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December 2007 Legal Case Study

Failure to Properly Monitor Man on Dilaudid From PCA Pump - Death - $500,000 Verdict.

The plaintiff's decedent was admitted to the defendant hospital in April 2002 for a below-knee amputation of the left leg. After surgery he was placed on morphine via a patient-controlled analgesic pump. Later that day, nurses determined that he had low blood pressure and altered mental status. The PCA was stopped, but no note was made in his chart. His regimen of Coumadin was supposed to be restarted the next day, but it allegedly was not. His pain was controlled with Darvocet and, on one occasion, Demerol.

Following the Demerol dose, an anesthesiologist, Shahid Rashid, was consulted. Dilaudid was prescribed, to be delivered by PCA. The dosage was allegedly higher than anything previously prescribed. The medication started between 8:00 and 8:35 p.m., reportedly coinciding with the last documented nursing assessment, until 11:45 p.m., when the decedent was found unresponsive in his bed. A code was called, but he was not able to be resuscitated.

The plaintiffs claimed that Dr. Rashid failed to appreciate the decedent's opiate sensitivity and failed to properly assess the appropriateness of Dilaudid PCA. The plaintiffs also contended that Dr. Rashid prescribed too much medication with a basal rate that could not be discontinued by the patient. The plaintiffs also claimed that the hospital's staff failed to recognize the signs of opiate overdose, failed to administer Coumadin and generally failed to properly monitor the dece dent. The defendants denied any negligence.

According to a published account a $500,000 verdict was returned against the hospital and a defense verdict was given for Dr. Rashid. The verdict included $200,000 for the decedent’s spouse and $100,000 for each of the three surviving children. Interest and costs were added after the verdict.

  With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.

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