Case Archive
Urology, Home Health Care, Pharmacy
Ref. # 16988

An Ohio woman suffering from chronic interstitial cystitis and migraine headaches was treated with various pain medications, including demerol, talwin and fiorinal. The pain from the cystitis did not subside and the woman was provided with a PCA pump for ongoing administration of demerol. The woman continued to work while on the pump and was seen frequently by a home health nurse, employed by a home health agency. During therapy and while at work the woman reported to the home health nurse that the pump malfunctioned, as the medication had run out. The home health nurse met the woman at her office to evaluate the situation. The nurse was instructed over the phone by the home health agency to drive the woman home, but she did not. While driving herself home, the woman was involved in a head-on collision, which resulted in critical injuries to herself, and the death of a boy in the other automobile and critical injuries to his mother.

A medQuest urologist reported that the treatment of the cystitis by the general practitioner was far below the standard of care, as the woman should have been referred to the Mayo Clinic or a comparable institution a long time prior to the auto accident.

A medQuest registered nurse specializing in infusion therapy reported that the day after the woman was placed on PCA therapy she was instructed how to unlock the pump in order to administer medication herself--an unacceptable practice. The medQuest nurse noted that there is a "no driving" policy during PCA therapy; the home health nurse should have driven the woman home. The medQuest nurse further reported that during the 48 hours prior to the accident the woman received 2200 mg. of demerol--an exceedingly high level of medication. The medQuest nurse questioned the pharmacist's role concerning liability, given that such an excessive dose was administered without questioning.

A medQuest pharmacist reported that the woman should have been strongly cautioned about the use of the pump, the side effects of demerol, and the "no driving" policy. The medQuest pharmacist further questioned the use of PCA therapy for migraine headaches in addition to the cystitis. The pharmacist should have early on reported the possibility of pump tampering to the physicians. Finally, the pharmacist's actions did contribute to auto accident.

The attorney noted there were criminal charges pending against the woman as a result of the auto accident.

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