbilt physician, he switched doctors because of Vanderbilt’s reputation as a transplant center.

Thornton said it’s hard to find a doctor who will challenge an institution like Vanderbilt. He does credit the hospital’s cardiac team for saving his life after his heart attack.

Contact Tom Wilemon at twilemon@tennessean.com or 615-726-5961 or follow him on Twitter @TomWilemon.

http://www.tennessean.com/article/20120127/NEWS07/301270075/TN-man-wife-s-kidney-blames-Vanderbilt-organ-decline?odyssey=tab|topnews|text|FRONTPAGE

[amanda100wilson]

That alarms me because I was switched from cyclosporine to rapammune shortly before my kidney packed up on me.     My creatine had gone up somewhat, hence the justification for the switch.  I was told that the eventual demise of my kidney was cyclosporine toxicity, but after they had switched me, my creatinine went up rapidly, and I demanded that they do a biopsy because I was concerned that it was acute rejection, my concern founded on the fact that they werenot monitoring the switch close enough.  I was told that no way it could be, but the biopsy revealed that this was indeed what it was.  The iv steroids given to combat this did little and creatinine continued to increase until I was initiated back on dialysis.  This was back in 2002 when the medication was very new.  I hasten to add that this was at another transplant unit, not Vanderbilt, but this has now got me wondering if this was malpractice.  When I was first taken off the meds. After I had started dialysis again, my PRA was 16%.  i was rapidly taken off the immuno- supression, and my PRA climbed to 99% where it has remained to this day which means little prospect of further transplant.

[Chris]

I was swtched to Rapamune in September of 200 and have had no problems. I have had improved creatinine levels and BUN since being switched from CellCept after 11 years.
 
We don't know the full story tho. When I was switched, I had blood test every week, then every two weeks, and finally back to my once a month schedule. So it would be nice to hear Vanderbuilt's side of this.