Mrs. M, a 34-year-old mother of five, tried to take her ondansetron, but she was overcome with dizziness. Her husband noticed that her breathing was shallow and her skin felt clammy.

He helped her back to bed, but within hours Mrs. M began to have seizures and lapsed into a coma. She soon stopped breathing and died, despite the efforts of paramedics.

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The news was all over the clinic the next morning. Ms. J was appalled to hear that Mrs. M had died.

“It seems to have been a fentanyl overdose,” a colleague told her. “Maybe due to a leaky patch.  What a shame.”

When the medical examiner ruled that a fentanyl overdose was indeed the cause of death, Mrs. M’s husband consulted a plaintiffs’ attorney, who said that other overdose incidents had led the the manufacturer to recall the patch several times.

“I believe that you have an excellent case against the pharmaceutical company,” the attorney concluded.

“I don’t just want to sue them,” Mr. M angrily replied. “I want to sue that NP my wife called the night she died. Maybe if she’d told us to take off the patch or to go to the emergency department right away, my wife would still be here.”

After meeting the defense attorney her insurance company had assigned, Ms. J felt confident that she would be exonerated.

“I answered the call, and I gave reasonable advice under the circumstances,” she told herself. “Mrs. M never said she was having trouble breathing.”

Two years later the case against Ms. J and the patch manufacturer reached trial. Mr. M took the witness stand first. He calmly characterized his former high school sweetheart as a devoted spouse and mother. But when it came time to describe her final hours, the bereaved man broke down.

After he regained his composure, he testified that his wife had been sent home after back surgery with fentanyl patches for pain and instructions for their use.

“Did she follow these instructions?” his attorney asked.

“Absolutely. She was conscientious about things like that.”

Mr. M then recounted how his wife began feeling ill in the middle of the night, called the clinic, and spoke to Ms. J.

“And as a result of that conversation, what did your wife do?” the attorney asked.

“She tried to take her antinausea pill, but it didn’t help. She just kept feeling worse and worse. I asked her if we should go to the hospital, but she wanted to follow the NP’s instructions and go back to bed. An hour or two later, she started having trouble breathing. I called the ambulance then, but she was in such bad shape that they couldn’t save her.”