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Diabetic Goes Into Coma, Suffers Neurological Damage After Nurse Fails To Follow Doctor’s Order | Ormond Beach Medical Malpractice Attorney

Diabetic Goes Into Coma, Suffers Neurological Damage After Nurse Fails To Follow Doctor’s Order

Even if a physician allows a patient to check or deliver certain aspects of their medical care while in the hospital, a medical professional should still be supervising the process.

That didn’t happen in the case of a woman with insulin-dependent diabetes who was allowed to check her own blood sugar and adjust her insulin as needed. She slept through a blood sugar check, was found unconscious with a high blood sugar, and after a week-long coma never returned to baseline neurological function.

The lawsuit against the hospital and the nurse, for ischemic brain damage caused by the defendants’ failure to monitor the patient’s blood sugar every four hours as her doctor ordered, was settled for more than $1 million.

Originally, the 36-year-old wife and mother was admitted to the diabetic unit of the hospital with complaints of a severe headache, nausea and high blood pressure. Her past medical history included Type I diabetes mellitus (since age 14), hypertension, renal or kidney insufficiency, and several other conditions.

Physician orders included IV fluids, insulin, finger stick blood sugar (BS) checks with an insulin sliding scale, and Labetalol. The following day, her endocrinologist ordered ‘when patient eating, discontinue sliding scale, let patient choose her own insulin dosage.’

Over the next day or so the patient’s blood pressure and blood sugar varied and her medications were again adjusted. Orders were written by her nephrologist for the IV fluids to be discontinued, and blood sugar to be checked every four hours (“wake patient at night – start now”). The plan was for the patient to be discharged home the next day if stable.

The following day she did not go home as planned due to a rising creatinine level, which indicates poor kidney function, along with the need for continued medication adjustments, and her history of asymptomatic hypoglycemia and hypertension.

Her physician noted that the “patient is very aggressive with her insulin dosage, BS = 59 this am and 197 at 11pm – have asked the patient to be careful about lowering her BS below 120. Patient is willing to stay to stabilize her BP and renal function.”

During her continued stay her renal or kidney function continued to decline, developing swelling edema in her legs and lower back, with crackles noted in her lungs and a weight gain of approximately 20 pounds since admission.

Orders for daily weights and strict measurement of food and fluids entering the body were written. Her BS also continued to fluctuate, frequently below the desired 120 as indicated in this note from a nurse: “4-11pm: BS = 42 at 4:45pm – patient ate dinner and BS rose to 103; the patient checked her own BS and administered insulin but not always consistent with orders for every 4 hours”.

One week after admission, the patient was taken to the OR for creation of an AV fistula – a link between an artery and vein – in preparation for upcoming hemodialysis, which cleans the blood like kidneys normally do. That night, when the patient checked her BS it was 128 at 10 p.m.). She gave herself 2 units of Humalog and 8 units of Lantus. At 4:15 a.m., the nurse wrote “will continue to monitor closely.”

Despite this, the nurse did not check any blood sugar between 10 p.m. and 6 a.m. At 5:40 a.m., the woman was found unresponsive; her BS was 30. She had decerebrate posturing with arms and legs stretched out – typically a sign of brain injury. She was intubated to help with breathing, and transferred to the mobile intensive care unit (MICU).

The nurse admitted that she didn’t wake the patient up in the middle of the night to make sure she checked her BS (but was aware of orders to check BS every 4 hours). Progress notes in the MICU state that the patient’s hypoglycemia was most likely due to her overly aggressive treatment of her BS before she went to sleep, which was compounded by her poor clearance of insulin secondary to renal insufficiency.

After multiple tests (e.g., head CT, brain MRI; EEG; CXR), the impression was that the patient likely suffered an ischemic brain injury (with cortical and subcortical involvement), which is lack of oxygen, from experiencing the low blood sugar of unknown duration.

Approximately one week later she was able to open her eyes and move her arms and legs spontaneously, and was transferred back to the diabetic unit. Within two months, with improved symptoms, the patient was discharged to rehab.

Later that year, the patient underwent both a kidney and pancreas transplant. Over the next several years her neurologic function improved but she was still considered disabled, especially with regards to her emotional/social health. She spends most of her time watching TV and shows no interest in interacting with her husband or children; she also does little socializing with friends.

This case was strong because it involved a direct violation of documented physician orders that more likely than not would have prevented this woman’s injury.

Other points of interest in this medical malpractice case include:

  • The responsibility for monitoring blood sugar was shifted to the patient without adequate monitoring. Part of a health care professional’s role is to help patients learn how to manage their own illnesses. The nurse is required to monitor the patient’s compliance and ability to manage her own illness. This should include documentation of the entire process, including patient education. The nurse is also responsible for notifying the patient’s physician when the patient does not adhere to the prescribed orders or parameters. The nurse was negligent in these areas.
  • The nurse should have considered all information about the patient. Having taken care of this patient previously, the nurse thought the patient was capable of checking her BS and administering her own insulin, but did not consider evidence to the contrary, including asymptomatic hypoglycemic events and the effects of recent surgery. A patient’s history of previous asymptomatic hypoglycemic events, whether due to aggressive insulin dosing or poor oral intake, is a key consideration in how vigilant the monitoring should be.

For more on patient safety, see the library of articles by Daytona Beach medical malpractice attorney.

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