What Families Should Do After a Nashville Medication Error: Potassium, Hyperkalemia, and Your Legal Deadline

If someone in your family went in for a routine orthopedic procedure and is now in an intensive care unit, you are not looking for a law firm. You are looking for an answer.

Reports have described a medication error affecting patients treated at a Nashville orthopedic practice, in which a preparation given to patients is reported to have contained potassium. Several of those patients are reported to be critically ill and receiving intensive care.

I am not going to pretend I know what happened inside that facility. Nobody outside of it does yet. What I can tell you is what potassium does to a person, what a family should be doing in the next seven days, and what Tennessee law is going to require of you whether or not you ever hire a lawyer.

What Potassium Actually Does

Families keep using the word “paralytic,” and I understand why. What they are watching looks like paralysis.

Potassium is not a paralytic drug in the way anesthesia paralytics are. But severe hyperkalemia, meaning too much potassium in the blood, produces almost exactly that picture. It disrupts the electrical resting potential of the body’s cells. Patients develop generalized weakness, flaccid paralysis, and loss of deep tendon reflexes.

Then it reaches the heart.

• At 5.5 to 6.5 mEq/L, the ECG shows tall, peaked T waves.
• At 6.5 to 7.5, the P waves flatten or disappear.
• At 7 to 8, the QRS complex widens.
• At 8 to 10, you get severe arrhythmias, a sine wave pattern, and progression to asystole.

Acute severe hyperkalemia can cause sudden cardiac arrest. Mortality approaches two thirds without rapid intervention. The treatment sequence is calcium gluconate to stabilize the heart muscle, insulin with glucose and beta agonists to push potassium back into the cells, diuretics, and dialysis.

When all of that is not enough, the patient ends up on life support in an intensive care unit. A person who survives a severe potassium event can be left with organ damage from the period their heart was not moving enough blood. A patient who reaches that point after a medication event has suffered a catastrophic injury by any clinical measure.

Source: Hyperkalemia, StatPearls, NIH

The Safeguards That Are Supposed to Prevent a Potassium Error

Here is what makes a potassium event different from most medication errors: the entire medical profession already knows this drug kills people, and built rules specifically to stop it.

Concentrated potassium chloride for injection is a high alert medication. The Institute for Safe Medication Practices has stated plainly that direct intravenous administration of concentrated potassium chloride “has proven fatal.” The national standard is that concentrated potassium must never leave the pharmacy undiluted. Hospitals pulled it from floor stock decades ago for exactly this reason.

The safeguards that are supposed to be in place include:

• Concentrated potassium restricted to the pharmacy, never stored on units
• Barcode scanning to verify the correct medication before dispensing and before administration
• Independent double checks by a second qualified person where barcode systems are unavailable
• Auxiliary labeling and physical separation of look alike vials
• Extra scrutiny of products sourced from compounding pharmacies and 503B outsourcing facilities, especially during drug shortages when packaging is nonstandard

Every one of those is a checkpoint. If a serious potassium event reaches a patient, the investigation’s first question is which of those checkpoints were in place and whether each one functioned. That is what the records are for, and it is why nobody outside the investigation should be assuming an answer yet.

The Five Things To Do This Week

I have handled enough of these to tell you that what a family does in the first two weeks often decides what is provable a year later.

1. Request the complete medical record, in writing, from every facility involved.

Not the discharge summary. The complete record. Specifically ask for the medication administration record, the pharmacy dispensing log, the anesthesia record, all nursing notes, and every lab value including each potassium level with its timestamp. Send the request in writing and keep a dated copy. A written request creates a record that the request was made, which matters if documents later go missing.

2. Write down every conversation, now.

Who told you what, when, and in what words. Get names and titles. In two months you will not remember the details, and in litigation, recollections on the other side frequently differ from yours.

3. Sign nothing.

Not a release, not a waiver, not a “routine” form from a risk manager, patient advocate, or insurer. Risk management works for the facility. That is not a criticism of them, it is their job. It is just not your job.

4. Keep everything with a dollar figure on it.

Bills, explanation of benefits forms, receipts, mileage, hotel nights, days missed from work. Economic damages are not capped in Tennessee, and they are proven with paper.

5. Do not wait for the investigation.

State and federal reviews routinely take a year or more. Your legal deadline does not wait for them.

Your Tennessee Deadline Is One Year, and It Is Already Running

This is the part families most often get wrong.

Tennessee medication error claims fall under the Tennessee Health Care Liability Act, Tenn. Code Ann. 29-26-101 et seq. The statute of limitations is one year from the injury, or one year from discovery if the injury could not reasonably have been discovered sooner. Tenn. Code Ann. 29-26-116(a). There is also a three year outer limit, the statute of repose, with narrow exceptions for fraudulent concealment and retained foreign objects.

Before you can file, Tenn. Code Ann. 29-26-121 requires written notice to each prospective defendant at least 60 days in advance, with specific required contents including a HIPAA compliant authorization. Proper notice extends the deadline by 120 days. Improper notice can be fatal to the case.

And under Tenn. Code Ann. 29-26-122, the complaint must be filed with a certificate of good faith confirming a qualified expert has reviewed the case. Filing without it can mean dismissal with prejudice.

None of that is designed to be navigated by a family sitting in an ICU waiting room. It is a good reason to at least talk to a lawyer early, even if you are not ready to file anything.

