According to a published report, a defense verdict was returned.
Failure to Recognize Adrenal Crisis
A 26-year-old Massachusetts woman had a history of type 2 diabetes and newly diagnosed adrenal insufficiency, for which she was taking hydrocortisone. She presented to an emergency department (ED) complaining of cold symptoms and abdominal pain.
She was evaluated by an emergency physician, who noted moderate pain and tachycardia, a heart rate of 100 beats/min, and tenderness in the woman’s sinuses, neck, and left lower quadrant of the abdomen. Laboratory test results included a positive pregnancy test and an abnormal potassium level. Subsequent cardiac monitoring revealed atrial tachycardia. ECG revealed a rapid heart rate and diffuse, nonspecific abnormalities.
A second physician assumed care of the patient and treated her with potassium chloride, IV fluids of dextrose and sodium chloride, and ondansetron for nausea and vomiting. Neither physician had noted the medications being taken by the patient.
She returned to the ED two days after her initial admission with complaints of vomiting, chest pain, and abdominal pain. Her vital signs were abnormal. A different emergency physician evaluated the patient and noted tachycardia and vitiligo (consistent with adrenal insufficiency). Laboratory study results revealed metabolic abnormalities, and the woman was diagnosed with pregnancy-related nausea and vomiting and poorly controlled diabetes.
Over the following week, five additional physicians examined and/or treated the woman, one of whom was told that she had been taking hydrocortisone but stopped when she learned she was pregnant. The woman’s condition worsened, involving blindness, severe metabolic acidosis, and respiratory arrest. The family agreed to a transfer to a tertiary care facility.
At this time, during conversations between the patient’s family and her physicians, the physicians were made aware that she was taking hydrocortisone for adrenal insufficiency. The physicians immediately began treatment with methylprednisolone. The patient’s neurologic status continued to decline, however, and CT revealed findings consistent with a diffuse anoxic injury. She was placed on comfort measures only, and she died nine days after her original ED admission.
The plaintiffs alleged negligence in the ED staff’s failure to take a thorough medical history. The defendant claimed that the decedent’s symptoms were not consistent with adrenal crisis and that she had not fully disclosed her use of hydrocortisone.
According to a published account, a $3 million settlement was reached.
High-Dose Morphine After DNR Order
At age 79, a woman with chronic obstructive pulmonary disease was admitted to a hospital in Georgia with breathing difficulties. During her hospitalization, the patient experienced respiratory arrest. A code was called and the defendant, the critical care pulmonologist on duty, responded.
Once bag ventilation was implemented, the patient started to breathe and the code was stopped. After the incident, the attending physician, who had also responded to the code, initiated a discussion with the patient’s daughter about the plan of treatment and the patient’s prognosis. At the conclusion of this conversation, the patient’s daughter agreed to a “do-not-resuscitate” order. The attending physician ordered 2 mg morphine as needed to keep the patient comfortable.
Five minutes later, the pulmonologist overrode this order and ordered 20 mg morphine pushed. Shortly after the medication was administered, the patient, who was talking to her daughter and granddaughter, lost consciousness. She died about three hours later without regaining consciousness.
The plaintiff claimed that the decedent’s condition improved during her hospitalization until the night before her arrest, when she was not given her scheduled breathing treatments. The plaintiff also alleged that the defendant pulmonologist was negligent in ordering the 20-mg dose of morphine and that the hospital nurse was negligent in administering such a high dose.
The defendants claimed that no negligence occurred and that the woman would have died sooner than three hours after the morphine was administered, if that indeed was the cause of her death.
According to a published account, a $3 million verdict was returned.