An alleged excessive prescription of opioid pain medications after surgery reportedly caused an overdose death after the patient was discharged and resulted in a $20 million megaverdict against a surgery center and surgeon.
A 50 year old patient traveled from Ohio to Pennsylvania to undergo lumbar laminectomy and decompression of nerve roots along with thermal ablation of paravertebral facet joint nerves for treatment of chronic low back pain. Prior to the surgery, the patient had been on long-term Oxycontin and Flexeril to control her pain. During the surgery, the patient received intraoperative Dilaudid (although the dose was never mentioned in records, reports were that it was “six times” what had initially been ordered). After the surgery, the patient was observed for two hours and then discharged. She and her husband planned to spend the night in a local hotel before traveling home the next day. Discharge instructions from the surgical center recommended that the patient seek immediate medical help if she experienced any difficulties after her discharge. The instructions also recommended that she continue her prior pain medications as needed. Several hours after her discharge, the patient’s husband found her unresponsive in their hotel room. Paramedics found the patient in cardiac arrest and the patient was pronounced DOA in the emergency department. On autopsy, the toxicology report showed presence of multiple CNS depressants including Dilaudid, Flexiril, Oxycontin or Oxycodone, and Donnatal. The cause of death was therefore listed as “Fatal Adverse Interaction of Drugs.”
The patient’s family sued, alleging that the patient should not have received a large dose of Dilaudid during surgery and that the patient should not have been discharged while the Dilaudid remained in her system. The defendants argued that the patient required a larger dose of Dilaudid due to her tolerance to opioids from taking Oxycontin. They also argued that the patient and her husband failed to follow discharge instructions by not returning as instructed at the first sign of problems.
The patient’s husband testified that he was mentally distraught after his wife’s death, visiting his wife’s grave every day for three years leading up to the trial and playing her favorite music on a CD at the cemetery. He had his wife’s face tatto0ed on his leg and her name tattooed on his ring finger.
A jury deliberated 90 minutes before awarding $10 million to the patient’s estate and $10 million to the patient’s husband for loss of consortium.
Several of the issues raised on appeal were deemed waived because they were not properly preserved. Questioning during the trial suggested that at the time of the surgery, the patient had divorced her husband and had obtained a protective order against her former husband due to neglect and extreme cruelty. However, the trial court would not allow the defense to present documents to prove these allegations. Ultimately, the appellate court upheld the $10 million verdict to the plaintiff’s estate, but held that the judgment of $10 million for the patient’s husband was so excessive as to shock the conscience and remanded the case to the trial court for a new trial on those damages.
Takeaways
- The defense reportedly questioned the medical examiner’s conclusions, but there was reportedly no evidence presented to counter those findings. Obtaining actual levels of Dilaudid and Oxycontin in the patient’s system at autopsy may have helped disprove the notion of “overdose” if those levels were low. However, if the levels were high, they may have bolstered the plaintiff’s case. As is common knowledge among physicians who treat patients suffering from alcohol intoxication, blood levels of a drug do not necessarily reflect a patient’s tolerance to that drug. In this case, the patient was up and walking around before and after the surgery with several of these CNS depressants in her system. It is unknown whether she took additional pain medication after she returned to her hotel. Because each person metabolizes medications differently, a fatal interaction between multiple central nervous depressants would be difficult to either prove or disprove.
- Wrongful death due to overdose from opiates is a difficult allegation to defend. Based on the large verdict, it appears that the jury was angry with the actions of the surgery center and anesthesiologist. With the Joint Commission doing an abrupt 180 degree turn on its assertions that pain is a “Fifth Vital Sign” (after being sued by several West Virginia counties because the Joint commission standards helped fuel the opioid epidemic) and the possibility of criminal charges being filed against physicians when patients overdose on prescription pain medication, it should be no surprise that physicians are becoming more reluctant to prescribe medications needed to control pain.
- Even though the discharge papers that the patient received instructed the patient and husband to return “at the first sign of problems,” the jury did not seem to give much weight to the fact that the patient and her husband allegedly did not follow those instructions. Juries are free to decide how much weight to give to evidence presented at trial and may choose to ignore what a party believes is pertinent evidence.
Case reference: Kimble v. Laser Spine Institute. Case 16-00569. Chester County, PA. Appellate Case: 617 EDA 2019, Superior Court of Pennsylvania
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