Case #4033 Death Resulting From Narcotic Intoxication Caused By Violation of the Standards of Care
On July 20, the Plaintiff’s Decedent was admitted to the Defendant Hospital under the care of the Defendant physician. It is alleged that the Plaintiff’s Decedent had undergone an above-the-knee amputation due to an injury he sustained, and was admitted for the purpose of undergoing and limb lengthening procedure so that a prosthetic leg could be fitted and function efficiently. The Plaintiff’s Decedent selected the Defendant physician and hospital because they held themselves out as specialists in the particular procedure which was scheduled.
Prior to the operation, the Defendant informed the Plaintiff’s Decedent and his family that the procedure was safe and would benefit him in resuming his activities with the prosthesis. Relying on the Defendant’s advice and recommendation, the Plaintiff’s Decedent agreed to undergo the procedure on July 20. It is alleged that the procedure was uneventful, with the Plaintiff’s Decedent being admitted to the recovery room (P.A.C.U.) at approximately 4:00 p.m. that day. At that time, the Defendants ordered 20 milligrams of Morphine (an extremely potent Class A narcotic) in addition to two doses of Demerol (a second extremely potent Class A narcotic). Subsequently, the Plaintiff’s Decedent was started on a PCA pump which is a device designed to automatically administer medications (such as Morphine in this case) on a set schedule. A “loading” dose of 5 milligrams of Morphine was infused at that time, with the pump set to additionally infuse 1 milligram of Morphine every nine minutes. Subsequently, the pump dosage was increased to 5-6 milligrams every nine minutes and later reduced to 2 milligrams every nine minutes. As a result of the combined orders and administration of medication, the Plaintiff’s Decedent received 52 milligrams of Morphine in a four-hour period of time in addition to Demerol.
At 10:00 p.m., an additional potent pain relieving medication known as OxyContin was ordered. It is alleged that these medications were ordered and administered without benefit of an assessment by a physician, which was required by the standards of care. Additionally, the OxyContin was administered orally and not through the pump, in further violation of the standards of care.
It is alleged that vital signs taken on the Plaintiff’s Decedent revealed a baseline blood pressure of 134/71. However, as the night progressed, it is alleged that the Decedent’s blood pressure steadily decreased so that at midnight, his blood pressure had fallen to 92/63 — a severe downward trend that required immediate physician assessment and intervention to reverse the effects of the narcotics. Further, it is alleged that the nurses negligently failed to monitor the vital signs after midnight — an additional breach in the standards of care.
By 2:00 a.m., it is alleged that the Plaintiff’s Decedent was unable to void urine, requiring catheterization. It is alleged that his inability to void constituted another clear sign that he was suffering with ongoing and cumulative narcotic intoxication. It is asserted that these Defendants had administered excessive doses of narcotics in violation of the standards of care, and then compounded the ongoing negligence by their failure to adequately monitor the Decedent’s downward spiraling vital signs, culminating in his inability to void. At that time, it is alleged that the standards of care again required immediate physician evaluation and a reversal of the narcotic intoxication. However, these Defendants continued to negligently ignore his signs and symptoms. Predictably, at 6:00 a.m., the Plaintiff’s Decedent was found pulseless. A resuscitation was conducted thereafter over approximately 34 minutes, which proved too little — too late. As a direct and proximate result of the ongoing negligence of these Defendants and each of them, the Plaintiff’s Decedent died during the early morning hours of July 21, 2001.
After pronouncing the Plaintiff’s Decedent dead, the Medical Examiner’s Office conducted an autopsy, and concluded that the Plaintiff’s Decedent died of “narcotic intoxication.”
It is alleged that these Defendants and each of them violated the standards of care by overmedicating the Plaintiff’s Decedent with Morphine and other narcotic medications. Further, they failed to adequately monitor the Plaintiff’s Decedent so that an otherwise perfectly healthy 32-year-old man died as a result of a drug overdose. Had these Defendants and each of them conformed with the applicable standards of care, appropriate dosages of the medications would have been utilized in addition to ongoing, necessary monitoring which would have prevented the needless and tragic demise of the Plaintiff’s Decedent. In fact, had these Defendants conformed with the required standards of care, the Plaintiff’s Decedent would have made an uneventful recovery, had his prosthesis fit, and would have returned to his family in an otherwise normal and healthy condition.