Patient Dies After COPD Medications are Withheld

This case involves a patient that had a below the knee amputation which was uneventful during surgery. The patient suffered from COPD and was taking several respiratory medications, preoperatively. The patient was cleared by medical doctors for surgery and was labeled as a moderate risk. During the first, postoperative day, the respiratory therapist failed to administer the prescribed respiratory medications to the patient. One of the defendant nurses was expected to administer theophylline on an empty stomach; however, the medication was given to the patient with his breakfast. Throughout the course of the day, the patient’s respiratory therapist failed to administer more than half of his prescribed medications. Also, the patient became euphoric and began hallucinating. The patient’s wife left the hospital at 8 PM and requested the nursing staff look after him. At 8:30 PM, another family member arrived to visit the patient but found him unconscious and unresponsive. They alerted a nursing staff member, who advised the visitor that the patient was tired and needed rest. About thirty minutes later, the patient coded and died from cardio-respiratory arrest.

Question(s) For Expert Witness

1. What is the mainstay for the treatment of COPD and did the medication error alter this patient's outcome?

Expert Witness Response E-001723

The goal of COPD management is to improve a patient’s functional status and quality of life by preserving optimal lung function, improving symptoms, and preventing the recurrence of exacerbations. Currently, no treatments, aside from lung transplantation, have been shown to significantly improve lung function or decrease mortality. Once the diagnosis of COPD is established, it is important to educate the patient about the disease and to encourage his or her active participation in therapy. To withhold or give inadequate dosing of COPD medications during a hospitalization is not within the standard of care and does not optimize the patient's lung function, which was the likely cause of the respiratory arrest.