Medical Malpractice - Emergency Department Opiod Overdose Death due to Respiratory Depression and Cardiac Arrest
Judge or Jury:
Breakstone, White & Gluck, PC
Commonwealth Mediation and Conciliation, Inc.
On June 27, 2012, plaintiff’s decedent, a 43-year-old, morbidly obese man, presented at a Massachusetts emergency department for treatment of severe low back pain. He had been diagnosed with severe sciatica. He had seen a neurosurgeon who had recommended he undergo a spinal fusion procedure. Because he was a Medicaid patient, it took a prolonged period of time to find doctors who would treat them. As a result he suffered four months with his pain.
Prior to appearing at the hospital, the patient had been confined to a couch in his apartment for four days. During that time he had not bathed or changed his clothing. When he arrived at the emergency department he yelled and screamed profanities at the doctors and nurses who were assigned to his care. Because he was such a large man, the first two doses of opioids had virtually no effect. In an attempt to stop him from screaming, the physician ordered dangerously high doses of opioids and sedatives to quiet him.
During his four-hour emergency room visit, he received multiple injections of Dilaudid, a powerful opiod narcotic for pain relief, as well as multiple injections of Ativan, a sedative.
Plaintiff’s decedent had a history of obstructive sleep apnea, which placed him at a high risk for respiratory depression which is associated with the administration of narcotic and sedative.
At approximately 4:00 p.m., plaintiff’s decedent was noted to be sleepy and difficult to arouse, warning signs of respiratory depression. Defendant Number 1, a hospitalist, notified Defendant Number 2, an emergency physician, of her concern about a potential narcotic overdose in the setting of a patient with obstructive sleep apnea who was had signs of respiratory depression. Defendant Number 1 left the emergency department to attend to another patient with the intention of returning. Defendant Number 1 never returned to the emergency department. Defendant Number 2, the emergency room physician, never went in to check the status of the patient. Defendant Number 3, an emergency room nurse, had observed signs of potential respiratory depression, which he understood could be fatal if untreated. However, Defendant Number 3 did not alert any of the physicians in the emergency department of the change in the patient’s status.
Ultimately, plaintiff’s decedent, a father of three, progressed from respiratory depression to respiratory arrest, to cardiac arrest. He was discovered by his wife who returned to the emergency department and found her husband blue in the face. Despite prolonged resuscitative efforts, plaintiff’s decedent expired. The evidence was that the physicians responsible for his care ignored the clear warning signs of respiratory distress, respiratory depression and respiratory arrest.
Plaintiff’s experts were prepared to testify that the three defendants violated the standard of care by failing to intervene to reverse the large amount of narcotic and the likely respiratory depression which plaintiff’s decedent was experiencing.
The case settled on the eve of trial, after a mediation conducted by Paul Finn of Commonwealth Mediation and Conciliation, Inc.