Welcome to another court case gone bad.
This week, in a landmark case involving the 2008 murder of Kristy Ragsdale by her husband David, the Utah Supreme Court ruled in favor of the victim’s family stating that the nurse practitioner overseeing Mr. Ragsdale’s care, “owed a duty to exercise reasonable care when prescribing medications that pose a risk of injury to third parties.”
David Ragsdale shot his wife while on six medications prescribed by the nurse practitioner, including Valium, Doxepin, Paxil, Concerta, pregnenolone and testosterone. Read full story.
Although blood toxicology reports show that the drugs he was taking were “within the prescribed ranges,” the lawsuit claims that the NP was negligent by “not consulting with a medical doctor in prescribing and increasing dosages of the medications and for keeping Ragsdale on the medications despite signs of toxicity,” a theory the convicted killer himself has used for his defense.
Isn’t it tragic; the convicted killer in this case has a better defense than the nurse practitioner.
But whether you agree with the ruling or not, NPs be on notice; The door is wide open for family members to sue you if they are “impacted” when things go wrong with a loved one’s care.
Your duty is no longer only to the patient but to the third parties connected to the patient as well.
So how do you protect yourself from this type of lawsuit?
I cannot over simplify the challenges of managing complex clinical cases but must stress the importance of using best practice guidelines and prudence that will serve as your best defense.
First and foremost, when prescribing, educate yourself, patients, and family members about all potential side effects and have them alert you immediately if they experience any of them.
Stay within your written scope of practice as defined by state law and agreed upon by you and your collaborating physician.
Know your limitations and consult with experts when possible, especially when dealing with psychiatric and chronic pain conditions that are resistant to initial treatment.
When prescribing drugs for these conditions, document all education regarding possible drug side effects, any outside consultations, and your rationale for initiating, adding, or increasing drug dosages.
Monitor the patient’s response to treatment, including any changes in medication, often, as defined by treatment guidelines.
Finally, for every prescription you write, use SCRIPT analysis (Side effects; Contraindications; Right medication, dose, frequency, and route; Interactions; Precautions; Transmittal).
Following each of these tips will help ensure that YOU have the best defense in any court of law.