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R. D. v Anonymous Physician/Hospital

Dr. Fagel negotiated a settlement of $3,500,000 on behalf of the surviving wife and two children of a 33 year old man who died after an appendectomy from pain medication overdose. The decedent was admitted to the hospital with abdominal pain and was diagnosed with acute appendicitis. The defendant doctor performed an appendectomy and removed the perforated appendix without complication. After surgery, the patient was transferred to the Post-Anesthesia Care Unit (PACU) and received 100mg of Demerol in small divided doses over one hour. He was then transferred to the Medical Surgical Unit with orders to be given 75mg of Demerol IV every 3-4 hours for pain. On the second post-op day, the defendant doctor ordered for two tablets of Vicodin to be given orally every 4-6 hours for pain, but did not cancel or modify the prior order for Demerol. The nurse continued to give the decedent IV Demerol because she thought the patient could not tolerate oral pain medication. The next nurse also continued to give the decedent Demerol because she felt it would be more effective at treating the patient’s significant pain.

On the third post-op day, another doctor covering for the defendant did not make any changes in the pain medication order so nurses continued to administer Demerol. At 5 p.m., the nurse called the doctor because the patient was having abdominal pain, so the on-call ordered an abdominal x-ray, but did not order for it to be done stat. At 2:40 p.m. on the fourth post-op day, an LVN that was assigned to care for the patient found him unresponsive. The patient then had a seizure-like episode and a Code Blue was called. The emergency response team attempted to resuscitate the patient for 50 minutes but was unable to save him. During the autopsy, the coroner discovered that the decedent had an enlarged heart caused by hypertensive cardiovascular disease. The official cause of death was listed as Acute Meperidine (Demerol) Toxicity with hypertensive cardiovascular disease as a contributing factor.

The defense contended that the Demerol levels were not at a toxic level and that the cause of death was the patient’s underlying cardiovascular disease. The LVN and charge nurse also claimed they saw the decedent walking around with no symptoms of any drug toxicity on the third post-op evening. On the other hand, Dr. Fagel argued that, although the patient had an enlarged heart and hypertensive disease, the ultimate cause of death was Demerol poisoning. Demerol is metabolized into normeperidine, which stays in the body and can build to toxic levels and cause seizures. As such, the doctor was negligent for not stopping the Demerol order and the nurses were negligent for continuing to administer IV Demerol after the Vicodin order was given.