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ARTICLE ID 168124

$________ - MEDICAL MALPRACTICE - MORPHINE OVERDOSE AT VETERANS HOSPITAL - FAILURE TO UTILIZE PULSE OXIMETER TO DETECT RESPIRATORY DEPRESSION - HYPOXEMIA - PERMANENT BRAIN INJURY.

U.S. District Court, Southern District of Florida

The plaintiff alleged that she has been left with debilitating permanent brain damage as a result of a morphine overdose suffered while at the defendant’s veterans’ hospital in Miami. The plaintiff claimed that the defendant’s employees were negligent in failing to take precautions to prevent the plaintiff’s respiratory depression by means of early detection with pulse oximetry, thereby causing a prolonged period of oxygen deprivation. The defendant maintained that the plaintiff’s treatment was within the standard of care and she was properly monitored, but suffered a sudden and unexpected respiratory depression.

The plaintiff, 54, underwent reconstructive breast surgery performed on April 19, ________ at the defendant medical center following a bout with cancer. Evidence showed that the plaintiff received 10 mg. of morphine intraoperatively during the surgery from 2:45 to 4:45 p.m. Following the surgery, she was transferred to the defendant’s post-anesthesia care unit where an additional 16 mg. of morphine was ordered, in periodic 2 mg. doses for pain control via intravenous injection. She was also given a patient controlled analgesia pump which allowed a 1 mg. dosage of morphine every six minutes.

Records showed that the plaintiff received 9 mg. of morphine through the patient controlled pump until the time of her arrival in her ward room at approximately 7:00 p.m. The plaintiff contended that a falling blood pressure level taken at 7:30 p.m. (despite the plaintiff’s significant pain which should have increased her blood pressure) raised a red flag that closer monitoring was required.

The plaintiff’s anesthesiology expert testified that the plaintiff did not receive telemetry (transmission of vital signs to a monitoring room for constant observation) and she was not being appropriately assessed or monitored by the defendant’s employees. The plaintiff’s expert opined that this was especially necessary because the plaintiff was at an increased risk of developing respiratory depression. The plaintiff’s experts testified that the defendant’s healthcare providers deviated from the required standard of care by failing to use a pulse oximeter, which is the most sensitive and most reliable tool for instantly detecting and preventing respiratory depression in a patient on morphine.

At approximately 8:15 p.m., the plaintiff was found by her husband alone in her room gasping for air, unresponsive, and in respiratory depression. Her oxygen saturation levels were tested at 75%. The plaintiff contended that a prolonged period of respiratory depression caused her to suffer hypoxemia and a resulted in a permanent mild to moderate brain injury.

Due to her injuries, the plaintiff’s experts testified that the plaintiff’s brain injury makes her a danger to herself and others and she requires medical care, therapy and treatment. The plaintiff suffers significant lapses in judgment, memory and executive function and will never be able to properly care for herself or live independently, according to her physicians.

The defendant argued that the plaintiff was properly monitored, including use of a baby alarm in her room which would detect any malfunction in her self-administered morphine pump. Nurses were ordered to assess and document the plaintiff’s level of arousal and respiration rate hourly upon her arrival in the ward room, according to evidence offered. The nurses were also instructed to notify a doctor if the plaintiff’s systolic blood pressure dropped below 90, her pulse rate below 60 or respiratory rate below 10.

The defense contended that the plaintiff’s vital signs were taken at 7:30 p.m. and her temperature was 97 degrees; she had a pulse rate of 77 and was breathing 20 times per minute at rest; her blood pressure was ________/59, with a pain score of 8 out of 10 and her pulse oximetry reading was 97%.

The defendant’s anesthesiology expert testified that the plaintiff was not a high risk for respiratory depression and the floor where she was appropriately placed was not equipped to provide constant oximetry for low-risk patients. This expert opined that, because the oximeters lacked telemetric capability, the defendant’s nurses would need to check the machines in person every few minutes, which would be unrealistic.

The case was tried as a bench trial. The court awarded the plaintiff and her husband a total of $________ in damages. The award included $________ for past and future medical care and $________ for past and future pain and suffering.

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