Alleged Iatrogenic Dilaudid Overdose

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A 53-year-old man was driving on Christmas Day when he was involved in a car accident.

When EMS arrived, he was noted to have severe chest pain and a right thigh deformity.

The patient was rushed to the ED, where he was met by the ED and trauma teams.

Workup revealed multiple right-side rib fractures, hemo-pneumothorax, sternum fracture, acetabular fracture, and a mid-shaft femur fracture.

A chest tube was placed.

The patient was admitted to the ICU by Dr. J.

The admission order set included standing orders for Dilaudid 1.2mg q3hrs PRN pain >7/10.

On arrival to the ICU, the patient was assessed by Nurse G.

He reported a pain level of 10/10.

Therefore, Nurse G gave 1.2mg Dilaudid at approximately 1:19am.

His pain improved to 5/10.

The patient was seen by Dr. S, an anesthesiologist.

An epidural was ordered.

Dr. S ordered 1mg Dilaudid at 1:45am.

A different nurse, Nurse S, gave the dose at 1:56am.

The epidural was subsequently placed without complication.

At 2:58am, the patient was reassessed by the nurse.

He was found to be apneic and pulseless.

A code blue was called and CPR started.

The ICU team was able to get ROSC, and the patient was intubated.

Over the next few days, sedation was weaned but the patient had no spontaneous movement.

An MRI was done 3 days later, showing a global hypoxic brain injury.

After several weeks with no improvement, the family withdraw care and the patient died.

He left behind a 10-year-old son.

A lawsuit was filed against the hospital, the anesthesiologist (Dr S), and the nurse who gave the second Dilaudid dose (Nurse G).

An anesthesiology expert witness was hired by the plaintiff:

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