Ferguson v. Baptist Health System, Inc.

910 So. 2d 85, 2005 Ala. LEXIS 19, 2005 WL 327354
CourtSupreme Court of Alabama
DecidedFebruary 11, 2005
Docket1022175 and 1030039
StatusPublished
Cited by8 cases

This text of 910 So. 2d 85 (Ferguson v. Baptist Health System, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ferguson v. Baptist Health System, Inc., 910 So. 2d 85, 2005 Ala. LEXIS 19, 2005 WL 327354 (Ala. 2005).

Opinion

HARWOOD, Justice.

Robert Ferguson appeals from the order of the Jefferson Circuit Court granting a new trial to Baptist Health System, Inc. (“Baptist”), in his medical-malpractice action against it (case number 1022175). Baptist cross-appeals from the court’s order denying Baptist’s motion for judgment as a matter of law as to Ferguson’s wantonness claim and the associated punitive-damages award (case number 1030039). We affirm in case no. 1022175 and reverse and remand with instructions in case no. 1030039.

On May 21, 1999, Ferguson, then 73 years of age, fainted while working in his garage and fell, striking his head; he experienced a period of unconsciousness. He was seen initially at the emergency room of Carraway Methodist Medical Center. He was subsequently transferred, at the request of his regular physician, Dr. Virgil MeGrady, to Baptist Medical Center, Montclair, a hospital operated by Baptist [87]*87(“the hospital”). After Ferguson was admitted, Dr. McGrady called in Dr. James Strong, a neurologist, for a neurological consultation. Dr. Strong and his partners, Dr. Rodney Swillie, Dr. Dallas Russell, and Dr. Kyle Hudgens, thereafter were responsible for Ferguson’s neurological care.

Dr. Strong determined that Ferguson was experiencing seizure activity and on May 23 ordered that he receive intravenously a “loading dose” of one gram (1,000 milligrams) of Dilantin, an anticonvulsant medication, to be followed by the administration of 300 milligrams of Dilantin orally every night of Ferguson’s hospital stay. Dr. Strong ordered that a blood test be done the morning after the loading dose had been administered to ascertain the level of Dilantin in Ferguson’s blood; the test reflected a level of Dilantin in the blood of “13.1 mcg/ml,” which was within the therapeutic range of 10.0-20.0.

Pursuant to Baptist’s policy, the hospital pharmacy generated each day a “medication administration record” (“MAR”), which listed all of the medications prescribed for a particular patient by his treating physicians. The MAR generated for the 24-hour period following Dr. Strong’s order for Dilantin accurately reflected it, as well as all of the other physicians’ orders then on record for Ferguson. Dr. Strong’s order, and the corresponding MAR entry, used the conventional medical shorthand of “Dilantin 300 mg po QHS” to describe the dosage, method, and time of administration.1

Ferguson complained of severe back pain, and it was determined that he had experienced spinal compression fractures, although when they occurred was uncertain. He was also experiencing confusion, especially at night, and his personal history supplied by his family led Dr. McGrady to suspect that he was suffering from dementia as a result of Alzheimer’s disease. His treating physicians prescribed a variety of pain medications, Valium, and, starting on May 24, the drug Risperdal, described by Dr. Hudgens in his deposition as “an atypical antipsychotic medication ... used to treat confusion, agitation in a patient.”

On May 25, 1999, Ferguson was transferred to the rehabilitation unit of the hospital. For record-keeping purposes, this represented a “discharge” and a new “admission,” requiring a new set of physicians’ orders and resultant MARs. Dr. Hudgens entered an order on that date directing that Ferguson receive, in specified dosages at specified intervals, a number of different medications, including Risperdal, Valium, and Dilantin, the latter to be at the previously prescribed rate of 300 milligrams “po QHS.” A daily MAR was generated by the pharmacy for the “administration period” May 26 at 5:01 a.m. to May 27 at 5:00 p.m. Thirteen different medications were listed for Ferguson, along with their individual dosage levels and intervals of administration. The entry for Dilantin was a departure from Dr. Hudgens’s order, however. It read:

“PHENYTOIN 100 MG CAP (Dilantin) ORAL
“GIVE = 3 CAPSULES = 300 MG TID ANTI-CONVULSANT”

“Phenytoin” is the generic name for the brand name “Dilantin,” and the initials [88]*88“TID” (often written “t.i.d.”) are an acronym for the Latin phrase “ter in die,” meaning three times a day. Merriamr-Webster’s Collegiate Dictionary 1S06 (11th ed.2003). This MAR entry was readily susceptible of the interpretation that Ferguson was to be given three 100-milligram capsules of Dilantin 3 times a day, for a total of 900 milligrams daily. As the evidence presented at trial demonstrated, this is exactly how the nurses on the rehabilitation unit read and applied that MAR entry.

Consistent with hospital practice, the nurses who administered the various medications listed on the daily MARs “checked off,” by initialing on the MAR, the administrations of the medications for each shift during which a medication was given. From May 26 through May 31, Ferguson was given 300 milligrams of Dilantin 3 times a day for a total of 900 milligrams daily; on June 1, he was only given 2 doses, totaling 600 milligrams before he was discharged from the hospital.

Baptist had an internal policy, designed as a safeguard against possible pharmacy errors in transcribing physicians’ orders onto the MARs, that any time a new physician’s order for medication was entered, the nurse initially undertaking to administer the medication was responsible for comparing the MAR to the actual order to “reconcile” the two. Thereafter, the nurses successively administering the medication in accordance with the directions appearing on the MAR were not responsible for again reconciling the MAR entry with the actual physician’s order; thus, the reconciliation process was designed to take place only once, for any new orders entered within the previous 24 hours. In this case the error of the hospital pharmacy in its manner of entering Dr. Hudgens’s order for Dilantin on the MAR was not detected by the reconciliation process.

There was no testimony at trial concerning the identity of the pharmacist who erroneously transcribed Dr. Hudgens’s order for Dilantin onto the MAR. Anthony Czaplicki, the director of pharmacy and clinical practice at the hospital at the time of the trial, was not employed at the hospital during Ferguson’s hospitalization. Czaplicki testified that he had not been able to identify the pharmacist who had made the erroneous MAR entry because the computer system at the hospital had been upgraded on at least two intervening occasions and by law pharmacy records were required to be kept for only two years.

There was no direct evidence concerning how or why the pharmacy error occurred. Dr. Russell was asked by Ferguson’s counsel for his opinion as to how the pharmacy error might have occurred; he testified as follows, without objection:

“If I had to guess, I would say this happened: Dilantin is often given three times a day, and they chose to give three hundred milligrams at night. But frequently, when Dilantin is started, it is given a hundred, three times a day. I don’t — this is a guess on my part, because I don’t know what anybody was thinking. But it’s possible the person had three times a day in their mind, because it’s very common to give Dilan-tin that way. So they had three times a day in their mind, yet we had this three hundred all in one dose. That’s my guess as to how this occurred.”

There was no testimony concerning which nurse was responsible for undertaking the “reconciliation” between the MAR printed after Dr.

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Bluebook (online)
910 So. 2d 85, 2005 Ala. LEXIS 19, 2005 WL 327354, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ferguson-v-baptist-health-system-inc-ala-2005.