A recent Missouri Eastern District Court of Appeals upheld a $15,000,000 punitive damages claim against St. Louis University and one of its physicians. The claim arose out of the excessive prescription of opioid pain killers that resulted in a patient’s addiction.
The evidence showed that the patient was prescribed ever-increasing amounts of opioids for his complaints of pain. This occurred over a period of several years. It reached a point where the patient received three different opioids for his pain. Combined, they totaled 13 times the recommended daily dose of opioids. In addition, the evidence was that the prescribing physician knew of the dangers of high dose opioids and did not perform the required risk-benefit analysis in prescribing the medications.
The court also noted that St. Louis University and its doctor were aware of the risks associated with prescribing the increasing amounts of opioids and the likelihood that it would cause the patient harm. This was evidence of “complete indifference” to the patient’s safety.
The court also noted that St. Louis University did not have a computer monitoring system to oversee the amount of opioids being prescribed. Because the University knew of an ongoing opioid epidemic, its failure to monitor the prescription of opioids also constituted a complete indifference to the safety of its patients.
What is perhaps most interesting about this decision, is its implications for health care institutions. The court seems to be saying that, in the face of a known public health care problem of epidemic proportions, the institution itself should do something to address the issue. The institution can not simply rely upon the discretion of its individual health care providers to address any potential issues. Failure to take corrective action could result in punitive damages.