I represented the family of a 33-year-old woman who had committed suicide while in the mental health unit of a local hospital. Note that not all suicides are the fault of others or the negligence of physicians. When a family thinks that a suicide was the fault of a physician or hospital, they are still very difficult medical malpractice claims. This is because the person who commits suicide does so by their own hand. However, in this medical malpractice case, we had errors by the treating doctor in the hospital in which they failed to safeguard plaintiff from committing suicide.
The deceased was placed on 15-minute suicide precautions by her treating doctor. She also had been on a Fentanyl patch for a chronic pain condition she had. Fentanyl is a highly potent narcotic. With the patch, Fentanyl slowly puts the drug into the body through the skin. However, if the patch is opened and the contents ingested, a deadly dose of Fentanyl can be administered. There is, and has been for a long time, a lot of medical literature on the abuse of Fentanyl and the fact that people do open these patches and suck on them, which can lead to a lethal dose. She was found the morning of August 16, 2005 dead in her bed.
We pursued medical malpractice claims on behalf of the family against the doctor for providing her with the Fentanyl patch while she was in the suicide ward. The doctor essentially provided her with a lethal dose of a pain reliever, when she had expressed a desire to kill herself and advised the doctor that her method of suicide would be to overdose on her medication. The doctor should have converted her to a oral pain relieving pill that the nurses could have administered every 4 to 6 hours for her pain. Just like a doctor would not provide a suicidal person with a three day supply of Darvocet or other pain pills due to the risk of overdose or abuse, this doctor should not have provided the decedent with a 72 hour (3-day) dose of Fentanyl. There were other allegations and evidence that the doctor failed to properly assess her suicidality, to research the Fentanyl drug or to guard against this likely suicide risk. In fact, three months before this death, the drug manufacturer had put out an FDA Black Box warning about misuse and abuse of Fentanyl and strongly recommended that history of abuse or misuse or other problems with Fentanyl be assessed prior to prescribing this medication. The doctor basically put a loaded gun in the hands of a suicidal person.
The allegations against the hospital were different. The evidence in the case showed that St. John’s nurses and technicians were not doing the suicide checks as they were supposed to. When the decedent was found, she had been dead for over an hour. Fifteen minute suicide checks (which check movement and respiration, even at night) should and would have caught her overdose. The suicide checks were so bad at the hospital that they didn’t even notice that she was dead for at least four checks. Fentanyl operates to kill someone by decreasing their respiration, which eventually stops. We believe that had this overdose been noted, the decedent could have been put on a ventilator until the drug was out of her body, and would not have died.
Extensive discovery and depositions were done in the case and we fought against the defense lawyers for about two years. The case against the hospital settled three weeks before trial and the case against the doctor settled the morning of trial. The terms of the settlement and the settlement agreement are confidential and cannot be discussed here. One of the lessons of this case was how much tort reform has affected the settlement value of cases. The fact of August of 2005, Missouri law has placed a limit of $350,000.00 for non economic damages in a medical malpractice case; which basically means that in a wrongful death medical malpractice case, the value of a person’s life is limited to this amount of money. Because the defendants knew that the maximum exposure would be capped by this limitation, they certainly delayed settlement and were not willing to offer as much money as they would have otherwise.
We also settled another case involving medical malpractice. In that case, Gilles Triplett was a 76-year old gentleman who was in intensive care for various heart and vascular problems. He had had a endotracheal tube (tube put down into a person’s stomach) placed by the physicians to both feed him and to relieve any gaseous pressure that might build up in his stomach. The nurses fed him that day through the tube. Later that night, about 11:00 p.m., Mr. Triplett had stomach contents come up through his esophagus. Unfortunately, even though he was in ICU and was constantly monitored, he suffocated on this emesis and died. The code was called but he was not able to be resuscitated. We filed suit and pursued the case alleging negligence on the part of the hospital in failure to monitor him on a telemetry unit. This case was vigorously defended with serious questions raised on whether the hospital could have identified this in time with their monitoring and whether the emesis was what caused him to die, or was the last result of heart failure or other causes. However, we pursued the case, filed suit, had our experts lined up and ready to testify. The defendants agreed to settle the case.