Confidential

Facts

The decedent was a 58-year-old married woman with four financially emancipated adult children. She suffered from diabetes mellitus, hypertension and end stage renal disease on hemodialysis.

On March 31, 2004, the decedent was admitted to Roe Hospital with a fractured ankle. While in the ER, over the course of 90 minutes, she was given 20 milligrams of Morphine Sulfate. Soon thereafter, she was found by nurses with a respiratory rate of 4 per minute. Roe nephrologist, her long-time treater, was paged and gave a verbal order for Narcan. This quickly reversed the effects of the narcotic, and decedent recovered without sequelae. During his deposition, Roe nephrologist testified that he considered this a "medically significant event." However, he did not chart this.

The decedent underwent an open reduction and internal fixation at the hands of Roe orthopedist and was discharged on April 2.

On April 12, the decedent was re-admitted to Roe hospital after a surgical wound dehiscence. She underwent further surgery at the hands of Roe orthopedist on April 13. Post operatively, Roe orthopedist ordered a Duragesic patch, which contains the narcotic Fentanyl, as well as 6 milligrams of Morphine Sulfate IMQ three hours. Roe nephrologist never told Roe orthopedist of the episode of respiratory depression in the previous admission.

The plaintiffs claimed that Roe hospital nurses administered 8 milligrams of Morphine Sulfate at three hours intervals, and not 6 milligrams as ordered. Roe hospital disputed this.

At 6:30 p.m. on April 13, the decedent was found unresponsive by Roe nurse. A code was called. According to the code sheet, first responders arrived nine minutes later at 6:40 p.m. A pulse was restored, but an irreversible anoxic brain injury was apparent. The family agreed to discontinue life support on April 20.

On autopsy performed by the Los Angeles County Coroner concluded that death was due to anoxic encephalopathy due to Morphine intoxication.

PLAINTIFFS' CONTENTIONS:
The plaintiffs contended that Roe orthopedist negligently prescribed a combination of narcotic medications which carried a significant risk of producing respiratory depression. The standard of care therefore required an additional order for continuous pulse oximetry and apnea monitoring.

The plaintiffs contended that Roe hospital nurses were negligent in giving 8 milligrams of Morphine Sulfate on multiple occasions on the afternoon of April 13, rather than 6 milligrams, as ordered. It was further alleged that there was an undue delay in responding to the code.

The plaintiffs also alleged that Roe nephrologist was obligated to make a detailed chart note as to the episode of respiratory depression on March 31, and to further communicate this directly to Roe orthopedist during the subsequent admission.

DEFENDANT'S CONTENTIONS:
Defendant Roe orthopedist contended that his prescription of medications was, at all times, reasonable and within accepted standards of care.

Defendant Roe hospital contended that the actions of their nurses were, at all times, were within accepted standards of care, and that there was no delay in responding to the code.

Defendant Roe nephrologist contended that his care and treatment of the decedent, was, at all times, within accepted standards of care.

Result

The case was settled for $210,000 at the mediation with Jay Horton, Esq. from Judicate West ($100,000 from orthopedist; $80,000 from hospital; $30,000 from nephrologist).