As seen on San Antonio Express-News (TX):
A local physician whose illegible handwriting led to the fatal overdose of an elderly patient was ordered by a civil court jury Thursday to pay $380,000 in damages to the woman’s family.
Dr. Flavio Alvarez, a kidney specialist, initially had prescribed 10 millimoles of potassium to dialysis patient Dalia Hernandez, 72, who was admitted to Northeast Baptist Hospital in November 2011 for amputation of a toe on her left foot.
Three days after that procedure, her right foot also had to be amputated.
Alvarez changed his mind about the dosage, intending to increase it to 20 millamoles, testimony during the weeklong trial indicated.
However, instead of scratching out the original amount on the form or starting over, he attempted to write a “2” over the “1,” the doctor acknowledged.
The result, witnesses said, was a misinterpretation by nurses and pharmacists that Alvarez had ordered 120 millimoles — a dosage described by plaintiff’s attorneys Marynell Maloney and Gavin McInnis as very obviously fatal.
“These are errors that are happening on a daily basis,” Maloney said during closing arguments Wednesday, suggesting such deaths usually are a “dirty little secret” that gets swept under the rug. “You, with your verdict, have the power to either suppress or encourage this type of behavior.”
Maloney contended that Hernandez’s five adult daughters, who filed the malpractice lawsuit last year, deserved to split $1.25 million for their loss of companionship and mental anguish.
They should also receive $250,000 for their mother’s pain and suffering and $19,000 to cover their funeral expenses, their attorneys argued.
The jury, which deliberated about eight hours over two days, gave the daughters substantially less — $110,000 — for their mental anguish.
The group gave the amounts requested for funeral expenses and Hernandez’s own pain and suffering.
Those amounts, however, could be altered at a later date by state District Judge John Gabriel based on another finding by the jury — that Alvarez only held 10 percent of the blame for the patient’s death.
The hospital, which has already reached an undisclosed settlement with the family, held the other 90 percent of the blame, jurors determined.
While the doctor acknowledged he was negligent that day, the unclear handwriting should have resulted in the medical equivalent of a speeding ticket, defense attorney Bruce Anderson argued.
Never in Alvarez’s wildest imagination would he have thought a dosage that high would be taken seriously by trained professionals, Anderson said, suggesting the jury should assign at least 75 percent of the blame to the hospital.
“That (dosage) is so far outside the norm,” Anderson said, adding that nurses and the pharmacist had a duty to call the defendant if anything was unclear.
“The hospital is a system that Dr. Alvarez and every other doctor relies on,” he added, pointing out that there were 13 hours before Hernandez’s heart stopped when the erroneous interpretation could have been clarified. “He can’t practice medicine without trusting everyone to do their jobs.”
Medical experts for the defense estimated during the trial that Hernandez, who also suffered coronary artery disease and other ailments, had roughly six months to a year to live had she not been overdosed.
That time probably would have included more amputations and suffering due to her preexisting conditions, Anderson argued.
An expert for the plaintiffs estimated Hernandez might have lived six more years.
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