Sample
Case
1. Screening
for Merit
2. Further Case-Development
A. Time-Line of Events with deviations from
Standard of Care
B. Medication Administration Record (MAR)
C. Physician Orders
1.
Screening for Merit
Damron Medical
Legal Consulting
1136 Walking
Horse Way
Sharpsburg, KY
40374
May 18, 2005
Mr. Edward
Franklin
Franklin, John
& Tackett, PLLC
0000 Main Street
Lexington, KY
00000
Re: Bobbi
Brooks v. Robert Moore, M.D. and General Hospital Inc.
Dear Mr.
Franklin:
As requested,
our office has screened the medical records of Ms. Brooks. This is a 28
year old female that presented to the emergency department with nausea,
vomiting and severe abdominal pain. The patient was subsequently taken
to surgery for an exploratory laparoscopic procedure and later died
that evening.
After screening
her medical records, it is of my opinion that there are significant
deviations from the standards of care, both medical and nursing that
directly contributed to the death of Ms. Brooks. Specifically, Dr Moore
failed to reevaluate her appropriately; he issued orders to administer
high doses of narcotics with disregard for her physical well being as
she was being cared for on a busy general Medical/Surgical unit. The
nursing staff caring for Ms. Brooks failed to provide standard of care
as is evidenced by the administration of high doses of narcotics in an
unmonitored environment.
Conclusion: Ms.
Brooks was over medicated with narcotics, experienced respiratory
arrest in an unmonitored situation and subsequently died from hypoxia.
This is an unfortunate case involving medical and nursing malpractice
and negligence. If you would like additional assistance in further
developing this case please contact our office.
Thank you for
the opportunity to consult on this case.
Best Regards,
Damron Medical
Legal Consulting
2. Further Case-Development
Damron Medical
Legal Consulting
1136 Walking
Horse Way
Sharpsburg, KY
40374
July 28, 2005
Mr. Edward
Franklin
Franklin, John
& Tackett, PLLC
0000 Main Street
Lexington, KY
00000
Re: Bobbi
Brooks v. Robert Moore, MD and General Hospital Inc.
Dear Mr.
Franklin:
As requested, I
have further developed the case by providing you with a Time-Line of Events (attachment A)
that identifies deviations from standard of care, a Medication Administration Record
(attachment B) that summarizes the total narcotics
received by Ms. Brooks and a summary of Physician Orders (attachment C).
I hope this will help to establish a clear recount of the actual events
as they took place.
I strongly
believe that this case is about the negligence/failure of Dr. Moore to
provide his patient with a safe environment of care and pain management
post-operatively. Ms. Brooks was requiring high doses of pain
medication and therefore should have been moved to a post-op intensive
care unit for constant monitoring of respirations and oxygen saturation
levels. Nursing management should have been notified of this
inappropriate patient care situation. The nurse's failure to follow
basic nursing practices and standards of care caused Ms. Brook's
respiratory arrest and unfortunate death directly related to an
overdose of narcotics.
Please note
that I have concerns regarding the nurse-to-patient staffing ratio on
this particular unit on the day of the occurrence, as well, I have
suspicions of possible tampering of the medical record.
Thank you for
the opportunity to provide additional medical-nursing insight related
to this case. If you would like, we will be happy to provide additional
services, including expert witness referral. Please feel free to
contact our office.
Best Regards,
Damron Medical
Legal Consulting
A.Time-Line of Events
|
Date/Time
|
Events
|
Standard of
Care Deviations
|
|
02/10/2005
1100
|
Nurse A Administered:
Morphine 6mg IV
Push
Patient
underwent Exploratory
Laparoscopic Procedure of Abdomen
& Pelvis.
Weight 118 pounds
Age 28
|
Nurse failed to
assess and/or document after administration of high dose of narcotic:
•
Vital Signs
•
Oxygen Saturation
•
Respiratory Effort
Vital signs
documented at 1015:
Temp 98, Heart
Rate 78, Resp 20
|
|
1300
|
Nurse A Administered:
Morphine 6mg IV
Push
|
Nurse failed to
assess and/or document after administration of high dose of narcotic:
•
Vital Signs
•
Oxygen Saturation
•
Respiratory Effort
Vital signs
documented at 1015:
Temp 98, Heart
Rate 78, Resp 20
|
|
1400
|
Nurse A Administered:
Percocet 10mg
PO Phenergan 12.5 IV Push
|
Vital Signs
Documented:
Temp 96.8,
Heart Rate (HR) 94, Resp 16, B/P 95/55
**B/P Falling
& HR Rising**
B/P at
admission, pre-op and immediately post-op ranged from 120/84 to 140/70,
HR was in 70's
Nurse failed to
document:
•
Oxygen Saturation
•
Respiratory Effort
|
|
1500
|
Post Op visit
by Dr. Moore
Pain meds
changed:
Morphine
increased from 6mg to 10mg every 2 to 4 hours as needed for pain.
