Medication errors come in all shapes and sizes.
We’ve recently been working on a case where a major pharmacy chain dispensed and filled a prescription for a heart medication. The same bottle contained some pills for the correct medication that was ordered by the patient’s doctor and other pills that were a different medication. When the man took the medication, he became extremely dizzy and had an irregular heartbeat. His coworkers called an ambulance that took him to a hospital, where his doctors and nurses fortunately discovered the medication error.
That’s the first time I’ve seen a situation where a pharmacist mixed two medications in the same bottle. We more commonly see pharmacy errors where they fill a prescription for a medication that’s contraindicated and dangerous for a particular patient. Another frequent error is mislabeling the medication altogether.
According to a medical malpractice lawsuit, that’s what possibly happened to a patient at Houston Methodist Hospital, located at 6565 Fannin St., Houston, Texas 77030, in the Texas Medical Center.
According to the patient, she was admitted to the hospital for surgery. Before she was taken to the operating room, she was seen in the pre-operative holding area by an anesthesia care team (ACT). The team included an anesthesiologist physician, two certified registered nurse anesthetists (CRNA), and a student CRNA from either Methodist or Baylor College of Medicine.
Up to this point, the healthcare events seem pretty normal. According to the standard of care described by the American Society of Anesthesiologists, before administering anesthesia, an anesthesiologist is responsible for performing the pre-anesthesia assessment.
The overall purpose of the pre-anesthesia assessment is to ensure that it is safe for the patient to go under anesthesia and proceed with the planned surgical procedure. Anesthesiologists and CRNAs should take a thorough history from the patient and consider the effective medications, other diseases or illnesses, and findings from any pre-operative testing including laboratory data or an EKG.
Not all surgeons or anesthesia providers require a pre-operative EKG, even though they are relatively quick and inexpensive to perform. A 12-lead EKG is an excellent screening mechanism to identify heart or cardiac issues that may require further investigation before clearing the patient for surgery. Even when the 12-lead EKG isn’t performed, though, routine monitoring recommended by the American Society of Anesthesiologists includes a 3-lead EKG. The standard of care requires anesthesia providers to look for abnormalities on the 3-lead EKG and gives them the discretion to cancel the procedure if they see something concerning.
While the patient was still in the pre-operative holding area, the student CRNA administered what she thought was a sedative called Versed (or Midazolam). The student CRNA did not know that she had actually administered a paralytic (paralyzing) drug called Rocuronium. In fact, no one recognized this fact until laboratory testing was done after this serious adverse event occurred.
Shortly after the patient received the mixed-up drug, she complained of having difficulty breathing. It wasn’t long before she was unresponsive and wheeled into the operating room. Within minutes, her blood pressure skyrocketed to 207/120. The OR team recognized that the patient wasn’t breathing, so they started emergency assisted ventilation with a bag and mask.
Next, the patient was intubated. This is a procedure where a provider, usually an anesthesiologist or CRNA, inserts a flexible plastic breathing tube down the patient’s throat. This is done to secure the airway and ensure adequate oxygenation and ventilation.
The OR team didn’t realize it at the time, but the patient was awake throughout all of these developments and painful medical interventions. That’s because she had been given the paralyzing drug Rocuronium.
In the medical malpractice lawsuit that followed, the patient alleged that she suffered hypoxic/anoxic encephalopathy, a brain injury caused by inadequate or a total lack of oxygen, along with post-traumatic stress disorder (PTSD), and other neuropsychiatric illnesses.
The defense challenge and appeal
As often seems to be the case when there is an emergency event, the hospital’s medical records were rather vague on some key events. For example, the appellate court observed that the timing of events in the pre-operative holding area and operating room is unclear. The medical record showed different times that medications were administered to her, including the time that she was given Rocuronium by mistake.
Sparse, inaccurate, conflicting medical records create problems for medical malpractice plaintiffs who are required under Texas tort reform law to produce medical expert reports fully describing the alleged negligence. These reports are due 120 days after each defendant files an answer in the lawsuit, in the context of a statutory discovery stay that doesn’t allow depositions and other written discovery beyond obtaining the medical records.
In this case, the plaintiff retained a board-certified anesthesiology expert to prepare an expert report. The expert relied on a statement in the lawsuit’s original petition that the student CRNA who administered the medication was associated with either Methodist or Baylor College of Medicine. The claims against Methodist by the plaintiff and the anesthesia expert relate to vicarious liability, meaning that Methodist was responsible for the negligence of its potential employee, the student CRNA.
Houston’s 14th Court of Appeals concluded that the anesthesia expert retained by the plaintiff was entitled to rely on the plaintiffs unrebutted allegations regarding the student CRNA’s relationship to Methodist in order to form his opinion. The court cited the Texas Supreme Court opinion in Loaisiga v. Cerda, 379 S.W.3d 248, 261 (Tex. 2012), which said, “Thus, we do not see why an expert, in formulating an opinion, should be precluded from considering and assuming the validity of matters set out in pleadings in the suit, absent a showing that the pleadings are groundless or in bad faith or rebutted by evidence in the record.”
I believe that the 14th Court of Appeals opinion reached the correct conclusion in this case. Healthcare defendants should not be able to have their cake and eat it, too. There needs to be a proper balance between the discovery stay that prevents full development of the facts and evidence and reasonable standards for plaintiffs and their experts to meet at the preliminary stage of litigation.
If you’ve been seriously injured because of poor medical or hospital care, then contact a top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.