Patient claims she suffered brain injury after B.C. doctors lost track of opioids given for pain

A woman has filed a lawsuit against Interior Health and three physicians that claimsshe suffered an opiate overdose and subsequent brain injury afterdoctors lost track of how much medicationshe'd been given for painduring a hospital stay in Cranbrook, B.C., two years ago.

In her claim, Barbie Torres alleged physicians gave her a combination of morphine, hydromorphone and ketamineafter she went to East Kootenay Regional Hospital(EKRH) for aflare-up of herCrohn's disease in 2021.

The lawsuit said doctorsdidn't chart her doses properly or "legibly," which led to an overdose.

"[The] injuries have caused and continue to cause the plaintiffpain, suffering, discomfort [and]loss of enjoyment of life," reads the claim filed in B.C. Supreme Court this month.

The case outlines what would beanother allegedinstance of a medication error leading to dire consequences, which experts say can happen more frequently than patients might realize.

"It's definitely not a common event, but it's also not an unheard of event either," said Dr. Michael Curry, an emergency medicine physician andclinical associate professor at the University of British Columbia.

An analysis by theInstitute for Safe Medication Practices Canada (ISMP)in 2020 examinedmore than 7,500 medicationincidents that harmed a patient over the preceding five years.

Nearly 86 per cent of those incidents were reported as mild in severity. Justthree per cent led to severe harm or death.

Through her lawyer, Torres declined to comment further as her case is ongoing. Her claims have not been proven in court and none of the defendants have filed a response to the lawsuit.

In an email to CBC News, Interior Health said it "cannot comment on matters before the court."

Combination of 3 medications for pain

The claim said Torres was admitted to EKRH for vomiting and pain related to Crohn's on May 16, 2021. It said the first doctor prescribed her morphine and hydromorphone, known by the brand name Dilaudid, around 11:30 p.m.

The lawsuit said Torres then received 10 milligrams of morphine and four milligrams of Dilaudid over 12 hours.

After that, it said she was given another20 milligrams of ketamine and another six milligrams of Dilaudidin the afternoon a total of 40 milligrams of medication over 19 hours.

Morphine and hydromorphone areboth opioids used to treat pain, though hydromorphoneisconsiderably more potent. Ketamine is a dissociativeanesthetic also used for pain management.

"Combining hydromorphone and morphine is not a problem. They actually work quite similarly, and there's no specific interaction between them," said Curry, who is not connected to the lawsuit.

"Where the potential for problems arises is thathydromorphone is much more powerful, on a milligram-by-milligram basis, than the morphine. So you have to be very careful."

TheISMPC reportsaid opioids were theclass of medication most commonly involved in incidents causing deathin incidents logged between 2015 and 2020.

The analysis also said nearly 66 per cent of incidents happened in a hospital, followed by community pharmacies, long-term care facilities and home or community care.

Hydromorphonewas found to be the medicationmost frequently involved in incidents that led to severe harm or death in the five-year period.

In 2019, ababy in Sherbrooke, Ont., nearly diedafter being given three times the appropriate dose of fentanyl, a lethally potent opioid. Later thatyear, a coroner's report found an 85-year-old man in Gatineau, Que. had died two years earlier becausenursing staff mistakenly gave him methadone, another opioidintended for a different patient.

Appropriate dose can vary

Curry said the appropriate dose for any given patient depends on acombination of factors that could influence their reaction to narcotics includingage, weight, kidney and liver function orany history of opioid use that might lead to increased or reduced tolerance.

"None of these three drugs are 'don't use with each other' drugs. You can definitely use all of them," Curry said.

"The issue with ... the hydromorphone and the morphine is they're all doing sort of the same thing. So you're adding them on top of each other."

The lawsuit said Torres's doses were documented on"separate Medication Administration Record (MAR) sheets due to paperwork problems."

Less than two hours after her last dose on May 17, Torres was found unresponsive without a pulse. The claim said staff woke her up withthree doses of naloxonebut that she had suffered a brain injury.

Torres is claiming general and special damages, as well as damages to cover the cost of her future health care.