Anonymous, as Personal Representative of the Estate of Anonymous Decedent, et al. v. an Unnamed Hospital
(Wrongful Death and Survival Action – failure to monitor a post-operative patient)

Case Facts: We represent the Personal Representative of the Estate of a deceased 41 year old man, who died in his hospital room following performance of an orthopedic surgical procedure. We also represent the parents individually for their claims under the Wrongful Death Act.

After an uneventful surgery performed under general anesthesia, our clients’ son was admitted to the recovery room at 7:10 p.m. He was later released in stable condition from the recovery room to his room on the floor on intravenous “morphine” to be self-administered via a PCA (patient controlled analgesia) pump.

At the time of his confinement at the Hospital, Decedent was overweight, having a BMI or body mass index of approximately 29, putting him at risk for development of and/or having conditions such as obstructive sleep apnea, a condition which leads to a shutting off the airway passages. Decedent also had a history documented in his Hospital’s records of bronchospasm and of having had prior problems with anesthesia.

The medical records describe in several places that this patient was allergic to Codeine.

No detailed evaluation of our client’s son’s history of allergy to codeine is documented.

Nonetheless, this young man was administered Dilaudid, which is hydromorphone, a compound which is chemically related to and in the same family as Codeine, another natural opiate. Codeine and hydromorphone can cross-react such that an allergy to one would provoke an allergic hypersensitivity response should the other be administered. Dilaudid is also known to cause and/or aggravate bronchospasms, laryngospasms, and/or severe allergic reactions and/or respiratory arrest. After his surgery was successfully completed, Decedent was admitted to a regular floor. He was discharged on 3/17/09 from the recovery room at or about 9:10 p.m. on 3 L of oxygen. He was not placed on any type of continuous monitoring and/or telemetry and/or bioacoustic monitoring, but instead was put on a patient controlled analgesic (“PCA”) pump which allows for intravenous delivery of narcotic pain medication.

Dilaudid/hydromorphone, a potent narcotic, was administered to Claimants’ decedent via the PCA pump which had a dosing schedule permitting this patient to have self-administered doses of hydromorphone via the pump while he was in his bed in a regular, unmonitored floor.

Dilaudid was given at the following intervals: this patient, our clients’ son, received 14 total doses of 0.2 mg of hydromorphone at the following times: 7:41 p.m., 7:51 p.m., 8:00 p.m., 8:18 p.m., 8:34 p.m., 8:53 p.m., 9:05 p.m., 9:18 p.m., 9:32 p.m., 9:42 p.m., 9:53 p.m., 10:04 p.m., 10:18 p.m., and 11:02 p.m. Additional morphine, apparently by bolus injection, is also recorded as being given to the young man at 7:44 p.m. and at 8:11 p.m. He was noted by the nurse to be sleeping at 8:15 p.m.

At or about 10:00 p.m. on 3/17/09, the clients’ son was documented by nurse to be alert and oriented, answering questions in response to the nurse’s evaluation, including, but not limited to, having unlabored, regular breathing with clear breath sounds in all of his lung lobes. He was described as being alert and keenly responsive, and exhibiting appropriate, calm, and cooperative behavior following the nurse’s commands and having completely normal vital signs at 10:00 p.m.: his respiratory rate was 20, and there was no problem with his blood pressure or his pulse. In short, all seemed to be well with this patient, who was generally a strong, healthy male. His family had just left him after having watched television with him and conversed with him before the nurse’s evaluation. He had been ordered a regular diet. The clients’ son was in excellent medical health following his orthopedic surgery and was expected to be discharged to his home the following morning. Instead, he was released to a funeral home.

On 3/17/09, orders were instituted for vital signs to be taken by the nursing staff for this patient on the general floor once an hour for four hours, i.e., to be taken again at or about 10:05 p.m., 11:05 p.m., and 12:05 a.m. on 3/18, 1:05 a.m. (3/18) and 2:05 a.m. (3/18). We allege and intend to prove that these orders were not followed.

No vital signs were recorded at any time from approximately 10:00 p.m. until at about 2:15 a.m., over four hours later, when our client’s son was found unresponsive, not breathing, and in a condition requiring immediate cardio-respiratory resuscitation, i.e., in a “Code” condition. The key to safe administration of narcotic pain medication is precise and frequent monitoring of vital signs and level of sedation which was not done for this patient.

A Code was called, and an unsuccessful attempt was made to resuscitate this young man, but by about 2:30 a.m., approximately 15 minutes later, the Code was cancelled and our clients’ son was pronounced dead.

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The above “Cases in Suit” represent a sampling of the types of cases being handled by the lawyers and professional staff of Nash & Associates. Each case varies not only in the facts but also in terms of the jurisdictions in which they are litigated as well as many other intangible factors. We will continue to give you further examples of our cases, which we hope may be of interest to you.