Sommers Schwartz attorneys Dina Zalewski and Judith Susskind filed a medical malpractice and wrongful death lawsuit for the estate of an 81-year-old woman who died at a Metro Detroit hospital one day after she arrived in the emergency department.
Before her hospitalization, the decedent lived independently at a senior living complex. She managed all her own daily activities without help and was socially active. Although she had a history of hypertension and hypothyroidism and used a walker for back pain, she needed no additional support. On the evening of November 13, 2023, the decedent was transported by EMS to the ER after she stood up in her building’s lobby, became unsteady, fell to her knees, and appeared confused and disoriented. Her speech was slurred, and her mental state was different from her normal baseline.
Bloodwork revealed multiple abnormalities consistent with metabolic acidosis, a condition in which the body accumulates too much acid, impairing organ function and, if left untreated, causing respiratory failure and death. While in the ER, the decedent was agitated and trying to get out of bed. She was given a 10-milligram intramuscular injection of Zyprexa (olanzapine) to calm her. According to the complaint, FDA prescribing guidance recommends that geriatric patients receive no more than 5 milligrams. Zyprexa is known to cause or contribute to respiratory depression in older patients, and a dose of this size requires close, continuous monitoring of her breathing. That monitoring did not occur.
After the decedent was admitted, a venous blood gas test was ordered to further assess her acid levels. It was not collected for more than eleven hours. Through the night and into the next morning, nursing documentation reflected that she was resting comfortably. At 8:32 a.m., a consulting neurologist found a different picture: the decedent was in a stuporous state with a snoring, obstructed airway and signs of upper airway distress. Her Glasgow Coma Score, a standard measure of neurological function, had dropped to 9 or 10 on a scale where 15 indicates full alertness. The neurologist’s assessment specifically directed the care team to avoid additional sedative medications and to address airway protection immediately.
Shortly afterward, the decedent’s chart indicated she was resting comfortably and sleeping. The blood gas results, finally collected at 8:57 a.m., showed a blood pH of 7.18 — critically low — confirming severe metabolic acidosis. Nothing was done to address her airway.
Betty’s condition continued to worsen through the afternoon. A second blood gas test ordered on a STAT basis by her doctor confirmed that her acidosis was getting worse. By 4:07 p.m., her oxygen saturation had dropped to 89 percent and was still falling. Sodium bicarbonate, the standard medication used to correct acid-base imbalances, was administered at 4:17 p.m., nearly twenty hours after Betty’s initial bloodwork had flagged the problem. Even then, her airway remained unprotected. By 6:50 p.m., the decedent was unresponsive and unable to maintain her airway on her own. BiPAP, a non-invasive breathing support device, was not initiated until 8:00 p.m., nearly twelve hours after the neurologist had directed the team to address airway protection. A Rapid Response team was called simultaneously, but she did not improve. After consultation with the ICU and her family, the decision was made to transition to comfort measures only. She died at 9:51 p.m.
According to the complaint, the decedent’s death was preventable, alleging that the defendants should have recognized and responded to metabolic acidosis warning signs, ensured that ordered laboratory tests were collected promptly and treated with appropriate urgency, and protected the patient’s airway when deterioration was evident. But the internal medicine physicians overseeing the decedent’s care failed to timely appreciate the severity of the decedent’s condition, failed to act on the neurologist’s urgent directive to address airway protection, and failed to ensure that blood gas results were obtained and acted on without delay. The nursing staff also failed to provide adequate respiratory monitoring after the decedent received double the recommended dose of a medication known to suppress breathing in elderly patients, did not timely recognize that her condition was deteriorating, and did not escalate appropriately to the treating team. Had the decedent’s metabolic acidosis been timely diagnosed and treated, and her airway properly managed, she would not have died.
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