Mix-up
Posted on 29. Jan, 2010 in Case Reports
Case Synopsis
Bad Diagnosis
Dr. Jacob Yates worked at a Life Extension Institute in California when he treated Randy. Randy had been diagnosed with emphysema, which usually occurs after a long history of smoking. During his series of appointments in 1997, 
Randy had blood work done and also underwent a computer “age scan”. As treatment, Dr. Yates prescribed Randy a regimen of thyroid supplements, DHEA, testosterone, and Human Growth Hormone (HGH) – these are not generally prescribed for emphysema.
Two years later in December 1999, Dr. Jacobs sent a letter to Randy to inform him that insulin would be added to his medication regimen. Since then, Dr. Jacobs would prescribe 4 ml’s of insulin (Ultralente) mixed with the vial of HGH. The HGH and HGH-insulin mixtures were concocted in the back room of the Life Extension Institute by two unlicensed employees.
Of note, insulin is usually given to diabetics – Randy did not have diabetes.
Shock and Denial
For 5 days Randy took the new HGH-insulin mixture as prescribed. On Christmas eve at 6 pm, Randy went into seizure and insulin shock. He was emergently hospitalized. On admission to the hospital, his blood glucose level was dangerously low at “26”. Randy was held in the hospital for 4 days.
After discharge, Randy was presented a disclaimer form regarding the HGH-insulin mixture. Randy refused to sign the form.
During investigation, the Life Extension Institute denied ever treating Randy. In fact, they provided a certification to attest to that. However, medical records from Randy’s family physician contained a copy of his medical records from the Life Extension Institute.
In February 2000, Dr. Yates had his license to practice medicine suspended.
But Wait, There’s More!
You would think that the story ends here, but there’s more. Without a license, Dr. Yates also lost the ability to prescribe medications. Not a problem. In August and November of 2000, Dr. Jacob Yates covertly used Dr. Debra Yates’ (his sister’s) license to purchase micronized testosterone and testosterone powder.
In addition, throughout 2000 and 2001, Dr. Jacob Yates would unlawfully export controlled substances to individuals in various countries. These drugs included anabolic steroids and Schedule IV stimulants. Even after being admonished by the U.S. Drug Enforcement Administration (DEA), he continued to export the controlled substances.
Outcome
Dr. Yates had his license revoked. However, the revocation was stayed and Dr. Yates was placed on 5 years probation. He also agreed to pay the medical board $10,000 for legal and investigation costs.
Analysis by Florence
To Randy for not signing the disclaimer, I want to say good job! He clearly understood what was happening and refused to give in to pressure. Now, having said that, I want to take this one more methodically than I normally do, so I will try to use our “DAISE” scoring as a rubric.
This case certainly caused some damage, mostly to poor Randy there. Luckily for him, he lived to tell the tale, and it seems like he had a full recovery. So, I think the overall damage is slightly lower compared to many of the other cases we’ve come across. As for anger while reading this story, I do feel slight anger at the doctor, but at the same time it is possible there was a mistake. However, my ire rises when I read about how they tried to get Randy to sign a disclaimer after he was hospitalized and then tried to lie about ever treating him.
I don’t know if the doctor was inept. It seemed that he was more into unconventional treatments rather than just being ignorant. I think he knew that what he was doing was not typical medical practice. He then tried to cover it up. I also think there are a lot of people with medical degrees not practicing mainstream medicine — with varying degrees of success. This is why this case does not shock me very much.
Ethically, however, I think this is pretty high on the scale. Dr. Yates knew what he was doing, so he is then also responsible for the results. Not only did he prescribe dangerous medicines, he also tried to lie about it. Then, after losing his license, he began using his sister’s! This must have put her in a difficult position! The bonds within a family should not be used in such a way.
So here is my final score:
| Score |
|---|
| 4.2 |
| Damage | Anger | Ineptitude | Shock | Ethics |
|---|---|---|---|---|
| 4 | 7 | 1 | 1 | 8 |
Response by Marc
Recently, TV shows have really sensationalized doctors being on the fringe of medicine. We almost encourage it and look for the newest, strangest snake oil.
After doing a bit of research, I found that using HGH to slow down or reverse aging has become somewhat of a growing fad. Sort of like Juan Ponce de León searching for the Fountain of Youth. To date, HGH has not been FDA approved for such use, and many doctors refuse to use it for it’s “anti-aging” effects because of potential harmful long-term effects. (The FDA does, however, approve it’s use for treating certain hormone-deficiencies.)
So why did Dr. Yates give HGH for emphysema? After all, emphysema is destroyed lung tissue caused by chronic smoking—not aging. It seems that Dr. Yates was under the belief that, with HGH, he could reverse the effects of emphysema by causing the destroyed lung tissues to grow back.
Now, why insulin? I haven’t a clue. I just know that there are many fans of Dr. Yates out there, and Randy had to have known what he was getting into. (Don’t get me wrong, I still think what the doctor did was unethical!) Practicing experimental medicine is something very dangerous. But being a patient who flocks to such unorthodox treatment, looking for that magical elixir, is just at fault.
| Score |
|---|
| 4.8 |
| Damage | Anger | Ineptitude | Shock | Ethics |
|---|---|---|---|---|
| 5 | 5 | 5 | 2 | 7 |
Response by Lyssa
I understand that Randy did not end up dying. However, he could have died! The fact that he didn’t testifies to the abilities of the ER workers, not to Dr. Yates! The doctor prescribed a deadly medication that he had to have known could cause harm.
However, I think the biggest deal was not the bad prescription, but rather Dr. Yates’ actions after the fact. It is one thing to mess up experimental medication, but it is another to lie and try to get away with the consequences. It certainly seems to me that 5 years’ worth of probation and $10,000 is awfully weak punishment for someone who blatantly disregards regulations surrounding restricted drugs.
| Score |
|---|
| 5.4 |
| Damage | Anger | Ineptitude | Shock | Ethics |
|---|---|---|---|---|
| 7 | 8 | 2 | 2 | 8 |
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RachLv
Jan 31st, 2010
I agree with Marc to a point. This doctor was providing a service other doctors were not. Just because the treatment failed doesn’t mean he should be stopped. The patient took the risk, the doctor shouldn’t be punished.
What_The_Heck
Feb 1st, 2010
@RachLv How can you agree with that point? I am for experimenting as this is the only way science can evolve but the fact that after the doc was reprimanded he then used his own sister’s med license to aquire drugs is just inexcusable.
Pat
Feb 1st, 2010
Experimental medicine? Okay. But I have some questions. Was the patient told this was experimental? After the patient was started on the HGH and insulin combination, were his blood sugars monitored in any consistent fashion? Patients are looking for a silver bullet for their problems and generally can’t be expected to know that they are getting snakeoil or worse. This doctor is an ethical nightmare.