2 year old takes methadone, doctors told to pay $2 million

by Walter Olson on March 2, 2011

Alabama: “A Jefferson County jury has awarded $2.4 million from an emergency physicians group to the mother of a 2-year-old who died after ingesting methadone.” Lawyers said the emergency department failed to take proper steps to rule out drug overdose as a reason for the child’s condition. [AP/WHNT via White Coat]

Plus: A more explanatory news account (h/t commenter John Rohan).

{ 10 comments }

1 Smart Dude 03.02.11 at 12:44 am

The baby took a methadone pill which was laying around for treatment of back pain? This is a common occurance?

Something is missing in this picture.

2 John Rohan 03.02.11 at 4:35 pm

That article was short on details. There is more information here:

http://blog.al.com/spotnews/2011/02/jefferson_county_jury_awards_2.html

3 Nicolas Martin 03.03.11 at 9:12 am

The child was sent home after a few hours observation at most. Medline describes the customary and proper way to treat possible methadone overdose:

How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery.

If an antidote can be given, recovery from an acute overdose begins immediately. However, since methadone’s effects can last for about a day, the patient is usually kept in the hospital overnight and may receive several doses of the antidote.

The most common complications are in those who did not quickly receive the antidote. Problems can include brain damage or respiratory arrest from lack of breathing.

4 William Nuesslein 03.03.11 at 11:39 am

Nicolas Martin in comment 3 seems to know what he is talking about, but I am confused about the incident. How could a lethal dose of methadone (or almost any other drug) have no discernible effect for several hours? How likely would one tablet be fatal? The 2 year old is smaller by a factor of 5 or so, but he did not swallow a bottle of pills.

5 No Name Guy 03.03.11 at 6:28 pm

Oxycontin / oxycodone.

The former is a delayed / long acting pain pill.
The latter is a fast acting / immediate relief pill.

The former enters the system at a “steady” rate due to it’s design as a long acting / timed release pill. Once it starts, it keeps coming, potentially faster than the child can metabolize it, resulting in a buildup to damaging concentrations in the blood.

There is also a build up in tolerance to opiate pain meds. I witnessed this first hand with a family member who died of bone cancer. The pain level was excruciating, or would have been without massive doses of morphine. The doctor needed to adjust up the dosages daily to keep up with the final stages of the cancer. The doses of IV morphine (both a back ground drip plus a ‘happy button’ on only a 6 minute delay) toward the end were 5-10x the hourly rate of what a person fresh out of major orthopedic surgery would have been on. (I asked the nurse for something to compare the dosages to, not knowing how much morphine an hour is “a lot”). I suspect these dosages, given to someone without any buildup of tolerance, would have been an overdose.

In this case, the methadone pill could have been at a dosage that someone with a tolerance needed to get sufficient pain relief. To the “inexperienced” user (in this case a small child) it could easily have been fatal.

6 robert 03.03.11 at 9:13 pm

What’s to prevent this scenario?

1. Bring kid to emergency room
2. Doctors observe for 4 hours, see nothing out of the ordinary, send kid home
3. Give kid a “methodone pill”
4. When kid stops breathing, bring him back to hospital
5. Profit!

7 William Nuesslein 03.04.11 at 11:00 am

No Name Guy of comment 5 seems knowledgeable too. But he did not answer my question as to how a lethal dose of methadone would show no signs for several hours.

Why did the caregivers suspect that the child took one tablet? Did they take the child to the hospital on a suspicion or did they notice a change in the child? I wonder if any blood or urine tests were done to confirm the suspision of the child’s consuption of the pill. We all hope that robert’s comment 5 is wrong.

My son was in my food closet when he was a toddler and was sitting in a pool of spilled gin when I found him. I checked the smell of his breath to see if he imbibed any of the alcohol. He was OK.

8 No Name Guy 03.04.11 at 12:16 pm

WN:

If it’s a time release pill, such as Oxycontin is, it may take some time for the signs to show up even though there is a lethal dose IN THE PILL. It doesn’t all hit at once – it builds up over time.

A graphical representation:
The vertical axis represents the concentration in the blood, the horizontal represents time. Draw a horizontal line some height above the X axis. Draw another horizontal above that. Those represent the thresholds at which there are observable (the lower line) and damaging (or lethal) effects (the upper line).

Now draw a line from the origin angling up and to the right. This represents the (net) increasing concentration in the blood as the time release of the pill drops the agent into the system, less that which is metabolized. The area under this line is the total dose of the medicine in the blood stream (recall back to your calculus education).

Of course, this is a gross simplification (assumes linear relationships, etc) but would suffice to show how a kid could ingest a lethal dose, yet not have the effects show up for some time.

If the kid is brought to the hospital before the first horizontal (concentration for observable effects) is reached, its conceivable that it could be missed.

Depending on how “steep” the curve of increasing concentration is, and how close the thresholds are between observable and damaging concentrations would indicate how long of time there is to spot the problem and act on it. If the threshold for observable effects is high, and lethal not far above that, with a steep line, it indicates there is little time to spot the problem once the effects are observable, yet there is a longer delay from the time of ingestion to the time that observable effects become apparent.

9 Cousin Dave 03.04.11 at 4:17 pm

William and others: My wife is a medical lab manager. From what she’s told me, I’m guessing that a test for methadone is not one that you can get run on a stat basis at night. I’ll ask her later.

10 William Nuesslein 03.05.11 at 8:30 am

Assuming no-name-guy’s model, might it be the case that the lines between observable effect and lethal effect might be so tight that once one observes the effect, it is too late?

Still I would think there would some dilation of pupils, sluggish response to that hammer tap on the knee, or something after three or four hours.

What justifies a life-time of earnings for the mother ($50,00 X 40 years)? The accident -taking a pill- occurred under her care in her home.

Comments on this entry are closed.