Case Study

Medical Toxicology

Medical toxicologists evaluate and treat patients who have been poisoned by any substance, whether it be a drug of abuse such as alcohol, cocaine or fentanyl, or an environmental or occupational toxin such as carbon monoxide, cyanide or lead.  Their work includes interpreting laboratory tests – drug screens, medication levels, kidney function tests, etc. –  and correlating them with clinical manifestations.  They are usually board certified in emergency medicine as well as medical toxicology, since they regularly treat acute poisoning cases in the emergency department, where speedy diagnosis and correct treatment may be a matter of life and death.

Medical toxicologists are most often asked to opine on causation, that is, whether a particular episode of poisoning caused death or permanent injury.  For example, a defense attorney recently asked us to provide an expert for a case involving an overdose of fentanyl in its proper use as a pain medication, not as a street drug.  The plaintiff, a woman in her 80s, was briefly hospitalized two years ago after falling in her apartment.  The hospital discharged her to a skilled nursing facility.  She was there for about a month and was then transferred to the facility’s assisted living section, where she remained for about a week and was then discharged home.  Throughout her five-week stay at the facility her pain was treated with fentanyl patches, which had to be replaced every 72 hours. 

About two days after discharge, the plaintiff presented to the emergency department with symptoms of a narcotic overdose and was admitted to the hospital, where those symptoms soon resolved.  While she was in the ED, it was supposedly discovered that there were multiple fentanyl patches on her body – at least two, possibly as many as four.  (The exact number claimed is not clear at this early stage of the litigation.)  The complaint alleges that the caregivers in the assisted living section applied one or more fentanyl patches without removing the used ones. 

The plaintiff, who lived alone in a standard apartment before she fell two years ago, now resides in an assisted living apartment, which she asserts is necessary because of long term or permanent sequelae (the nature of which is not clear at this stage of the litigation) of the fentanyl overdose.  The rent for an assisted living apartment is substantially higher than the rent for a standard apartment, and she is claiming the difference as an item of damages.  Defense counsel needed an expert to provide an opinion as to validity of the plaintiff’s assertion that she has a long term or permanent injury, disability, or other sequelae of the fentanyl overdose, and that as a result she requires an assisted living apartment.

The expert we provided, who was engaged by our client, is triple boarded in emergency medicine, medical toxicology and addiction medicine, and is the medical director of the emergency department at a  large midwestern community hospital.

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