Nashville nurse charged with reckless homicide after administering wrong medication.
This is textbook manslaughter. This nurse “knew or should have known” that such a reckless disregard for patient safety would put the patient in danger of death. My guess is that she was either arrogant, ignorant or both. So sad.
– Mark Plaster, MD, JD
There were many system breakdowns that allowed this horrible medication error to occur. What hospitals store paralytics in a Pyxis machine? Under what circumstances were system “overrides” allowed to the point that typing “VE” in the machine could give a nurse vecuronium instead of Versed? Why was a patient receiving Versed for a PET scan and why wasn’t the patient being monitored after receiving the medication? The nurse in this case deserves professional disciplinary action, but criminal prosecution for an unintentional error is overboard. Why weren’t the hospital CEO, the pharmacy director, and the CEO of Pyxis charged? Their errors could have contributed to this event as well. Putting medical providers at risk of incarceration for medical errors will lead to a drastic decrease in available medical care. Who will want to practice medicine or take care of high-risk patients if they’re at risk of incarceration for mistakes? I’ve seen the argument that instead of complaining, medical providers just need to “stop making mistakes.” Unfortunately, I’ve never seen the model on how perfect medicine should be practiced. We need to tread very carefully here.
– William Sullivan, DO, JD
The CMS report of this horrible error is here. It does seem to me, however, more like an error and less like a crime. I’m not a lawyer, but see that reckless homicide is defined as “a crime in which the perpetrator was aware that their act (or failure to act when there is a legal duty to act) creates significant risk of death or grievous bodily harm in the victim, but ignores the risk and continues to act (or fail to act), and a human death results.” If Vanderbilt is taking steps to make it harder to order vecuronium accidentally (and they should be) it seems like a tacit admission the system was flawed, and the vendor and CMIO and head of Pharmacy and others are also liable to some degree.
Lots of experts are calling for us to move away from blaming/punishing the frontline clinicians and instead making it easier and safer for them to identify risks and improve practice. And yet, sending this nurse to jail and penalizing RIH ED docs for filing EHR risk reports is a step in the wrong direction.
– Nicholas Genes, MD, PhD
Painkiller left man ‘totally disabled’
https://www.cbc.ca/news/canada/british-columbia/prescription-painkiller-lawsuit-888k-ketorolac-ulcer-1.5006892I’ve got 99 problems and ketorolac is one. As if we don’t have enough issues with opioid prescriptions/abuse, now we have to worry about NSAIDs too?
– Salim R. Rezaie, MD
The fact that a CT scan and ultrasound didn’t show an ulcer a few days before it was ultimately diagnosed means very little. Neither modality has a sensitivity >50% for diagnosing duodenal ulcers. The patient argued that his duodenum went from “normal” to hemorrhaging ulcer in three days? I’d love to see literature on how that happens. He initially went to the hospital for 9 of 10 pain due to his Crohn’s disease and had “been to different hospitals for similar issues before.” Suddenly, after surgery, he has no issues whatsoever with his Crohn’s disease, but has “debilitating” postoperative pain and PTSD from his hospital admission that prevents him from ever going to work again. I call BS.
Adding to what Salim mentioned, I fear that we’re progressing toward an era of strict liability in medicine — regardless of what you do, if a patient suffers an injury, the physician is liable. Don’t treat a patient’s pain as a “fifth vital sign?” Low Press Ganey and HCAHPS scores will jeopardize your job. Prescribe Tylenol? That doesn’t work for my pain, silly. Prescribe NSAIDS and patient develops a bleeding ulcer three days later? Get sued for $1 million. Prescribe opioids and patient overdoses or prescribe too many opioids? Get sued and have state or feds come after your license. On one hand we’re trying to decrease the practice of defensive medicine. On the other hand we’re increasing liability for any perceived patient injury. What’s going to give? The article mentions that the patient is now having withdrawals from a reduction in dosage of his opioids. I’m wondering who is going to get sued for that …
– William Sullivan, DO, JD
While this was clearly negligence and should have been settled for the limit of liability insurance, it seems clear to me the doctor did not have adequate representation. It was unfortunate that the patient had such a strong reaction to Toradol, though not foreseeable. However, the patients injuries were somewhat exaggerated, in my estimation to achieve maximum reward. That’s good lawyering for him. But it doesn’t say so much about the level of liability in my mind.
– Mark Plaster, MD, JD
About 900 healthcare workers in danger of losing licenses due to student loan defaults.
OK, first, let’s make it clear that if you take out student loans, you’re responsible for paying them back. But the idiocy of revoking licenses for missing student loan payments is striking. Someone can be declared in default by missing only a couple of payments. Perhaps the health care provider (which includes RNs, CNAs, pharmacists, and opticians) lost a job and is trying to find another one. Perhaps the salary they receive doesn’t cover the student loan payments plus other expenses. Maybe the professional was hospitalized … or suffered a financial crisis … or was on a vacation.
Now Florida piles on the hurt by making it so that those professionals are unable to go back to work so that they can’t earn money and can’t pay back the loans. There are many other ways to collect on delinquent loans. Institution of a modern-day debtor’s prison shouldn’t be one of them. I wonder what would happen if Florida law required that legislators lose their jobs and pensions and had to pay back all of their campaign donations if they defaulted on any of *their* loans. Pure outrage, I’m sure.
– William Sullivan, DO, JD
Outstanding student loan debt has gotten out of control in the US and nearly tripled in the past decade. Even worse, it has surpassed auto and credit card debt. If that is not bad enough, if you live in Florida, it turns out they can suspend your license over this debt. What?!? How are people supposed to pay off their outstanding debt, if we are taking away their means of paying? This has become a true economic emergency leaving what many believe to be the American dream, just that…a dream.
– Salim R. Rezaie, MD
Losing your license to practice for failure to pay med school loans is something akin to debtor’s prison. They can’t pay their debts if they can’t work. Other states realized that and overruled such laws. Every now and then legislators do the right thing, even if it is late.
– Mark Plaster, MD, JD
Hopefully this becomes a campaign issue and the people of Florida remember which of their reps are in cahoots with the predatory student loan system in the US, and who is actually interested in letting trained healthcare professionals with money problems stay on the job.
– Nicholas Genes, MD, PhD