$850,000 settlement
A hospital patient who was left with permanent brain damage after receiving twice the amount of morphine considered toxic in an adult has settled her medical malpractice claim against a hospital for $850,000.
On Aug. 2, 2006, the patient, a 46-year-old married woman with two adult children, underwent total vaginal hysterectomy and removal of her fallopian tubes and ovaries. The surgery went smoothly. Afterward, her doctor wrote a prescription for morphine containing three directives—a loading rate, a basal rate and a patient-controlled analgesia (PCA) rate—to help control the patient’s pain.
The prescription called for the patient to receive a loading dose, the amount given at the beginning of treatment, of 3 milligrams of morphine. The basal rate, or amount of morphine delivered continuously to the patient, was zero. The amount of morphine the patient could give herself in a set window of time, known as the patient-controlled analgesia rate, was supposed to be a maximum of 1 milligram every 10 minutes.
A nurse correctly administered the 3-milligram loading dose around 4:10 p.m. However, she misinterpreted the remaining two orders. First, she set the PCA apparatus to allow the patient to administer herself 1 milligram of morphine each hour instead of once every 10 minutes, an underdosage. It was the nurse’s second error that caused significant harm: Instead of following the physician’s order for a zero basal rate, she administered morphine at a basal rate of 4 milligrams per hour. Three other nurses and several people working in the hospital pharmacy did not spot the error, and it went uncorrected for 15 hours.
Around midnight, about eight hours after the loading dose had been administered and the patient had received 4 milligrams per hour, she began vomiting and continued to do so intermittently for the next several hours. By 6:30 a.m., the patient had received 60 milligrams of morphine through the erroneous basal rate delivery of the drug.
Between 7 and 7:15 a.m., the surgeon examined the patient, who was still being administered morphine at the basal rate of 4 milligrams per hour, and, noting that she was too drowsy, had the PCA removed. At that point, the surgeon believed that the patient had had only 7.2 milligrams of morphine through PCA and that the order for a zero basal rate had been followed. The morphine infusion was stopped at 7:30 a.m.
Around 9 a.m., the surgeon examined the patient after she complained of lightheadedness, breathing difficulties and extreme confusion. By 9:25 a.m., the patient’s respiratory rate had dropped from 14 to 6 breaths per minute and her oxygen saturation rate had fallen to 70 percent. (Normal oxygen saturation is in the high nineties.)
The surgeon, suspecting a morphine overdose, administered a drug to counteract an overdose, particularly the side effect of respiratory depression, which restricts oxygen supply to the brain and can cause permanent damage. The patient was given a second dose of the drug to counteract a morphine overdose. At 10 a.m. the patient was still vomiting, was having problems with short-term memory and was confused.
A neurologist examined the patient and concluded that her acute amnesia was caused by cerebral hypoxia, a shortage of oxygen to the brain.
The patient was discharged six days after surgery but underwent outpatient treatment for her brain injury. She continues to suffer from amnesia, short-term memory loss, seizures and a sleep disorder. As a result of the brain damage, the patient can no longer cook, pay bills, feed her pets, work or make phone calls. She has been advised not to drive, forgets people and places and has trouble managing her own medications. The brain injury also exacted an emotional toll, making the patient more easily frustrated and depressed and subject to suicidal tendencies.
In March 2007, the patient and her husband filed suit against the hospital, alleging medical malpractice and loss of consortium, in a Missouri circuit court. The patient alleged that the hospital breached the standard of care by administering morphine in a dosage far exceeding the surgeon’s order; that the nurses failed to verify the correct dosage of morphine and knew or should have known that the amount prescribed posed a high risk of overdose; that the pharmacy’s employees and agents did not attempt to verify that the dosage was safe; and that the hospital and its employees failed to properly monitor the patient for dosage errors and recognize the symptoms of an overdose.
The plaintiffs also alleged that the hospital either failed to establish procedures to ensure that patients do not receive overdoses of dangerous drugs or, in the alternative, failed to follow procedures designed to prevent such overdoses. The suit also claimed that the hospital failed to adequately supervise and train its nurses and pharmacy personnel to prevent clear dosage errors.
On Aug. 28, the parties agreed to settle the case. Without admitting liability, the hospital agreed to pay the patient $850,000. As part of the settlement agreement, the identities of the plaintiffs and defendants will remain confidential.