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News: A young woman died from fatally low oxygen levels after being prescribed a narcotic pain relief patch after treatment for pancreatitis. This pain relief patch caused her oxygen levels to fall well below normal, which resulted in a lack of oxygen to the brain. The woman had received treatment from a hospital for pancreatitis and was discharged after five days. However, after suffering from additional abdominal pain and fevers, the woman was prescribed a pain relief patch, which depresses the respiratory system even further, especially if the patient has a fever. In this case, the combination of the patch and the woman's fever resulted in a fatally low oxygen saturation level and a fatally depressed respiratory system. Her parents brought suit against the hospital for negligently prescribing the medication while knowing that she was suffering from fevers. After three trials, a jury returned a verdict against the hospital for $2.25 million, which included loss of consortium damages.
Background: After experiencing severe abdominal pain, a young woman went to her local emergency department and was diagnosed with pancreatitis. She was promptly admitted to a nearby hospital for treatment. The patient remained in the hospital for five days and was discharged. Once at home, she began to experience increasing abdominal pain. Three days after being discharged from the hospital, the woman returned to the emergency department. She was diagnosed again with pancreatitis and again admitted to the nearby hospital for treatment with antibiotics. Throughout her stay in the hospital and on the day she was discharged, the woman had a fever. Unfortunately, she was not provided additional antibiotics upon discharge from the hospital, and she still was suffering from an intra-abdominal infection.
Upon discharge, the hospital neglected to provide the woman additional instructions on how to care for herself after going home. Specifically, the hospital failed to provide the woman with proper instructions emphasizing that she might be particularly vulnerable as she was still suffering from a fever. Tragically, the narcotic pain relief patch prescribed to alleviate her abdominal pain resulted in a fatal decrease of her oxygen saturation levels. The day she was discharged from the hospital, her oxygen saturation levels had dropped to as low as 48%.When she was discharged, her levels had risen to 88%; however this level still was considered low. Fentanyl can further exacerbate low oxygen levels as it has a depressive effect on the respiratory system. Sadly, the young woman was found unconscious 18 hours after being discharged. Despite multiple attempts to resuscitate her, she was pronounced dead.
Five days after her death, the family filed a wrongful death lawsuit against the hospital and the treating physician for medical negligence for failing to provide the woman adequate medical care. The jury found the hospital and physician guilty of medical negligence, but jury members could not reach a verdict as to whether or not the negligence was the proximate cause of the woman's death. A second trial was granted with a subsequent verdict for the hospital; however the presiding judge ordered a third trial after defense attorney misconduct. After the end of the third trial, the jury found the hospital and physician guilty of medical negligence and awarded the family $2.25 million, which included $1.25 million for loss of consortium damages.
What this means to you: Pain relief patches often are prescribed to treat ongoing pain. Great care must be taken while a patient is using this medication because of the significant side effects, namely addiction. In this case, fentanyl is particularly sensitive to increases in body temperature from a fever or even exercise. When there is an increase in body temperature, the fentanyl patch releases additional medication into the patient's system through the skin, which in turn causes depression of the respiratory system. Here, the young woman already was suffering from decreased oxygen saturation levels, which combined with the effects of fentanyl, left the woman particularly vulnerable to a fatally low oxygen levels. Physicians must be extremely mindful of all aspects of their patient's conditions in relation to prescribed medications. It is always important to take the time to read through the warnings for medications and possible side effects to ensure the patient will be safe. Fentanyl in particular is considered a high-risk medication and comes with a black box warning that alerts physicians to the specific risks of prescribing the drug to patients. Unlike oral narcotic analgesics that are effective for three to four hours, fentanyl remains on the skin and is active for 72 hours. This time element is especially critical to keep in mind if your patient is going to be taking the medication at home without the supervision of a healthcare professional.
Additionally, a well-established protocol for patient discharge is vital to ensure that the patients and their caregivers are well informed about the needed care after discharge. A patient with an oxygen saturation level of 48% qualifies for ventilator assistance, not discharge from the hospital. She should not have been released until her levels were within a normal range of 95-100%. Her nurse should have alerted the physician of her abnormal oxygen levels and stopped the discharge. If the physician disagreed, the nurse has the responsibility to go up the chain of command within the hospital and advocate for the patient.
It is also the nurse's responsibility to provide discharge instructions to every patient. These instructions include a review of the medications to be taken at home, the dose, the side effects, and a review of when to seek medical attention. Had the nurse of the physician taken the time to explain the risks of the fentanyl patch, including its respiratory depression effects, the outcome for this patient likely would have been quite different.
A significant turning point in the litigation for this case was the second trial in the case. By that point, the hospital had received a verdict in their favor. However, a third trial was ordered by the judge as a result of misconduct of the hospital's attorney. Specifically, the attorney made a number of improper objections during the trial, asked various improper questions that were ruled unacceptable by the judge, and made improper comments in front of the jury. Despite being warned by the judge on more than one occasion, the attorney persisted with improper courtroom behavior and demeanor. While sitting at the bench, the judge noted that this trial was the first new one he had ordered because the attorney's behavior was so offensive.
It is important for healthcare professionals to seek out law firms who are committed to zealously defending their clients. However, there is a line drawn between a zealous defense and improper tactics and behavior. Given that there are very high stakes in medical negligence and malpractice cases, it is extremely vital to select a law firm that has an established history of reputable behavior, both in and out of the courtroom. It would be wise to consult with other legal professionals to determine what kind of overall reputation a particular attorney or law firm has. This kind of due diligence will be invaluable when a verdict is on the line. Here, the failure of the defense attorney to heed the judge's warning about his behavior resulted in a third trial. Not only did this third trial cost the hospital a significant additional expense, but it cost the hospital an undisputed verdict in its favor.