Raleigh General Hospital in Beckley
CHARLESTON – A mother says Raleigh General Hospital staffers overdosed her infant son on morphine.
The plaintiff – identified as T.B., as parent of H.B. – filed her complaint January 9 in Kanawha Circuit Court against Raleigh General Hospital, Dr. Weston Childers, Dr. Malik Moh’d Saleh Hamdan, registered nurse Amanda Clark and registered nurse Cynara Clark.
According, to the complaint the teen was under the care of the Raleigh General staff from June 30, 2023, to July 1, 2023. He presented to the hospital’s emergency department by ambulance on June 30, 2023. He was less than three months old, and he had been born prematurely and had had an inguinal hernia.
The admitting diagnosis was listed as apnea, and the notes said he was showing signs of “decreased responsiveness at home” as well as “episodes of vomiting and diarrhea” as well as “very lethargic.” He weighed right at 7 pounds, according to the complaint.
Records don’t show if staff started him on supplemental oxygen, but Childers did order imaging of his chest and abdomen. That revealed suspicion for incarcerated left inguinal hernia and small bowel obstruction but no gross pneumoperitoneum or pneumatosis or bilateral pneumonia.
“Patient appears in no acute distress, alert, awake, lethargic. HYPOTHERMIC,” Childers wrote in his notes at 11:25 p.m. He also noted the infant’s abdomen was slightly firm “Hernia: noted in left inguinal area. REDUCED AT BEDSIDE.” Childers also noted the child was alert and responsive.
IV fluid hydration and antibiotics for suspected infection were started, and the infant was placed in a warmer. Childers contacted Hamdan, the on-call pediatrician. Despite examining the infant in the ER, Hamdan failed to create a consult note or document his encounter.
But the complaint says Hamdan recommending transferring the infant to Charleston Area Medical Center and initiated the transfer to CAMC’s Women and Children’s Hospital.
In her notes, Amanda Clark said Hamdan requested 1 milligram of morphine for the infant “because patient appeared to be in pain from possible acute abdomen.”
The complaint says Hamdan lacked a valid or active controlled substance registration or license required to prescribe, order, administer or otherwise handle.
The complaint also says Hamdan said he could not “put in med host,” so Amanda Clark noted that she asked Childers “to put in the dose” and that Hamdan was sitting beside Childers and verified the dose.
Childers entered an order for “Morpid21 1 – Morphine Sulfate (Morphine Sulfate (NOS)) 2 mg/ml CRP, dose: none, order type INP accudose,” which is dispensed in a Carpuject syringe, which is a pre-filled syringe drug delivery system that consists of a reusable holder and disposable pre-filled medication cartridge.
The notes say the infant was given 1 mg at 11:44 p.m., but the complaint says the hospital chart has no documentation reflecting that any portion of the 2 mg/ml dispensed was wasted or that defendants destroyed any unused controlled substances, which is required by law.
Billing shows the hospital itemized a charge for 2 mg of morphine.
Cynara Clark’s entered after the transfer to CAMC say “medication order and dosage repeated and verified by 3 RNs and ED physician.” Amanda Clark’s notes entered after the transfer to CAMC say “staff questioned the order and dr stated ‘pt is in pain, after abdomen assessment.’ Morphine dose was given over 5 min. vital signs remained stable. Will cont to monitor.”
About six hours later, this note was deleted from the chart by Amanda Clark, according to the complaint.
“There is no evidence in the Raleigh General Hospital chart that defendants Amanda Clark, RN or Cynara Clark, RN attempted to intervene or otherwise escalate their concerns regarding Dr. Hamdan’s request for morphine to the charge nurse, shift supervisor, head of nursing or hospital administration,” the complaint states. “Further, defendant Amanda Clark, RN noted that ‘THIS NURSE ASK DR. CHILDERS TO PUT IN THE DOSE’ after defendant Dr. Hamdan stated he could not put in med host.”
The complaint also said notes don’t show Childers express any concerns about the medicine or dosage.
“The administration of morphine to H.B. at any dose was not medically indicated, appropriate or necessary given his clinical presentation and physical condition,” the complaint states. “Had the morphine been medically indicated, appropriate and/or necessary, the appropriate dose, given H.B.’s weight … would be between 0.05 mg/kg and 0.1 mg/kg, for a maximum dose of 0.3 mg of morphine.”
The complaint also says the label on the Carpuject included the following contraindications: significant respiratory depression and known or suspected gastrointestinal obstruction, including paralytic ileus.
H.B.’s notes reflected “respiratory effort is with retractions, respiratory pattern is apnea … the patient has severe shortness of breath … abdomen is distended, discolored.”
“H.B. was severely overdosed on morphine that was not medically indicated, appropriate or necessary and was contraindicated given his presentation,” the complaint states.
Shortly after he was given at least the morphine, H.B. coded at midnight. Notes say he was grey in color and became apneic/bradycardic.
Hamdan tried to intubate H.B. but was unsuccessful, according to the complaint. After receiving assistance from a respiratory therapist and epinephrine, H.B. improved. But 40 minutes later, he coded again with more unsuccessful attempts at intubation by Hamdan.
The infant was pulseless for about five minutes, according to the complaint. After two doses of epinephrine and BVM assistance, he improved again.
Bloodwork reflected severe respiratory acidosis, and Hamdan notified. At the request of the accepting physician at CAMC, H.B. was given Narcan to reverse the effects of the morphine at 1:18 a.m. on July 1, 2023.
The CAMC transport team arrived at 2:48 a.m., and H.B. was described as “pink,” “pale” and “mottled.” He had bilateral edema around both eyes.
H.B. was taken to CAMC, where records show he had been overdosed on morphine at Raleigh General and that “when the call was made for transfer we did advise giving Narcan due to the dose of morphine that was given.”
He was diagnosed with morphine overdose and multiple failed intubation attempts among other conditions. He was taken to the Pediatric Intensive Care Unit, intubated and placed on mechanical ventilation. He was hospitalized there until July 14, 2023.
The complaint accuses the defendants of negligence and violation of the West Virginia Medical Professional Liability Act.
The plaintiffs seek compensatory damages for past and future medical expenses, cost of long-term and supportive care, loss of earning capacity, past and future pain and suffering, emotional distress, mental anguish, permanent disability and impairment, loss of enjoyment of life as well as educational and rehabilitative expenses.
They also seek punitive damages, pre- and post-judgment interests, court costs, attorney fees and other relief.
They are being represented by Bernie Layne and Jonathan Mani of Mani Ellis & Layne in Charleston and by L. Dante diTrapano, Timothy D. Houston and David H. Carriger of Calwell Luce diTrapano in Charleston. The case has been assigned to Circuit Judge Stephanie Abraham.
Kanawha Circuit Court case number 26-C-27
