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. Resolution 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
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