Medical Malpractice Case Report: $500,000 Settlement Where Inappropriate Monitoring of Patient Results in Death

Firm Partner Peter A. Schmit succeeded in obtaining a $500,000 settlement in a medical malpractice case involving an inappropriate monitoring of a patient with acute pancreatitis, ETOH intoxication, and administration of excessive narcotic pain medication resulting in the death of a 37-year-old man.   Read the following Minnesota Case Report, Vol.29, No.1, Feb. 2010.

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(Excerpts taken with permission from Minnesota Trial Lawyer Association’s (MTLA) “Minnesota Case Reports”)

Decedent patient was 37-years-old when he died at the hospital.  The cause of death was reported to be anoxic encephalopathy due to mixed alcohol and hydromorphone toxicity.

On October 27, 2005 (the day before his death), paramedics were called to patient's home for his complaint of abdominal pain from a "pancreatitis attack." He reported that he had drunk alcohol all day.

Patient arrived in the emergency room (ER) at 2025 hours. A breathalyzer indicated that he had a blood alcohol level of .207. He was noted to be alert and oriented and cooperative but anxious with pain rated at 10 out of 10. Intravenous (IV) fluids were ordered.

Doctor ordered Dilaudid 1-2 mg. IV every 20 minutes as needed, with a note to keep the systolic blood pressure greater than or equal to 100.  Doctor also testified that she was not aware of his BAC; that she assumed the nurses would put the appropriate monitors on patient and that the nurses would use their judgment in deciding how much Dilaudid to administer based on patient's response.  The nurses testified the Doctor didn't order any monitoring, they likely would have told the Doctor the BAC level and the Doctor never sought out the nurses to inquire as to patient's status.

Dilaudid (hydromorphone) is used to treat moderate-to-severe pain.  Over the course of an hour, 6 mg. of Dilaudid were administered. While the nurses' testimony differed, the record revealed only one full set of vitals was taken and recorded.  It was undisputed the patient was placed in an overflow room with no continuous monitoring.  At approximately 2206 hours, the Doctor found him to be in cardiopulmonary arrest and a code was called.  Despite extensive resuscitation efforts, he was pronounced dead at 0850 hours.

Autopsy identified the cause of death to be anoxic encephalopathy due to mixed alcohol and hydromorphone toxicity.  Interestingly, a physician contacted the Medical Examiner's office over concern about the amount of Dilaudid given.

Defendants contested liability, causation and damages.  On liability, defendants disclosed multiple experts who were prepared to testify the amount of drug ordered was appropriate for an obese man with 10 out of 10 pain; that given is oxygen stats on presentation and his interactions with the nurses, continuous monitoring was not required.  On causation, defendants disclosed experts who opined that the patient actually died from effects of severe hemorrhagic pancreatitis and the autopsy demonstrated this process. on damages, due to his medical history and condition, plaintiff's experts felt the patient had a 5-10 year life expectancy; defense experts opined less than 5 years was likely.  The patient was survived by, among others, his wife and a minor son.  All the settlement proceeds were placed in a supplemental needs trust for the minor son.