The plaintiff's decedent, age eighty-one, was admitted to a Medical Center in December 2003 for treatment of sciatic pain after a fall. Fifteen milligrams of morphine sulfate controlled release tables (MS Contin), twice a day, was prescribed. Shortly before the decedent was transferred to a skilled nursing facility for pain management and rehabilitation an increase in the MS Contin to thirty milligrams was ordered. The hospital’s case manager recorded the increase of MS Contin to thirty milligrams, twice a day, without striking out the previous order for fifteen milligrams twice a day. Transfer orders contained two separate orders for MS Contin.

The skilled nursing facility’s nurse telephonically reviewed the medication orders with one defendant, a nurse practitioner, acting in her capacity as Long Term Care’s on-call employee. The nurse practitioner recommended verification of the accuracy of the transfer orders with the Medical Center Pharmacy. The plaintiff claimed that the skilled nursing facility administered forty-five milligrams of morphine twice a day. This caused hallucinations, lethargy and twitching. The woman died of acute morphine intoxication a couple of weeks after admission. The medical examiner noted a blood alcohol level of .09 percent, which the plaintiff attributed to postmortem alcohol production, not ingestion of alcohol.

The plaintiff claimed that the nurse practitioner was negligent in approving the medication orders admitting the decedent to the skilled nursing facility and in not checking the accuracy of the order herself. The plaintiff also claimed that Long Term Care and defendant should not have permitted a nurse practitioner to approve the admission orders, but should have had a system in placed which would have a physician notified immediately on new patient admission.

The plaintiff also claimed that the Pharmacy was negligent in dispensing the morphine and should have recognized that the order was excessive and contacted the ordering physician to verify the accuracy of the order. The skilled nursing facility settled for a undisclosed amount. The court granted partial judgment, as a matter of law, to the Long Term Care and defendant, leaving them in the case only as to vicarious liability for the defendant nurse practitioner.

The defendants claimed that the skilled nursing facility was solely at fault, that the order was not obviously incorrect, and that the nurse practitioner had acted properly in recommending verification of the morphine order. According to The Trial Reporter, a jury awarded $6 million, but found Long Term Care and defendant, the nurse practitioner and the Pharmacy not at fault. The jury found the Medical Center ten percent at fault and the settling skilled nursing facility ninety percent at fault. That resulted in a $600,000 recovery from the Medical Center.

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