Nurse A Administered:
Morphine 10mg
IV Push
|
Nurse failed to document:
•
Oxygen saturation
•
Respiratory Effort
•
Mental Status
Vital Signs
Documented:
B/P 90/48, HR
108, Resp 16
**BP continues
to Fall & HR continues to rise**
|
|
1700
|
Nurse A called
Dr. Moore concerning continued complaints of pain:
Dr. Moore
Issues Verbal Telephone order to:
Discontinue
Morphine
Administer
Demerol 50 to 100mg IV Push every 4 to 6 hrs as needed for pain.
|
After ordering
high dose narcotic, Dr. Moore failed to:
•
Order Vital Signs every hour
•
Order bedside monitoring of oxygen saturation
• Move
patient to a higher level of care such as ICU
•
Re-evaluate Pt. condition
•
Follow Up on patient
After
administering high dose narcotic, nurse failed to:
•
Obtain Vital Signs
•
Assess Resp Effort
•
Monitor Oxygen Saturation
•
Contact Nursing Manager for appropriateness of care
•
Recognize change in acuity
Patient remains
on a busy Med/Surg floor with 6 to 8 patients per nurse. Patient status
changed requiring high dose of pain medication, needs to be moved to a
nursing unit that delivers a higher level of care with a lower patient
to nurse ratio such as a post-surgical ICU.
|
|
1800
|
Nurse A
Administered:
Demerol 50mg IV
P Phenergan 12.5mg
IV P
|
Nurse failed to
assess/document:
•
Complete set of Vital Signs
•
Oxygen Saturation
•
Respiratory Effort
BP 90/40,
remains low
|
|
2100
|
Nurse B
Administered:
Demerol 100mg
IV Push
Insert is
attached to this document regarding vital signs and respiratory effects
related to Demerol and Morphine
|
Nurse failed to
assess/document:
•
Complete set of Vital Signs
•
Oxygen Saturation
•
Respiratory Effort
Patient
respiratory arrested 30 minutes after administration of demerol.
Following an unsuccessful Code 500 attempt, the patient died of hypoxia
(lack of oxygen) at 2200.
|
B. Medication
Administration Record Post-operative
until Death
1000: Morphine
6mg IV Push administered in recovery room
1100: Morphine 6mg IV Push given
by Med/Surg Nurse A
1300: Percocet 10mg PO & Phenergan
12.5mg IV Push administered by
Nurse A
1500: Morphine 10mg IV Push
administered by Nurse A
1800: Demerol 50mg IV Push,
Phenergan 12.5 mg IV Push administered by
Nurse A
2100: Demerol 100mg IV Push
administered by Nurse B
2130: Respiratory Arrest Code 500
Unsuccessful
2200: Time of Death
Total
Narcotics received by Ms. Brooks within 11 hours
Morphine 22mg
Intravenous Push
Demerol 150mg
Intravenous Push
Percocet 10mg
by mouth
C.
Physician Orders
1000: Standing Post-Op Orders:
Medical & Surgical Floor
Morphine 2mg to
6mg IV Push every 2 to 4 hours as needed for pain
Percocet 10 mg PO every 4 to 6 hours
as needed for pain
Ambien 10mg PO
at bedtime for sleep as needed
Phenergan
12.5 mg IV Push every 4 to 6 hours as needed
for nausea
1500: Written Orders per Dr.
Moore-Post Operative Visit
Increase
Morphine to 6 to 10 mg IV Push every 2 to 4 hours as needed for pain.
1700:
Nurse A
called Dr. Moore about the patient's recurrent complaints of lower
abdominal and pelvic pain and informed him that after administration of
pain medication, her Pain level was documented at 8 on a scale of 1 to
10. Dr. Moore issued the following verbal telephone order: Discontinue
Morphine and administer Demerol 50mg to 100mg IV Push every 4 to 6
hours as needed for pain.
This
was the final Medication Order issued
DISCLAIMER: This
sample work case is based on an actual wrongful death case.
All information related to names, places, dates and people have been
changed. Any similarity to any one person or place is purely
coincidental.
