Five milligrams or five ampoules of 10 milligrams? A former nurse and a former intern at the Assistance Publique-Hôpitaux de Marseille were tried on Monday before the criminal court for a fatal overdose of morphine to a patient, after a fatal misunderstanding.
Admitted on January 23, 2014 for a suspected stroke, an 80-year-old retiree dislocated his shoulder when he fell in his room in the geriatrics department of the North hospital. Preparing to proceed with the reduction of this dislocation, the intern in the orthopedics department had orally prescribed to the nurse an injection of morphine in preparation for this painful procedure.
Now an orthopedic surgeon, he had requested the administration of five milligrams, but without writing a prescription, contrary to the regulations on narcotics. The nurse maintains that she was asked for five ampoules, or a dose of 50 mg, as the North hospital only uses 10 mg ampoules. She then asked for validation of “five”, and the intern confirmed this to her by showing her the five fingers of his hand. “I heard five light bulbs,” argued the nurse on the stand Monday before the Marseille criminal court.
No prescription
Explaining that we never prescribe by volume but by quantity, the intern was also categorical: “If she had said the term ampoule, I would have taken it again,” he said, saying he was a victim of “an incompetent and dishonest nurse who made a mistake.” In fact, after the intervention, the intern wrote the prescription, writing “5 mg” of morphine. And the nurse admitted, “in a gesture of panic”, to having added a zero to show 50 mg. Having graduated sixteen months ago, she cited insufficient training in the face of a legal expert’s assertion that such a disproportionate and dangerous dose should have alerted her.
For the former intern, tried for involuntary manslaughter, for not having respected the obligation of a written and not oral prescription, the prosecutor Guillaume Bricier demanded an 18-month suspended prison sentence: “What is prevented him from taking two minutes to write his prescription? The experts say there was no emergency,” he argued.
Referring to “a succession of faults”, the magistrate requested a two-year suspended prison sentence against the nurse, also tried for “alteration of a document with the aim of obstructing the manifestation of the truth”. In their pleadings, the defenders of the two defendants called for their release, passing the buck. “Yes, he talked about blisters,” assured Hervé Ghevontian, the nurse’s lawyer: “He puts everything on his back, but it is the prescription error that led to this dosage.”
“He is accused of a constant, current, taught medical practice that corresponds to the rules of the art,” retorted Philippe Carlini, the ex-intern’s counsel, for whom the emergency was there and the oral prescription was frequent. . Certainly, “it’s difficult, the public hospital is underwater,” conceded Olivier Rosato, representing the victim’s sons and daughter: “But when we administer narcotics, we can take two minutes to write a prescription”. The judgment will be delivered on January 24.