Medical board reprimands psychiatrist Derek A. Ott in patient death

May 18, 2009

The Medical Board of California issued a Stipulated Settlement and Disciplinary Order on psychiatrist Derek A. Ott, consisting of a mere public reprimand and a few remedial requirements for repeated negligent acts. In February 2009, the Board charged Ott with gross negligence and repeated negligent acts relative to the treatment of a 43-year-old female patient who died from lithium toxicity. At the time Ott prescribed lithium, the patient was also taking the medication vasotec for high blood pressure. Cases of lithium toxicity have been reported in patients receiving vasotec and lithium concurrently, so serum lithium levels in such patients must be monitored more frequently. Following the prescription of lithium, the patient’s first serum level check showed an abnormally high lithium level, which was noted by the staff but not reported to Dr. Ott. At the next treatment session, Dr. Ott found the patient still aggressive and assaultive and so, without checking the patient’s serum lithium level, he doubled the lithium dosage. The standard of care calls for the lowest dose and blood level of lithium necessary to obtain a therapeutic response. Dr. Ott should have ordered a serum lithium level check before doubling the dose or, at the very least, within four or five days after doubling it. At the last treatment session, the patient was more depressed, anxious and fearful as well as delusional and confused. She had tremors and was refusing to eat. She also was having bouts of diarrhea and vomiting. Her speech and thought patterns were noted by staff as incoherent and illogical—all known side effects of lithium toxicity. Dr. Ott did not feel that the patient was exhibiting lithium toxicity, but rather side effects of the antipsychotic, so he ordered her re-started on an anti-cholinergic drug. The next morning the patient was transported to the emergency department of a local hospital (where she was found to have an extremely elevated serum lithium level) and died there within 24 hours of admission. Ott is additionally ordered to successfully complete a prescribing practices and medical record-keeping course, among other requirements.

(Stipulated Settlement and Disciplinary Order, In the Matter of the First Amended Accusation Against: Derek A. Ott, M.D., Case No. 06-2006-178587, Medical Board of California, ordered April 17, 2009.)