Medical Malpractice Case Report: $500,000 Recovery for Innappropriate Monitoring of Patient with Acute Pancreatitis, ETOH Intoxication and Adminstration of Excessive Medication

Feb 2010

Firm Partner Peter A. Schmit succeeded in obtaining $500,000 for the family of a 37-year-old man who died after inappropriate monitoring of his acute pancreatitis, ETOH intoxication, and administration of excessive pain medication. Read the following Minnesota Association of Justice (MAJ) Minnesota Case Report, Vol.29, No.1, Feb. 2010.

Selected Result*

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

Thirty-seven-year-old patient died in the hospital.  The cause of death was reported to be anoxic encephalopathy due to mixed alcohol and hydromorphone toxicity. On the day before his death paramedics were called to his home for complaints of abdominal pain from a "pancreatitis attack." He reported that he had drunk alcohol all day. The patient arrived in the emergency room at 2025 hours and a breathalyzer indicated that he had a blood alcohol level (BAC) of .207.  He was noted to be alert and oriented and cooperative but anxious with pain rated at 10 out of 10.  Intravenous fluids were ordered.

The doctor ordered Dilaudid 1-2 mg. 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 the patient and that the nurses would use their judgment in deciding how much Dilaudid to administer based on the patient's response.  The nurses testified the Doctor didn't order any monitoring.  They likely would have told the Doctor the BAC level.  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 diludid 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 (brain damage due to lack of oxygen) and hydromorphone toxicity.  Interestingly, a physician contacted the Medical Examiner's office over concern about the amount of Dilaudid given.

Defendant's 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 severe pain; that given his oxygen stats on presentation and his interactions with nurses, continuous monitoring was not required. On causation, defendants disclosed experts who opined that the patient actually died from effects of his severe hemorrhagic pancreatitis and that 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.  All of the settlement proceeds were placed in a supplemental needs trust for his minor son.

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