A Charleston, South Carolina nurse is fined $500 for the 2012 death of a patient after an outpatient knee surgery. What caused the patient’s death?

Outpatient Surgery Death

On April 18, 2012, a 63-year-old patient underwent a knee arthroscopy, an outpatient surgery. After the procedure, the patient reported a 10 out of 10 on the pain scale, so nurse Laura Bilancione followed the post-operation order sheet in which it is stated that she could give the patient 0.2mg up to 4mg of Dilaudid every five minutes. Dilaudid is an opioid for the treatment of severe pain.

Bilancione administered a total of 4mg of Dilaudid from 9:02 to 9:28 in the morning. She also gave the patient 5mg of Percocet at 9:42 a.m. The patient’s pain level then went down from 10 to 3, and she was later discharged at 10 a.m.

However, the woman’s husband called 911 that afternoon because she reportedly had not woken up. She died five days later, with the cause of death being ruled as an accident due to probable mixed drug toxicity.

Specifically, the forensic autopsy of the woman cited fentanyl, promethazine, hydromorphone, oxycodone, and midazolam. Percocet contains oxycodone while Dilaudid contains hydromorphone.

Case Review

The case was reviewed in 2014, and it was found that Bilancione actually gave the patient a higher dose of Dilaudid than specified in the doctor’s order. Also, she gave the Percocet without any orders.

According to Bilancione, she panicked when the woman stated that her pain level was at 10 out of 10, and that the woman appeared to be fine when she left the facility. In fact, she was even able to dress herself before leaving. She further states that the case was an isolated incident in an otherwise remarkable nursing career.

Upon careful consideration of the circumstances surrounding the events, the South Carolina Nursing Board ordered Bilancione to pay a fine of $500. She also needs to complete two board approved education courses within six months and appear before the board if she wants her license to be reinstated.

“The sanctions imposed are designed not to punish Respondent, but to protect the life, health, and welfare of the public at large,” the board stated in the November order.