Florida Death from Prescribed Methadone

Florida has passed legislation known as "tort reform" which places limits on what a person can recover in a medical malpractice case. For example, the statute sets out who can claim a loss for the death of a person, and what kinds of losses can be claimed. Funeral expenses are recoverable, as is the wage loss to the heirs of the deceased. But what if the person who died had no children and no spouse? What are the losses? His lost wages are not recoverable, as no one was depending on his income. His funeral expenses are recoverable. His parents can claim a loss for his society and companionship. But the statute caps the amount of money that can be awarded for this loss. A mother called me yesterday to tell me that she has contacted law firms who have refused her case because her son who was given a drug overdose in a hospital had no heirs or spouse and the case "just wasn't worth it." If there is no consequence to medical providers who cause the death of a patient, will the medical providers change their behavior? How can the loss of a human life be "just not worth it?"

What Your Doctor May Not Know About Methadone

Frank's family called me a year ago after Frank went to a local hospital for a stomach ache. The physicians suspected an ulcer or a bleed and decided to keep him overnight. Frank had a history of back surgery and had been on 100 mg of morphine daily for a year. When Frank was admitted, he asked if he could make a call and get a family member to bring his morphine for his chronic back issue. The physician told Frank "no" and said they would take care of getting him the morphine from the hospital pharmacy. For whatever reason, Frank's gastroenterologist called in a neurologist to consult on getting Frank his morphine. The neurologist told Frank she was going to give Frank methadone instead of morphine-- that it was also an analgesic and would work like morphine. So the neurologist wrote an order for methadone 100 mg to replace Frank's 100 mg morphine. The mistake in the neurologist's conversion of morphine to methadone cost Frank his life. He went into respiratory depression within several hours, coded, was resuscitated and eventually transferred to ICU in a coma on a ventilator.
Phyllis Lile-King

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What is Respiratory Depression?

Methadone toxicity often manifests itself-- causing death by something called respiratory depression or central nervous system depression. Respiration is controlled principally through the part of the brain called the medullary respiratory center with peripheral input from chemoreceptors and other sources. We all understand that breathing is something that is involuntary-- like blinking ones eyes or beating one's heart. We don't "make ourselves breathe." Rather, chemoreceptors in the carotid arteries measure CO2 levels and transmit that information to the brain, which then directs the diaphragm and intercostals/lungs to "breathe." Thank goodness for this process. It would be difficult to sleep if we had to worry about making our bodies breathe. Opioids like methadone inhibit the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. So, a simpler way to understand this is to say that methadone interferes with the messages the chemoreceptors send to the brain. Methadone desensitizes the medulla, making the brain unaware of the need for the lungs to breathe. The result is respiratory depression. Families report that the son or daughter feels really sleepy, falls asleep and , the lucky families report that the child is difficult to awaken during the respiratory depression process. The unlucky mother tells me that she heard her son snoring heavily, and found him dead the next morning. Phyllis Lile-King

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