A Philadelphia-area hospital is liable for $2.4 million in damages in a wrongful death lawsuit waged by the estate of a knee replacement patient who died in the hospital as a result of post-op drug interactions.

The patient's death - which the lawsuit attributed to the unexpected interaction of psychotropic medications, anesthesia and morphine, as well as to negligence on the part of the hospital staff - serves as a potent reminder that patients administered psychiatric drugs must be closely monitored for such rare but potentially lethal reactions.

The patient, Pearl Cominsky, underwent total knee arthroplasty at Holy Redeemer Hospital in Meadowbrook, Pa., under the care of Marc Manzione, MD. She was prescribed patient-controlled morphine to manage her post-op pain. After the surgery, she also received a psychiatric evaluation in order to maintain her previous prescriptions to Clozaril, Anafranil and Ativan. The psychiatrist, Mary Donovan, MD, allegedly failed to order heightened monitoring or observation for Ms. Cominsky, however, a step which the lawsuit says should have been taken, given the possibility for adverse interactions between the psychiatric drugs, the morphine and the anesthesia.

Less than 24 hours after surgery, Ms. Cominsky's blood pressure reportedly dropped significantly, her respiratory rate increased and her temperature spiked. Court records say she was found "severely hypotensive, with cyanotic lips and a dusky appearance" less than 2 hours later. She was transferred to the intensive care unit, where she was placed on mechanical ventilation and diagnosed with respiratory arrest and resulting hypoxic encephalopathy. She died 19 days later.

In the lawsuit, Ms. Cominsky's husband, Seymour Cominsky, argued that the hospital and its providers were negligent in failing to order heightened monitoring or observation; to recognize, diagnose and treat the changes in her respiratory and neurologic status; to select and retain competent physicians and employees; to properly supervise those employees; and to adopt and ensure adequate patient care policies.

Mark McGraw