Joseph Hoff was a 66-year-old man. He was originally from Germany, and his family moved
to the United States when he was 3 years old. Joseph grew up in Chicago and then settled
in Omaha, Nebraska, where he ran a family business - furniture restoration and repair.
He loved the midwest and never really wanted to leave. One afternoon, Joseph was repairing
an old cupboard with his son, when his heart started pounding in his chest. He felt out
of breath and sat down on the cement floor, and before he knew it, he was lying down on
the floor. His son ran over and didn’t waste any time, as he called for emergency services.
About 15 minutes later, Joseph and his son were being taken into the Emergency Department.
The emergency room team was notified that he was arriving, and a team of folks worked
in unison to get him treated. Among other things, they set up monitors and IV lines
placed, obtained lab work, and performed an ECG.. A few minutes later, Dr. Daria Baldwin,
the cardiologist, came down to see him. She was handed the ECG. She look at the tracing
and shouted “he has ongoing V-tach, let’s give him amiodarone.”
Within a few hours, Joseph was stable. He was sent up to the medical floor for observation.
Dr. Baldwin swung by to pay him a visit him and explained that she had reviewed his medical
chart and that she wanted him to continue taking amiodarone. She said, “alright Joseph,
we’ll place you on the loading dose of 1200mg of amiodarone. Is that clear?” Joseph nodded.
She also told him to make a follow up appointment with her next week in order to check his condition
and reduce the amiodarone dose.
One week later Joseph arrived for his appointment. Dr. Baldwin asked Joseph if he experienced
any exhaustion, fluttering in his chest, or shortness of breath lately, but Joseph said
no. His ECG now showed normal electrical activity. As she was finishing up the appointment, Dr.
Baldwin got paged about another patient who was being combative and insisting on seeing
the doctor in charge. She apologized and headed off to deal with the situation, and asked
Joseph to continue the amiodarone and to see her again in 3 weeks.
Three weeks later, Joseph was on an unexpected road trip with his son. He called Dr. Baldwin
to let her know that he’s doing great and feeling well but needed to cancel his office
visit. She asked him to continue taking his medication, and asked him to check back with
her in a year. As she spoke to him on the phone, she mistook Mr. Hoff for Mr. Hoffman,
another patient of hers who was on a low dose of long-standing amiodarone. She noted the
phone call in the wrong chart.
Many months later, while Joseph was watching his son work in the workshop, he started to
cough. The cough worsened over a few weeks and he went in to his general physician who
asked him to get a chest X-ray. The chest X-ray that showed evidence of interstitial
pneumonitis, likely due to amiodarone toxicity.
Joseph sought out another cardiologist who was surprised that he had been taking such
high levels of Amiodarone for so long. Within a month, Dr. Baldwin received a letter stating
that her hospital was being sued and that she was being named specifically because she
was responsible for the ongoing amiodarone therapy of Joseph Hoff.
Now - to rewind this back - let’s imagine that Dr. Baldwin had been more careful to
explain the importance of tapering the medication to Joseph during his first appointment. If
that had happened, he would have been vigilant about not taking high doses for so long. In
addition, let’s say that Dr. Baldwin had been more careful when she received the phone
call about the canceled clinic appointment. She would have had a chance to reschedule
Joseph at a more appropriate time, and would have likely reduced his Amiodarone dose when
she saw him again Ultimately, without being on such a high dose, Joseph would probably
not have developed severe amiodarone toxicity. The moral? Review patient’s medications
with them carefully, and make sure that individuals on chronic medications are carefully monitored.