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Case #4022 Anaphylactic Reaction to Medication Lead to Death


On January 11, the Plaintiff’s Decedent voluntarily checked into the Defendant facility for alcohol dependency.  At the time of the Plaintiff’s Decedent’s admission, he was a 66-year old gentleman with no significant medical history other than hypertension for which he was taking 300 milligrams of Cardizem LA daily.

On January 17, the Defendant 1, a primary care medical doctor at the Defendant location, saw the Plaintiff’s Decedent and changed his medication, adding 20 milligrams of Lisinopril daily for the management of hypertension.

On January 19, at 8:00 p.m., the Plaintiff’s Decedent presented to the nurses’ station at the Defendant facility reporting that he was feeling the sensation of a lump in his throat.  The nurse on duty consulted with the Defendant 2 (a psychiatrist and not a primary care physician) and advised him that not only did the Plaintiff’s Decedent complain of a lump in his throat, but that his tongue appeared to be swollen.  The Defendant 2 violated the standards of care by failing to transfer the Plaintiff’s Decedent to the emergency room of a local hospital where appropriate examination, care and treatment would be rendered. At 10:00 p.m., the nurse on duty at the Defendant facility finally contacted the medical doctor, the Defendant 1.  The Defendant 1 was provided with all of the information that the nurse had previously provided to the Defendant 2.  Amazingly, the Defendant 1, who was not in the facility but was attempting to manage the Plaintiff’s by telephone, violated the standards of care by failing to recognize the severity of the Plaintiff’s Decedent’s condition and by failing to arrange for an immediate transfer to the emergency room.

It is alleged that the Decedent’s condition continued to deteriorate due to a lack of proper treatment.  At 11:00 p.m., the Defendant 2 again evaluated the Plaintiff’s Decedent and confirmed the increased difficulty breathing, swollen tongue and increased anxiousness.  Finally, the Defendant 2 belatedly considered the possibility of an anaphylactic reaction to the new medication and ordered that he be transferred to the emergency room which did not occur until 11:45 p.m.

On January 20, at 12:10 a.m., the Plaintiff’s Decedent arrived at the Defendant Hospital emergency room via ambulance.  At 12:35 a.m., five minutes after the cricothyrotomy tube had been placed, the Plaintiff’s Decedent vomited, dislodging the cricothyrotomy tube.  At 12:48 a.m., an ear, nose and throat specialist arrived and finally performed a tracheotomy which proved to be too little, too late.  At 12:55 a.m., the Plaintiff’s Decedent sustained a cardiac arrest and was pronounced dead at 1:15 a.m.

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