Daniel F. Ryan, III and Michael O. Pitt obtained a defense verdict in favor of defendant neurologists and a nurse practitioner in a medical malpractice action in Philadelphia County.
In February 2009, plaintiff’s decedent, a 25 year old female, presented for a follow-up visit for treatment of migraine headaches. At that time, the patient reported experiencing headaches six days per week. She also had an extensive psychiatric history, including severe depression and inpatient admissions for suicidal ideation.
At the first office visit in February 2009, the nurse practitioner ordered a three day, consecutive course of DHE infusions, in accordance with the attending neurologist’s plan established at the patient’s last visit in December 2008. On the morning of the second infusion, the nurse practitioner noted the patient to be lethargic, having difficulty keeping her eyes open and was hypotensive. The nurse practitioner changed that patient’s medications to ensure less sedating effects. At the time of discharge, around 3:00 p.m., the patient’s vital signs and gait were normal. At approximately 6:00 p.m., the decedent went to her bedroom and was not seen by any family member for the remainder of the evening. The next morning, she was found deceased in her locked bedroom. Toxicology results, included the autopsy report, concluded that the decedent died as a result of an overdose of Prozac and Effexor taken in the hours before her death.
Plaintiff argued that the patient was suffering from multiple medication toxicity following her second day of infusion therapy and that the standard of care required the patient to be sent to the emergency room for evaluation and possible admission. Also, plaintiff was critical of the fact that the patient had not been seen by an attending physician on either day of her infusions.
The defense expert neurologist testified the nurse practitioner appropriately ordered infusion therapy for the patient, in accordance with the plan established by the attending neurologist. The decedent exhibited no signs or symptoms of medication toxicity on the second day; rather, as the day progressed, she became more alert and her vital signs normalized. The expert also confirmed that none of the medications given to her during her infusion could have caused her levels of Prozac and/or Effexor to be raised above therapeutic levels. The defense argued that the plaintiff’s decedent took either an accidental or intentional overdose of medications.
After deliberating less than an hour, the jury returned a verdict in favor of the defendants. The jury concluded that neither the defendant neurologists, nor the nurse practitioner whom they supervised, breached the standard of care and were not negligent.