An uncooperative and
intoxicated patient forces
clinicians to take matters
into their own hands.
BY ANN W. LATNER, JD of carisoprodol (Soma) had been ﬁlled the day
As the nurse practitioner with the least seniority, After crashing before, but only seven pills were left. Had the
Ms. P was stuck working the graveyard shift in her car, medication been taken as prescribed, there would
the hospital emergency department (ED). Some the patient have been 16 pills remaining in the vial.
nights were slow and uneventful while others Ms. P asked the ofﬁcers to bring Ms. D into an
could be highly stressful and demanding. When admitted to exam room. The patient had difﬁculty walking
Ms. P saw the police escorting a stumbling and taking pills without assistance and was unable to walk in
muttering woman into the ED one night, she that had been a straight line. Ms. P explained to Ms. D that
knew she was in for the latter. she was going to check her BP and heart rate,
One ofﬁcer placed the woman into a chair
prescribed for but the patient barely seemed to hear her. Her
and another came to talk to Ms. P. Apparently her sister. pulse was normal, but BP was borderline low
the patient, Ms. D, was observed crashing her (90/60 mm Hg). Ms. P asked the patient her
car into a tree and then driving away on the name several times before receiving a slurred
wrong side of the road. When the police pulled response. Ms. D did not seem to be aware that
her over, Ms. D appeared to be intoxicated but she was in a hospital and was disoriented as to
passed a Breathalyzer test. The ofﬁcer noted that the date. When questioned about the Soma,
the woman had glassy eyes, slurred speech, and Ms. D said that she believed she had taken two
was shaking violently. He also noticed a vial of pills a few hours ago. Ms. P noted that the patient
pills in her front seat. According to the police alternated between nodding off to sleep and
report, Ms. D was disoriented and questions
had to be asked repeatedly before she would
Cases presented are based on actual occurrences.
answer. Ms. D admitted taking pills that had Names of participants and details have been changed.
been prescribed for her sister. Cases are informatio