PMHNP Legal Case Study

PMHNP Legal Case Study
Nu 668
A fifteen-year old female went to her primary care clinic in January 2012. The patient had been seen in an emergency room two days earlier for nausea, abdominal pain and vomiting. The patient was seen at the outpatient mental health clinic by the psychiatric nurse practitioner, who worked under the supervision of the off site psychiatrist. The clinic received federal funding.
The psychiatric nurse practitioner was informed of the recent emergency room visit via intake paperwork completed by the fifteen-year old’s mother. The psychiatric nurse practitioner wrote prescriptions for Zofran 4mg po q4 hours prn nausea and Prozac 40mg po QAM on a prescription pad which had been pre-signed by the supervising psychiatrist. The psychiatric nurse practitioner’s notes indicated that the Prozac was prescribed for depression, but in depth screening and safety risk assessment was not documented.
The patient was told to return in one month. Three weeks later the patient hung herself in her bedroom closet with a belt. She was found by her mother and brother and was transported to a nearby hospital. The patient suffered a catastrophic brain injury and died three years later. She required around-the-clock care during those three years.

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The family claimed that Prozac should not have been prescribed due to a lack of signs of clinical depression and claimed that the FDA had issued a warning regarding the use of Prozac in adolescents, specifically that Prozac use in adolescents increased the risk of suicidal thinking and behavior.

The psychiatric nurse practitioner claimed that the clinical evaluation for depression supported the diagnosis. The psychiatric nurse practitioner also claimed that the suicide attempt followed a breakup with her boyfriend and a fight with her father and that the medication played no part in the incident.
(1) Identify the defendants AND areas of negligence in this case.
(2) Identify and describe appropriate screening measures and safety risk assessment procedures in adolescents with depression.
(3) Reflect on this case and identify what you would have done differently as a psychiatric mental health nurse practitioner.
(4) What do you think the verdict was and why?
Adapted from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411