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ARTICLE ID 157472

$________ AGAINST HOSPITAL ONLY - MEDICAL MALPRACTICE - NEGLIGENT FAILURE TO ADMINISTER ORDERED DOSAGE OF SALINE FOR ELECTROLYTE IMBALANCE - RAPID INCREASE OF SODIUM - CENTRAL PONTINE MYELINOLYSIS - PERMANENT BRAIN DAMAGE - ATTENDANT CARE REQUIRED.

Allegheny County, PA

This medical malpractice action was brought against the defendant hospital, as well as an attending physician, endocrinologist and nephrologist who were involved in the plaintiff’s care while she was hospitalized for an electrolyte imbalance. The plaintiff alleged that she received four times the amount of saline ordered to increase her sodium levels and that the defendant doctors were negligent in failing to detect the mistake. As a result, the plaintiff alleged that she sustained permanent brain injury and will require living assistance for the remainder of her life. At the beginning of the trial, the defendant hospital stipulated that an error was made in the plaintiff’s saline administration. However, the hospital denied that the error caused the plaintiff’s brain damage. Each of the three defendant physicians maintained that they met the standard of care in treating the plaintiff.

The plaintiff was a 57-year-old female who presented to the emergency room of the defendant hospital on December 21, ________. She was disoriented and confused and was admitted to the hospital and diagnosed with an electrolyte deficiency and low sodium levels. One of the defendant physicians ordered ________ cubic centimeters of saline to be administered over the course of an hour in order to gradually increase the plaintiff’s sodium levels.

However, the plaintiff alleged that records showed that a hospital nurse (who was in her third day at the hospital) administered ________ cubic centimeters of saline during the course of an hour, eight times the dosage ordered. The plaintiff also alleged that the defendant physicians were negligent in failing to investigate the cause of the plaintiff’s rapidly rising serum sodium levels when it became apparent that the plaintiff exceeded the 24-hour sodium goal within the first 12 hours. The defendant’s should have halted fluids and given vasopressin to decrease sodium levels, according to the plaintiff’s experts.

The plaintiff argued that a review of the plaintiff’s medication administration record would have clearly shown that she should have received one liter of saline over the course of eight hours, but instead had been given one liter in less than an hour. Evidence showed that the defendant’s nurse followed a medication administration record regarding the saline dosage. The medication administration record is a computer-generated document indicating the medications ordered for each patient. According to hospital policy, the accuracy of the medications should be checked before they are put onto the medication administration record. However, in this case the dosage shown for saline was in error.

The defense contended that the error resulted from a default in the pharmacy computer. Because the computer does not indicate the rate of IV fluid administration, this information must be obtained from the doctor’s order. If no rate is entered, the computer default rate of Q1H (________ cubic centimeters per hour) would have been listed, according to the defense. The mistake was not discovered until more than two weeks after the plaintiff’s admission when she was being transferred to another hospital at the request of the family. By that time, the plaintiff contended that the brain damage was irreversible.

The plaintiff’s experts testified that the rapid increase in sodium levels resulted in central pontine myelinolysis, confirmed by MRI results. Central pontine myelinolysis is a neurologic disease caused by severe damage to the myelin sheath of nerve cells in the brainstem, more precisely in the area termed the pons. The condition is known to be associated with rapid correction of low blood sodium levels. The plaintiff spent an extended period of time in the hospital and a nursing home. She currently lives with her daughter and requires daily assistance with hygiene, eating, and ambulating. The plaintiff is also incontinent and will not be able to live independently, according to testimony offered.

The plaintiff was employed with a community services group at the time of her hospitalization. She contended that she has been rendered permanently, totally disabled from employment as a result of the brain injury sustained. The plaintiff’s economist estimated the plaintiff’s total loss of wages to be between $________ and $________. The plaintiff’s life care plan in a nursing home was estimated to cost $2 million and her in-home care $4.6 million.

The defendants argued that the plaintiff experienced a unique response to the administration of the saline and that it was her excessive urination and other complications that drove her serum sodium level up. Defense experts testified that the error in saline dosage alone could not have caused the huge rise in the plaintiff’s serum sodium and, therefore, there had to be other medical factors involved.

The defendant endocrinologist and attending physician testified that the co-defendant nephrologist was the specialist in the field and he was in charge of making sure that the plaintiff was undergoing a gradual correction of her sodium levels. The nephrologist testified that he realized that there was a risk of central pontine myelinolysis when he saw the plaintiff’s rising sodium levels and that he decreased the plaintiff’s fluids and then stopped them altogether.

The jury found the defendant hospital ________% negligent. It found that the three defendant physicians were not negligent. The plaintiff was awarded $________ million including $2.4 million lump sum payment and ________ in future medicals which will result in guaranteed payments of $________ per year for the next 25 years. An appeal is expected.

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