9.PMHNP Legal Case Study

Name: Lucia

Age: 15

Gender: Female

Guardian/parent: Mother

Other details: Hispanic

Visits

1January 2012

Lucia was seen in an emergency room two days earlier for nausea, abdominal pain and vomiting. She was then 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 during the review of the intake paperwork completed by Lucia’s mother. The psychiatric nurse practitioner prescribed Zofran 4 mg by mouth every 4 hours prn for nausea and Prozac 40 mg by mouth every morning 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 an in depth screening and safety risk assessment was not documented.

2February 2012

The patient was instructed to return in one month. Three weeks later Lucia 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.

Family’s Complaint

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.

NP’s Claim

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.

Review the Case

Please review the listed questions.

  1. Identify the defendants and the 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. Review the risks that NPs face associated with practice identified in Buppert (2021) p. 299 and identify which of these apply to the case. What strategies might have reduced the risk of the outcome presented in this case? Refer to Buppert (2021) Chapter 8: Risk Management.
  5. What do you think the verdict was and why?