Psychiatrist Derek A. Ott, reprimanded in patient death, received $94K from pharma companies

December 1, 2010

Los Angeles psychiatrist Derek Ott’s website informs the reader that he "focuses on psychopharmacology in children, adolescents, and adults" and that the "services provided include comprehensive psychiatric diagnostic assessments, psychopharmacological medication management, second opinion consultations and case management."

It does not mention that he was reprimanded by the Medical Board of California ("Board") in 2009 for repeated negligent acts, resulting in the death of a patient.    

That information was posted on the Psychcrime.org website last year but was recently reiterated by the public interest news agency ProPublica, in their recently issued the report "Dollars for Docs."  The article identified 384 physicians who received more than $100,000 from one or more of the seven pharmaceutical companies which publish such information (such companies include Eli Lilly, GlaxoSmithKline and Pfizer).  

Pharmaceutical companies may pay physicians for various reasons, such as for giving promotional speeches about a company's drug to groups of doctors or being a company's paid consultant. 

Their research shows that Ott received more than $94,000 from three pharmaceutical companies between late 2009 and early 2010: $37,818 from Eli Lilly & Co.; $8,200 from Astrazeneca and $48,000 from GlaxoSmithKline.  Most of this was fees for "Healthcare professional education programs" (i.e., fees to speak to groups of doctors about a pharma company's drug). 

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 Ott. At the next treatment session, 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."

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.

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 was additionally ordered to successfully complete a prescribing practices and medical record-keeping course, among other requirements.

* A drug or agent that blocks nerve impulses, used to control intestinal spasm, increase the heart rate, dilate the pupils for examination of the eyes, dry secretions in anaesthesia, and in some forms to treat Alzheimer's disease.

Dr. Ott has particular expertise in the areas of neuropsychiatry, developmental disabilities, attention-deficit hyperactivity disorder (ADHD) and childhood psychosis. He has extensive experience working with individuals with neurological disorders, developmental disabilities (such as autism and Asperger's), as well as comorbid behavioral/psychiatric disorder.

The University of Cincinnati website describes schizophrenia researcher Henry Nasrallah as "an internationally recognized psychiatrist, educator and researcher."  Thanks to the work of the ProPublica news group, the University can now add "internationally recognized researcher compromised by pharmaceutical company influence."  

Source: 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.