Nurse Practitioner Case Study: Failure to properly obtain/perform a complete patient history; improper prescribing of controlled drugs

This case study involves a family nurse practitioner working in a pain management clinic.

Indemnity Settlement Payment: $0
(Monetary amounts represent only the payment made on behalf of the insured nurse practitioner)
Legal Expenses: Greater than $90,000
The patient was a 37 year-old female with a past medical history of chronic pain related to chronic sinusitis and multiple sinus surgeries, anxiety, panic attacks, sleep difficulty, depression and opioid abuse.
Her chronic pain was being managed by her otorhinoloryngolist and infectious disease practitioner due to the retirement of her pain management physician.
The physicians referred the patient to the defendant nurse practitioner for pain management because they received letters from the patient’s medical insurance provider warning them about the patient’s prescriptive habits and potential opioid and methadone abuse.
The referring physicians neither shared the warning letter with our nurse practitioner nor made her aware that the patient had been obtaining duplicate prescriptions from multiple medical providers.
On the day of the consultation, the nurse practitioner obtained and documented a thorough list of the patient’s prescription use and past and current medical history.
A urine analysis was performed to inquire about the patient’s methadone level which was noted as appropriate for the patient’s height and weight and reflected that patient was taking methadone within the normal range. 
The nurse practitioner did not observe any “red flags” which would have required further investigation before prescribing methadone and had the benefit of a drug screen that was done on the patient three weeks prior to the consultation.
The nurse practitioner prescribed the patient methadone for the next 28 days and had the patient acknowledge a narcotics and medication regiment compliance agreement. 
The patient was found dead fifteen days after her consultation with our nurse practitioner and the autopsy revealed the cause of death was methadone toxicity.
Risk Management Comments
The nurse practitioner made very detailed entries in the patient’s medical record about the patient’s use of the opiate prescription and the fact that the patient was instructed and educated on only utilizing the prescriptions provided by the pain management clinic.
The insured contacted the referring physicians for copies of the medical records, but did not receive them prior to the patient’s appointment.
The plaintiff’s experts (from various nurse practitioners) were critical of the defendant prescribing methadone for the patient due to her recent history of opioid abuse.
Our defense experts found that the nurse practitioner’s actions at the time of the consultation were within the standard of care. The methadone toxicity levels and opioid level led the medical examiner and subsequent experts to the opinion that the patient may have ingested methadone received from another source besides the pain management clinic.
There were several codefendants in the case, including the referring physicians and several local pharmacies. Given the positive expert opinions, we vigorously defended our NP.
Testimony was heard over the course of several days, eventually leading to a verdict which found no liability attributed to the nurse practitioner.
Risk Management Recommendations

  • Obtain a thorough and accurate history prior to providing patient with treatment or medications.
  • Prescribe medication in compliance with state nurse practice act, state prescriptive authority, authority for nurse practitioners and employer policies and protocols.
  • Educate and document patients regarding their responsibilities for adhering to medication and treatment regiments, including lifestyle modifications as well as the risk of noncompliance.
  • Remain current regarding clinical practice, medication, treatment and equipment utilized for the diagnosis and treatment of acute and chronic illnesses and conditions related to my clinical specialty.

NSO Learning Center

More insights from some of the best minds in nursing.

Certified Registered Nurse Anesthetist - Improper Technique When Performing a Peribulbar and/or Retrobulbar Block

Failure to perform a post-operative assessment, failure to accurately document anesthesia complications in a medical record, and failure to complete a proper informed consent.

Certified Registered Nurse Anesthetist Case Study: Failure to conduct anesthetic of a patient during a procedure

This case study involves a CRNA working in an outpatient endoscopy center.

Nurse Case Study: Alleged failure to properly assess and monitor the impaired, restrained patient

The patient was intoxicated and aggressive when brought to the ED, and had to be restrained. Shortly after an assessment check, the patient attempted to burn off his restraints with a cigarette lighter. He suffered severe burns over 25 percent of his body, resulting in permanent disability.

Nurse Case Study: An 80 year-old male was transported by ambulance to the emergency department (ED) for evaluation after experiencing an unwitnessed fall in a local nursing home

Medical malpractice claims may be asserted against any healthcare practitioner, including nurses. This case study involves a nurse working in an emergency department (ED).