Hypoglycemic event lawsuit settles for $4 million

2008 Trial Lawyers Report

Medical malpractice settlement: Failure of Massachusetts General Hospital nurse to monitor diabetic woman’s blood sugar results in hypoglycemic event and permanent brain damage.

The plaintiff is a now 42-year-old woman who suffered a hypoglycemic event in 2004 which led to a protracted coma and permanent brain damage. On April 15, 2004, the plaintiff was admitted to Massachusetts General Hospital for treatment of her hypertension and acute renal failure. She had a past medical history which included Type-1 diabetes mellitus with associated nephropathy. She had tendency to experience prompt and severe hypoglycemic episodes and this was known to her medical care providers.

Upon admission, the physician placed orders for insulin administration and for blood glucose fingerstick testing 4 times a day. These orders were taken off and reviewed by the defendant nurse. On 4/17/04, the plaintiff was placed on Labetalol for blood pressure control. According to a note dated that day in the medical records, the plaintiff had a history of experiencing hypoglycemia when taking Labetalol in the past. Beneath the documentation regarding the connection between the use of Labetalol and the prior episodes of hypoglycemia, there is a notation that reads: "Thanks. We’re watching closely."

Also on 4/17/04, the same day that Labetalol was added to the plaintiff’s medication regimen, the medication and fingerstick orders were changed. The new orders discontinued the regular insulin sliding scale and replaced it with the order that "patient may take novolog qac (before meals) according to her own sliding scale." In addition, the order for the blood glucose fingerstick testing was increased to every 4 hours. On the order transcription sheet, it specifically reads, "wake patient for blood sugar checks every 4 hours" and "every 4 hours check sugars, at night wake patient."

Between 4/18/04 and 4/22/04, the plaintiff performed her own blood glucose monitoring with fingersticks and self-administered her insulin as ordered. The fingersticks were consistently clearly documented by the nursing staff on an average basis of every 2 – 4 hours. On 4/18/04, 4/20/04, and 4/21/04, the plaintiff experienced episodes of hypoglycemia. According to the nursing diabetic records, there is no indication that she was ever symptomatic with her hypoglycemic events.

On 4/21/04 – 4/22/04, the defendant nurse was responsible for the plaintiff during the overnight, 11:00 p.m. to 7:00 a.m., shift. On the day and evening shifts of 4/21/04, fingerstick glucose levels are documented approximately every 2-4 hours. The last fingerstick recorded on 4/21/04 was at 10:00 p.m. According to the nursing documentation, the defendant nurse did not record a blood glucose level until 6:00 a.m. the next morning. This was 8 hours after the last recorded blood glucose level. The 6:00 a.m. fingerstick on 4/22/04 showed a blood glucose level of 68, which indicated that the plaintiff was hypoglycemic. The defendant gave the plaintiff ginger ale to drink and two hours later her blood glucose level was 78. On the evening of 4/22/04, the defendant nurse was again assigned to care for the plaintiff from 7:00 p.m. until 7:00 a.m. the next morning. At 10:00 p.m., the defendant recorded a blood glucose level of 127. She then medicated the plaintiff with Darvocet at 11:00 p.m. and Ativan at 12:00 a.m. According to the physician’s order, the defendant should have then checked a fingerstick glucose level at 2:00 a.m. There is no recorded blood glucose level for that time. At 4:15 a.m., on 4/23/04, the defendant wrote a note regarding the plaintiff that read, "will continue to monitor closely." However, despite this notation, the defendant had not documented a blood glucose level in the past 6 hours. At 5:40 a.m., the defendant found Ms. Thompson-Hines unresponsive. She had gone to check on the plaintiff and upon finding her unresponsive she then checked the blood glucose level and it was 35. Medical specialists were called to evaluate the plaintiff and found her unresponsive with decerebrate posturing, right gaze deviation, and a question of possible seizure activity. The plaintiff was intubated and treated with medication to stabilize her blood sugar and control seizure activity. The plaintiff was transferred to the medical intensive care unit (MICU) where she remained comatose for over a week. Over the following two-month period, she had a gradual return in some of her neurological functions but she continued to have difficulty writing names and identifying objects. She also required verbal cues to complete simple tasks and remained emotionally labile. On 6/15/04, she was discharged to a rehabilitation facility for intensive neurological therapy. Currently, the plaintiff is still profoundly affected by her neurological injury. She requires cueing to begin activities, has an irregular gait, slow speech, and remains emotionally labile. She is not able to care for herself on a daily basis and needs constant supervision for all aspects of daily living.

During the course of litigation, the defendant alleged that due to the severity of the plaintiff’s diabetes, this type of a hypoglycemic event was unavoidable. The case was scheduled for trial in October 2008 and settled the week prior for Four Million Dollars ($4,000,000).

Lubin & Meyer lawyers represented the plaintiff in this medical negligence lawsuit.

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