Did the hospital kill this man?

Factual Questions
1

I just learned that someone I know died Monday night, and I wonder whether the medical experts here might express an opinion as to whether the hospital screwed up.

This person, a man in his late 40s, loving husband, devoted father and also a lifelong heavy smoker, had been fighting inoperable lung cancer for several months. He received standard chemotherapy and also participated in at least three university-based studies of experimental treatments, with less-than-sparkling results. But he wasn’t giving up, and as recently as last week his doctors were talking to him about trying other treatments.

Monday afternoon, he began to experience severe pain and his wife took him to the hospital where he had been receiving his care. He walked in under his own power. One of his regular doctors and others saw him, and they administered what they described as a strong narcotic ( I don’t know the name). Subsequently they asked him to rate his pain on the 1 to 10 scale, and he continued to call it 9-plus. They gave him an additional dose, and he quickly fell asleep. His wife stayed with him, and periodically doctors and nurses checked on him and seemed to think everything was as it should be. But when the time came to wake him up, they couldn’t revive him. Within moments large numbers of doctors arrived with a crash cart. They administered Narcan and did whatever else they thought was appropriate. Apparently he had already signed a DNR, and his wife elected not to put him on a ventilator after the doctors told him that he would likely never come off it. Within a fairly short time he simply stopped breathing, a few hours before his only child was able to get there from college. The doctors basically told his family that the cancer got him.

But as I heard the story, I could only think overdose. Apparently he had no significant response to the first dose of narcotic (including no allergic reaction) so they gave him more and he fell asleep, which as a layperson I would think would not necessarily be a good thing. As I understand it, Narcan, which they administered while they were trying to revive him, is a standard emergency treatment for a drug overdose. On the other hand, he was weak from cancer and chemotherapy, and certainly had less resilience than other patients might have.

So here’s the question: Given these facts–and I don’t have many more–does this sound like somebody screwed up, either in the choice of painkiller, the dosage or the monitoring? Or does this sound like standard treatment for severe pain that just had a bad outcome? Do people die from hospital-administered painkillers? How far apart are a therapeutic dose and an overdose? Is Narcan in itself also potentially lethal?

His family knew the end was coming. But he and they believed, and the doctors had encouraged them to believe, that he would get through the holidays and might even make it past his birthday in the spring. Now they’re not sure what to think. The grieving wife is not inclined to raise hell, but she would like to understand what really happened. How can she find out? She has felt that her husband’s doctors were trying hard to help him during his illness, but she also suspects that doctors generally cover for each other and bury their mistakes. Any thoughts? (This is more of a medical question than a legal one. The wife is not thinking of suing anybody, and if she changes her mind she has access to lawyers.)

2

Obviously, should have been “the doctors told her…”

3

My condolonces on your and your friends’ loss.

IANAD, but I’ve been at plenty of bedside deaths (home & hospitals) and have been a consultant for people who had to make end-of-life decisions for themselves and for loved ones.

Firstly, when a man says his pain is 9+, he’s in a hell of a lot of pain (usually). And so, heavy pain relief medication is in order.

Secondly, if someone was slowly dying on their death bed (and we’re talking truly terminal here), and they were in great pain, it would be normal, if the patient agrees (or their designated person who can make such decisions) to give them large doses of pain relief medication, even if it has the unintended (but likely) chance of hastening death. This is within the bounds of most medical and religious ethics. And so, in the case of the OP, it wouldn’t be out of bounds to give a terminal person who’s in great pain a large dose of pain relief medication even if it would have a possible side effect of hastening death.

But the fishy part of the story is the part about ‘when the time came to wake him up.’ Huh? How does one determine, “OK, now’s the time to wake the terminal patient in great pain, but whose vital statistics on the monitor looks fine”?

And when he doesn’t wake, why the crash cart? Not all unconsious people need to be immediately wakened.

I’m guessing the monitors signaled something was wrong while he was unconsious, otherwise they don’t go into panic mode.

Did the dosage cause the death? It may have. It may not have. An autopsy and medical review board can only determine that, and maybe not with full certainty at that.

Consider a possible alternative: They would only have given enough pain relief medication that was strictly within saftey bounds. Then the man would be in constant pain, still hanging on to life, his last hours or days or weeks suffering in a bed as the cancerous mass continued to press on his internal nerves and lead him towards congestive heart failure as his lungs drown in his own bodily fluids and he is in a constant state of anxiety since he feels like he can’t catch his breath and is suffocating (which he is).

The chance to say final good-byes would have been a good reason not to use dangerously high dose of pain relief medication. But if he already had a DNR and knew he was terminal, the family should have already said what they needed to say to him.

Peace.