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Bad
medicine
A case study of medication error and neglect
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By
Texas Medical Liability Trust
Risk Management Department
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The
following closed claim study is based on an actual malpractice claim
from Texas Medical Liability Trust. This case illustrates how action or
inaction on the part of physicians led to allegations of professional
liability, and how risk management techniques may have either prevented
the outcome or increased the physician’s defensibility. An attempt has
been made to make the material less easy to identify. If you recognize
your own case, please be assured it is presented solely for the purpose
of emphasizing the issues presented.
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Clinical
presentation
A 32-year-old female, heavy smoker, with a long history of migraines
and respiratory difficulties presented to her family physician’s after
hours clinic with complaints of severe headache, dehydration, fever and
urinary infection. Past medical history reflects numerous workups, which
failed to find the etiology of her severe onset of respiratory
suppression.
Physician
action
Her current condition was treated with Stadol, Rocephin and Decadron.
Later that evening at home, the patient died of pulmonary emphysema. A
toxicology report revealed the patient’s urine was positive for opiates
and bloodstream found various substances including Dilaudid. Medical
records did not indicate that the patient ever told the physician she took
Dilaudid nor had the physician prescribed it.
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Allegations
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Negligently
prescribed and administered drug to the patient and in such quantity
that resulted in her death
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Negligently
failed to refer the patient to a specialist to adequately evaluate her
condition
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Negligently
failed to admit the patient for further treatment and evaluation of
her condition during the entire period of treatment
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Abandoned
the patient
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Failed
to communicate to other treating and evaluating physicians who had
knowledge of the condition, the
treatment, drugs prescribed and administered to the patient.
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Legal
principle
Negligence is defined as the failure to use ordinary care; that is,
failure to do that which a health care provider of ordinary prudence would
have done under the same or similar circumstances or doing that which a
health care provider of ordinary prudence would not have done under the
same or similar circumstances. Ordinary care means that degree of care
that a health care provider of ordinary prudence would use under the same
or similar circumstances.
Disposition
In this case treatment with Stadol was contraindicated for a patient
with respiratory problems. Monetary value in this settlement was reduced
since the patient never advised the physician she was taking Dilaudid,
thereby contributing to her condition.
Risk
management issues
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At
each visit ask the patient what medications they are taking and
document them in the medical record.
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Be
familiar with pharmacodynamics of drugs prescribed, especially with
the patient’s history in mind.
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All
articles and any forms, checklists, guidelines and materials are for
general information only, and should not be used or referred to as primary
legal sources nor construed as establishing medical standards of care.
They are intended as resources to be selectively used and always
adapted—with the advice of the organization’s attorney—to meet
state, local, individual organizations and department needs or
requirements. This article is published with the understanding that Texas
Medical Liability Trust is not engaged in rendering legal services. ©
2001 TMLT. Reprinted with permission.
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