TAMPA — Mable Mosley checked into Brandon Regional Hospital complaining of shoulder and neck pain on a Saturday last year.
The following Tuesday, she stopped breathing. A doctor's report said she choked on her own vomit. After days on life support, Mosley, a 68-year-old county school bus aide for special-needs children, died.
On Tuesday, her husband sued the hospital, its corporate owners and seven pharmacists, claiming they dispensed enough pain medicine to kill her. The hospital declined to comment on the lawsuit.
The suit focuses on Duragesic, a patch that contains high concentrations of the narcotic fentanyl.
According to a patient leaflet for Duragesic, it should be used only by "opioid-tolerant" people, or people who have taken strong doses of opioids for at least a week. The lawsuit states that Mable Mosley wasn't tolerant. She was the opposite, "opioid-naive."
"It's like shooting an ant with an elephant gun," said Paul Doering, a pharmacy professor at the University of Florida retained as an expert by widower Alvie Mosley's attorney.
The Food and Drug Administration, in a 2007 warning, cautioned against inappropriate use of fentanyl patches.
"For patients who are not opioid-tolerant, the amount of fentanyl in one fentanyl patch of the lowest strength is large enough to cause dangerous side effects, such as respiratory depression … and death," the FDA said.
The Duragesic leaflet cautions that elderly people should begin on a patch that administers no more than 25 micrograms per hour.
According to the lawsuit, Mable Mosley arrived in the emergency room on May 24, 2008. A hospital record states that her pain reached a level of 8 on a scale of 0 to 10. A doctor admitted her and prescribed three types of pain medications: Toradol, morphine sulfate and Dilaudid.
The suit alleges that her pain, once treated, dropped to a 1. But later that day, the same doctor ordered a 50-microgram Duragesic fentanyl patch, the suit states.
The day after Mosley was admitted, the doctor increased the dose to 75 micrograms, the suit states. The next day, he increased it to 100 micrograms, and prescribed an additional medication, Neurotonin, used to treat pain caused by nerve injury.
"All pharmacists, including the defendant pharmacists, knew or should have known that fentanyl patches are slow to work," the suit states. "The drug's delivery through the skin means that peak levels are not reached for days, not hours.
"In Mable Mosley's case, it had been less than 12 hours since the first lower dose patch had been applied. The manufacturer recommended waiting 72 hours before increasing the dose."
Melissa Morgan, a spokeswoman for Brandon Regional Hospital, said that because the lawsuit was filed Tuesday, there was insufficient time to gather the information to comment on the case.
HCA Inc. did not respond to a request for comment.
One pharmacist said she was not authorized to speak to a reporter. The others could not be reached or did not return phone calls.
Mosley's lawsuit does not name the doctor who prescribed the patches, but the widower said he, too, is to blame.
That doctor, Antonio Zumpano, could not be reached by the Times Tuesday. He did not return a call left at his office, and an attempt to reach him at his home was unsuccessful.
Mosley's attorney, Patrick Dekle, said Florida statute requires him to communicate with the doctor for 90 days before taking legal action, and that has not yet happened.
The doctor provided Mosley's widower a report titled "death summary," which the attorney shared with the Times. It does not mention fentanyl. It describes Mrs. Mosley as 5-foot-5, obese at 257 pounds, and suffering from sleep apnea.
The report says Mrs. Mosley became claustrophobic in an MRI machine, then experienced nausea and vomiting, and aspirated.
According to the lawsuit, on May 26 at 8 p.m., Mosley's oxygen level fell below normal. Half an hour later, she was showing signs of respiratory depression and increasing lethargy. At midnight, she was found unresponsive. She was taken off life support on June 2.
In his attorney's office Tuesday, Mosley spoke of his grief, of having lost his wife of 39 years, a woman he once loved at first sight.
"I prayed every day that I would die," he said. "I didn't want to live without her."
Alexandra Zayas can be reached at firstname.lastname@example.org or (813) 226-3354.