Case reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
In January 2006, a 15-year-old Georgia girl presented to a clinic for recommended follow-up. She had been seen in an emergency department (ED) two days earlier for nausea, abdominal pain, and vomiting. At her clinic visit, the patient was seen by an NP, Ms. M., who practiced under the supervision of Dr. P.
Ms. M., after being informed about the girl’s ED visit, wrote prescriptions for antinausea medication and fluoxetine, using a prescription pad with pages that had been pre-signed by Dr. P. According to Ms. M.’s notes, the fluoxetine was prescribed for depression. The patient was told to return in one month.
Three weeks later, the girl hanged herself with a belt. She was found by her mother and brother and transported to the hospital. The patient suffered a catastrophic brain injury and required around-the-clock care until her death three years later.
The plaintiff claimed that fluoxetine should not have been prescribed because the decedent had no signs of clinical depression. The plaintiff also noted that the FDA had issued a warning specifying that fluoxetine use in adolescents increases the risk for suicidal thinking and behavior.
The defendant claimed that the NP’s clinical evaluation for depression supported that diagnosis. The defendant also claimed that the girl’s suicide attempt followed a breakup with her boyfriend and an argument with her father, and that use of the medication played no part in her suicide attempt.
Outcome
In a bench verdict, the plaintiff was awarded $3,459,892.
Comment
When an NP prescribes a medication despite a black-box warning and the warned event occurs, the defense has little hope; when the medication is written on a pre-signed script, there is no hope for the defense attorney. I have warned NPs and PAs never to use pre-signed scripts. It is simply illegal. If an NP does not have prescribing privileges because she practices in a state without such authority, then every script must be signed at the time written by the collaborating physician.
In this case, the NP may have been correct in her diagnosis, but under the circumstances, referring the patient to a specialist or at least having the collaborating physician weigh in on the decision was certainly in order.
I can’t help but notice that the physician was not a part of this action. —JP