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$________ - Failure of surgeon and pain management team to communicate regarding pain medications to be administered to the plaintiff post-surgery - Overdose of narcotic medication as a result of administration of competing narcotics to the plaintiff - Hypoxic brain injury - Quadriplegia.

San Francisco County, California

This was a medical malpractice case in which the male plaintiff, a 44-year-old registered nurse, suffered hypoxic brain injury and quadriplegia as a result of receiving a narcotic overdose following elective surgery. The defendants maintained that the pain medications ordered were reasonable and indicated. The defendants disputed the nature and extent of the plaintiff’s alleged damages.

During the early 1990s the plaintiff developed intermittent neck and upper left extremity pain. Imaging studies that had been performed during that time demonstrated a large disc with ossification at C5-6. The plaintiff’s pain progressively worsened with time and in late ________ he filed for disability benefits. On December 18, ________ the plaintiff consulted with the director of spinal services at the defendant Roe Medical Center at the suggestion of a friend. As a result of that consultation, it was recommended that the plaintiff undergo an anterior cervical discectomy and fusion at C5-6. The plaintiff was admitted to the defendant facility on December 26, ________ and the surgery proceeded without incident. Due to the plaintiff’s high levels of pre- operative pain it was the agreed-upon plan of the surgeon and the anesthesiologist to have the Pain Service perform a full evaluation of the plaintiff at the PACU.

Immediately after the surgery was concluded the assistant surgeon wrote post-operative pain medication orders including Percocet, Valium, Ambien and Neurontin. Simultaneously and unknown to the assistant surgeon, the Pain Service also wrote pain medication orders which included Morphine Sulfite up to 35 mg/hr by way of a PCA. The assistant surgeon indicated that it was his understanding that after the evaluation by the Pain Service that they would write superceding medication orders and access the plaintiff’s need for continued pulse oximetry once the plaintiff was released from the PACU to the medical-surgical floor. The Pain Service evaluation in the PACU did not take place. The plaintiff was taken to the medical-surgical floor at approximately 7:45 p.m. on December 26, ________. The nurse primarily responsible for his care was employed by the defendant, Roe Traveling Nursing Agency. The pain service orders written at the conclusion of the surgery indicated that the plaintiff’s respiratory rate and level of consciousness should be assessed every two hours for the following eight hours and then every four hours thereafter. Therefore, the plaintiff should have been evaluated at 10 p.m., 12:00 a.m., 2:00 a.m. 4:00 a.m. and 8:00 a.m. In fact the nurse only made assessments at 11:00 p.m. and 5:00 a.m. The authenticity of the 5 a.m. notation was questioned by the plaintiff since the nurse indicated to other physicians that she had not observed the plaintiff after 2:00 a.m.

On December 27, ________ at 6:00 a.m. the plaintiff was found unresponsive with a respiratory rate of 4/min and an oxygen saturation rate of 46%. The defendant nurse summoned the charge nurse and over the next 15 minutes the plaintiff was ventilated with a non-rebreather mask instead of an AMBU bag. The plaintiff’s saturation only rose to 53% by 6:15. At that time the AMBU bag was utilized and Narcan was only then administered. Over the next five minutes his respiration rate increased and his saturation rose to 93%. The plaintiff however remained comatose and unresponsive. The plaintiff was transferred to the ICU where he was examined by the surgeon. It was determined that he had suffered hypoxic brain injury as a result of a narcotic overdose. The plaintiff remained hospitalized at the defendant hospital in a chronic vegetative state until March 20, ________. He was then transferred to St. Jude Medical Center in Orange County, California. Although he subsequently regained consciousness, he is a severely brain-damaged quadriplegic.

The plaintiff brought suit indicating that the failure of communication between the surgical staff and the pain management staff resulted in a narcotic overdose which caused the plaintiff’s brain injury and quadriplegia. The two competing sets of pain medication remained on the chart and were interpreted by the nursing staff to both be in effect which was not accurate. The plaintiff also maintained that the nursing care provided by the nurse was inadequate and was the cause of his irreversible condition. The plaintiff maintained that even at 6:00 a.m. when the plaintiff was discovered to be unresponsive by the nurse, if the proper AMBU bag and medication would have been immediately administered his condition may have been salvageable.

The plaintiff contended that protocols require that an AMBU bag be in the room at all times and such was not the case in this matter.

The plaintiff’s elderly parents moved from their retirement home in Atlanta to Orange County to care for the plaintiff. The plaintiff’s home was sold to pay for his care and he alleged that in five years’ time he would be required to become an in-patient at a full time care facility since due to his parents’ age, they would not be able to provide long-term care for him. The plaintiff sought damages for the loss of the value of his home, for the value of his parent’s care and for his medical expenses and loss of future earnings. At the time of this incident, the plaintiff had been earning $________ per year as a registered nurse.

The defendants contended that all of the pain medications listed on the chart were reasonable and indicated. The defendants further maintained that the standard of care did not require continuous pulse oximetry or apnea monitoring. The defendant nurse indicated that she did, in fact, properly monitor the plaintiff and they argued that the plaintiff’s condition and ability to be salvaged at that point in time was uncertain.

The defendants further disputed the plaintiff’s claim for loss of the value of his home and the rates for the care provided by the plaintiff’s parents. The defendants likewise disputed the plaintiff’s estimated cost of future in-patient care.

The case was mediated twice and settled for the sum of $________ at the second mediation session on June 20, ________.

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