3451 Case Study: Psych. Patient Mismanaged Blood Pressure | Harry S. Cohen & Associates

Psych. Patient Mismanaged Blood Pressure

Filed under Brain Injuries

The Johansen Case

Mr. Johansen was a 51 year-old married gentleman with a history of mental illness and high blood pressure. His medical records reflected that his blood pressure would usually rise to dangerous levels when he was in a psychotic episode. He had been stable for many years with close monitoring of his medications. He was a functioning, productive member of both his family and the community.

In December 2001 the Plaintiff’s blood pressure rose. His primary care physician changed his anti-hypertension medication which, in retrospect, caused his anti-psychotic medication to become ineffective. Over the next few weeks he became mentally unstable, anxious, and aggressive as he became more and more non-compliant with all of his medications.

In January 2002, his wife had him admitted to the psychiatric emergency unit of the Defendant hospital. He was noted to be dangerously psychotic but also to have critically high blood pressure. Over the next three days the patient was repeatedly transferred back and forth at least four times between the medical floor and the psychiatric unit. The psychiatric unit would insist that he was medically unstable and required close medical management, whereupon the medical floor would briefly stabilize the blood pressure and send him back to psychiatric unit insisting that his problem was not primarily medical. Both units were guilty of dumping the patient on the other unit while failing to address the critical medical issues. Neither the psychiatric unit nor the medical floor, and neither the treating psychiatrist nor the treating internist, recognized that the patient’s psychosis was rising and falling with his blood pressure, and that his blood pressure was cycling between dangerous highs over 200/100 and dangerous lows below 90/60.

Finally, on the fourth day of the admission, the patient was in the psych ward refusing to take his oral medication and refusing to allow his blood pressure to be taken. He got into a dispute with a male nurse and was tackled, sedated and dragged to an isolation room. Within moments of his being locked in isolation it was realized that he was not breathing, not responsive and not moving. It took several minutes for the attending nurses to get access to the isolation room and start a “code”. By the time he was resuscitated he had suffered severe brain damage. The Plaintiff suffered quadriplegia, permanent unconsciousness, and required total life support and tube feeding for the remainder of his life.

Suit was filed against the hospital, the psychiatric unit and the treating physicians for failing to address the severely cycling blood pressure and failing to admit him to an intensive care unit where IV medications would have returned the blood pressure to normal levels and prevented the blood pressure event and brain damage. Controlling the blood pressure would also have resolved his psychosis.

The case settled in the high six-figure range. The case would have had higher settlement potential based upon the long-range costs of maintaining the Plaintiff on life support except that he became medically unstable and was not expected to survive to the scheduled trial date. The Plaintiff did in fact die several weeks after the settlement, and several weeks before the date on which trial had been scheduled, allowing a substantial portion of the funds to be deposited into an annuity for the lifetime benefit of the surviving widow.

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