If you or a family member has developed polycythemia, particularly while undergoing testosterone replacement therapy (TRT), you may have questions about whether your medical care was appropriate.
Polycythemia, a blood disorder where there’s an excess of red blood cells, requires careful management. Blood work including a high red blood cell count, elevated hematocrit, and increased hemoglobin can be warning signs of this potentially life-threatening condition. We see similar medical malpractice cases around blood disorders. You can read about it in our article “Sickle Cell Crisis: Neglected Symptoms Cost African American Man’s Life”.
When doctors, nurse practitioners, or physician assistants fail to meet the expected standard of care, particularly in cases involving TRT, it can lead to serious complications and may constitute medical malpractice. This article aims to inform you about potential malpractice issues in polycythemia cases, including the risks associated with TRT, and your rights as a patient in Texas.
Understanding Polycythemia and Testosterone Replacement Therapy
Polycythemia is a condition where your blood becomes more viscous or thickened because of an excessive number of red blood cells in the bloodstream. There are two main types:
- Primary Polycythemia (Polycythemia Vera): A rare blood cancer caused by genetic mutations.
- Secondary Polycythemia: This is the more common type. It can be caused by testosterone replacement therapy, other medical conditions, or external factors like smoking or living in a high-altitude setting.
Testosterone replacement therapy (TRT) is a treatment used for men with low testosterone levels. However, TRT can increase the risk of developing or worsening polycythemia, as testosterone stimulates red blood cell production.
When Might Medical Malpractice Occur?
Medical malpractice in polycythemia cases, especially those involving TRT, can happen at various stages of medical care:
Failure to Screen or Monitor
- Not screening for polycythemia before starting TRT
- Failing to monitor hematocrit levels regularly during TRT
If a urologist, endocrinologist, or primary care physician starts a patient on TRT without checking baseline hematocrit levels or fails to monitor these levels during treatment, it violates the standard of care because of a failure to screen or monitor, and can lead to undetected polycythemia. When it comes to blood disorders, learn how hospital laboratory errors can cause patient injuries and even death.
Ignoring Risk Factors
- Prescribing TRT to patients with pre-existing polycythemia or high risk of developing it
- Failing to consider other risk factors that may compound the risk of polycythemia with TRT
Before starting a patient on TRT, the standard of care requires doctors and providers to collect a thorough patient history and perform any necessary tests to have a clear understanding of the patient’s risk factors. If a physician or provider writes a prescription for TRT for a patient with a history of polycythemia or other risk factors like sleep apnea without proper precautions or monitoring, it violates the standard of care.
Failure to Diagnose
- Ignoring or dismissing symptoms that suggest polycythemia in patients on TRT
- Not ordering appropriate blood tests when symptoms are present
If a patient on TRT reports symptoms like headaches, dizziness, and fatigue, but the doctor or provider dismisses them without investigating for polycythemia, it violates the standard of care and puts the patient at risk for dangerous complications and even death.
Delayed Diagnosis
- Not following up on abnormal test results in a timely manner
- Failing to refer the patient to a hematologist when polycythemia is suspected
If a TRT patient’s blood tests show elevated hematocrit levels, but the doctor or provider doesn’t act on these results promptly, it’s medical negligence that places the patient in unnecessary risk.
Improper Treatment
- Continuing TRT despite clear signs of polycythemia-
- Not adjusting TRT dosage or administration method when polycythemia develops
- Failing to discontinue TRT when necessary
If a physician or provider continues TRT at the same dosage despite a patient’s hematocrit rising above safe levels, it increases the risk of potentially life-threatening blood clots. Discover how one of the most common drug errors is giving 10 times the correct dose.
Medication Errors
- Prescribing inappropriate TRT formulations or dosages
- Failing to consider drug interactions between TRT and other medications
If a doctor or provider prescribes a high dose of injectable testosterone to a patient already at risk for polycythemia, rather than considering a lower dose or transdermal application, then it may constitute medical negligence.
Inadequate Monitoring
- Not scheduling regular follow-up appointments and blood tests for patients on TRT
- Failing to monitor for complications of polycythemia in TRT patients
If the doctor or provider managing TRT doesn’t schedule a patient for regular hematocrit checks, it can cause a delay in detecting dangerous polycythemia and preventing thrombotic (blood clot) complications.
Failure to Inform
- Not educating patients about the risks of polycythemia associated with TRT
- Failing to obtain informed consent that includes discussion of polycythemia risks
When a doctor, physician assistant, or nurse practitioner starts a patient on TRT without informing him about the risk of polycythemia or signs to watch for, it leads to delayed recognition of important symptoms.
Legal Considerations for Texas Patients
If you believe you’ve experienced medical malpractice related to polycythemia care, especially involving TRT, here are important points to keep in mind:
Statute of Limitations
In Texas, you generally have two years from the date of the medical error to file a malpractice lawsuit. However, in some cases where the injury wasn’t immediately apparent, this time might be extended under the discovery rule. It’s important to consult with an experienced medical malpractice attorney for an opinion on how the law applies to the facts of your particular situation.
Proving Malpractice
To have a valid malpractice claim, you must be able to show:
- A doctor-patient or provider-patient relationship existed
- The care fell by the doctor or provider below the accepted medical standard
- This substandard care caused you harm
- You suffered damages as a result
Expert Testimony
Texas law requires an expert report from a qualified medical professional shortly after a medical malpractice lawsuit is filed. This report must explain how the doctor or providers’ care fell short of standards and how it caused your injury.
Damage Caps
A lot of people have heard about tort reform measures that apply to Texas medical malpractice cases. Fortunately, these draconian measures don’t apply to all types of recoveries.
For example, there’s no cap that limits the amount a jury may award based on evidence of on economic damages for things like medical bills and lost wages.
On the other hand, Texas law limits non-economic damages (like pain and suffering) to $250,000 no matter how many physicians are involved and named as defendants. If a hospital or facility is also named as a defendant, another non-economic damages cap of $250,000 is available. It’s important to understand that under the Texas corporate practice of medicine doctrine, physicians are generally not hospital employees – this means that hospitals aren’t legally responsible for physician negligence.
Shared Fault
If you’re found to be partially at fault for your injury (for example, by not following doctor’s orders), your compensation may be reduced. If you’re more than 50% at fault, you may not be able to recover damages at all.
Steps to Take If You Suspect Malpractice
If you believe you’ve experienced medical malpractice in your polycythemia care, especially related to TRT:
Seek proper medical care to address any ongoing health issues.
Obtain copies of all your medical records, including testosterone levels and hematocrit measurements.
Keep a detailed journal of your symptoms, treatments, and conversations with healthcare providers.
Don’t sign any releases or agreements with healthcare providers or insurance companies without legal advice.
Consult with a qualified medical malpractice attorney who has experience with polycythemia and TRT cases.
Mistakes in managing polycythemia, especially in the context of testosterone replacement therapy, can have serious consequences. If you’ve suffered harm because of negligent care, you have the right to seek compensation in court. Medical malpractice cases involving polycythemia and TRT require specialized legal and medical knowledge. An experienced medical malpractice attorney can help evaluate your case, navigate the legal process, and fight for your rights.
Remember, early action is crucial because of the strict time limits the law imposes on filing a claim. If you suspect medical malpractice in your polycythemia care, particularly if it involves testosterone replacement therapy, don’t hesitate to seek legal advice to understand your options and protect your rights.
