Legal Review & Commentary-Magnesium sulfate OD causes coma: $7.4 million
News: A Chicago jury returned a $7.4 million verdict against a hospital in which a post-childbirth patient sustained severe brain damage due to an overdose of magnesium sulfate.
Background: The 19-year-old woman was admitted to the hospital in August 1996. She was diagnosed with preeclampsia, and Pitocin and magnesium sulfate were ordered IV. The drugs were administered through separate lines controlled by a double IMED pump. She gave birth to a healthy girl. After the placenta was delivered, the obstetrician ordered more Pitocin and left the room.
The nursing manager, who had been caring for the baby, went to the IMED pump to open the Pitocin line, then she left the room. Eight to 10 minutes later, an obstetric technician noticed the patient thrashing. The patient then became unresponsive, and the technician called the physician. The patient had no heart beat or respiration. The physician noted that magnesium sulfate was flowing freely into the patient. Calcium gluconate was administered, and a code blue was called. The patient was resuscitated but sustained profound anoxic brain damage and remains in a persistent vegetative state. She is in a nursing home.
The hospital admitted liability, but the nurse who removed the line denied making the error. The physician contended that he had no duty to supervise the nurse who carried out his orders or to inform her that the patient was on magnesium sulfate. The doctor won a defense verdict.
What it means to you: "Under the facts presented in this case, the nurse manager certainly had a responsibility to take a look at the lines running both the Pitocin and magnesium sulfate to assure the correct adjustment of the Pitocin flow rate, as ordered by the physician," says Vivian B. Miller, national account risk and safety manager for the PHICO Group Inc. in Mechanicsburg, PA.
However, the physician should have made sure the nurse knew that the patient was being given magnesium sulfate, in addition to the Pitocin, Miller believes. "A physician must oversee the care that is being provided, and as such, has an obligation to inform the nurse of all actions he or she has taken on the patient's behalf. The fact that the jury found in favor of the physician still does not negate that responsibility."
Miller says the top five allegations in claims against all specialists, physicians as well allied health professionals, involve the failure to monitor or effectively supervise patient care. "Monitoring problems include lack of recognition of changes in the patient's condition, failing to ensure that the patient is on the proper medications at the proper dose, and the like," she explains.
The allegation that this patient was not adequately monitored was a major claim in the case, Miller feels. "Eight to 10 minutes is a long time to be out of the room of a patient who just had a baby. There are too many risks. Her blood pressure could have dropped suddenly, or she could have started hemorrhaging. Someone needs to be with the patient for a specified period of time post-delivery in case such events occur."
Miller notes that the hospital may have had a policy such that the patient was supposed to be monitored in the room by an RN or other qualified professional for a specified period of time after delivery. "If there was such a policy in place and it was not adhered to, then the hospital has learned a very hard lesson." Had the nurse stayed with the patient, she might have discovered the patient's change in condition much earlier, Miller says; also, administering calcium gluconate at an earlier point could have minimized the patient's injury.
Miller also wonders whether it is permissible or appropriate for an obstetric technician to monitor the patient after delivery. If so, there must be assurances that the person who is taking care of the patient is competent to do so, she adds.
Finally, what appears to be a glaring problem is the communication failure among the health care providers, she says. "Many people say that communicating with the patient is a key to preventing litigation. That is true, but as this case shows, communication is crucial between everyone who is involved with the patient's care. Explicit, clear, and concise communication between health care providers and hospital staff is vital to effective and appropriate patient care. It could have prevented this patient's resulting injuries."
Reference
Conley v. Advocate Health and Hospital Corp. d/b/a Bethany Hospital, Cook County (IL) Circuit Court, Case No. 97L- 3535.
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