One provision worth knowing about: Tenn. Code Ann. 29-26-115(c) creates a rebuttable presumption of negligence when the instrumentality that caused the injury was in a defendant’s exclusive control and the injury is one that ordinarily does not happen without negligence. Where a claimant can show exclusive control, that shifts the burden. Exclusive control is often the fight in a case where a drug passed through several sets of hands, which is one more reason the chain of custody records matter so much.

Who Would Actually Be Responsible

Families assume it comes down to one person who made one mistake. In serious medication cases it almost never does.

A drug passes through a chain, and every link has a duty: the prescriber who wrote the order, the pharmacy that dispensed it, the compounding pharmacy or outsourcing facility that mixed it if it was compounded, the clinician who administered it, and the facility whose systems either caught the error or did not.

That last one is usually where the real case is. Did the barcode system exist, and was it working? Was concentrated potassium anywhere it should never have been? Was there an earlier near miss nobody reported? Was the double check a real check or a signature?

If a compounded or outsourced preparation is involved, the analysis widens further. Claims against a compounder or manufacturer can proceed under the Tennessee Products Liability Act, Tenn. Code Ann. 29-28-101 et seq., and a batch problem affects everyone who received that batch, not one patient.

What I Have Seen in Medication Cases

I want to be specific rather than say something generic about fighting for families.

We represented a hospice patient’s family after she was brought to a facility for a short respite stay. Her family told the staff clearly that she was diabetic and needed her insulin. The facility took the medication and did not administer it. Her blood sugar spiked, she was hospitalized, and the family lost weeks of the last time they had with her. The facility offered $220,000 to settle. We tried the case. The jury returned $350,000.

In another case, a resident was prescribed a powerful antibiotic, one pill per day for one week. The facility gave it four times a day. Nobody caught the error until the medication ran out early. By then she had accumulated a toxic dose, and she died. That case resolved for a confidential amount.

And in a third case, the facility’s own records were the evidence. Care notes had been signed by staff who were not in the building, and the chart showed a resident being fed and bathed after she had already died. That matters legally as well as morally: under Tenn. Code Ann. 29-39-102(h), Tennessee’s cap on noneconomic damages is removed entirely when a defendant intentionally falsifies, destroys, or conceals records containing material evidence for the purpose of wrongfully evading liability in the case.

In none of those cases did the facility hand us the answer. We got it from the records and from depositions.

Prior results do not guarantee or predict a similar outcome. Every case depends on its own facts.

What This Costs You

Nothing, to find out where you stand.

We review these cases at no charge and handle them on a contingency fee, which means there is no attorney’s fee unless we recover money for you. We advance case expenses, and we will explain exactly how those are handled before you sign anything. If we look at your situation and do not think you have a case, we will tell you that, and you will have lost nothing but an hour.

If your family member was hospitalized after a medication given at a Nashville clinic, surgery center, or hospital, we will look at it.

Call Now | Request a Free Case Review | No Fee Unless We Win

Frequently Asked Questions

What is hyperkalemia?

Hyperkalemia means too much potassium in the blood. Mild elevations of 5.0 to 5.5 mEq/L are often symptomless. ECG changes typically begin in the 5.5 to 6.5 range, and levels above 6.5 are considered severe, causing muscle weakness, flaccid paralysis, and progressive ECG changes that can lead to severe arrhythmias and cardiac arrest.

Why would a patient end up in intensive care after a medication error?

Severe hyperkalemia affects the heart’s electrical conduction and can cause dangerous arrhythmias or cardiac arrest. Treatment requires continuous cardiac monitoring, drugs given intravenously, and often dialysis. When the heart cannot maintain circulation on its own, patients require life support in an ICU.

How long do I have to file a medication error claim in Tennessee?

One year from the injury, or one year from discovery, under Tenn. Code Ann. 29-26-116, with a three year outer limit. Proper pre-suit notice under 29-26-121 extends the deadline by 120 days, but the notice requirements are technical and easy to get wrong.

Can I sue more than one party?

Yes. Liability commonly extends across the chain of custody, including the prescriber, the dispensing pharmacy, a compounding or outsourcing facility, the person who administered the drug, and the facility itself. Claims against a compounder or manufacturer may also arise under Tennessee product liability law.

What should I ask the hospital for?

The complete medical record, not the discharge summary. Specifically request the medication administration record, pharmacy dispensing records, the anesthesia record, all nursing notes, and every lab value with timestamps, including each potassium level. Make the request in writing and keep a dated copy.

Is there a limit on what I can recover in Tennessee?

Economic damages such as medical bills, future care, and lost income are not capped. Noneconomic damages are capped at $750,000, or $1,000,000 for catastrophic loss as narrowly defined by statute, under Tenn. Code Ann. 29-39-102. The cap is removed if a defendant intentionally falsified, destroyed, or concealed records containing material evidence for the purpose of wrongfully evading liability.

What if my family member died?

Tennessee wrongful death is a single claim, and Tenn. Code Ann. 20-5-106 sets who holds the right to bring it: the surviving spouse first, then the children or next of kin if there is no surviving spouse, or the personal representative on their behalf. Recoverable damages include the pecuniary value of the life, medical and funeral expenses, and the decedent’s conscious pain and suffering. The same one year deadline and pre-suit notice requirements apply.

Should I wait for the state investigation to finish?

No. Regulatory investigations frequently outlast your filing deadline and do not preserve evidence on your behalf. Records can be amended, staff turn over, and memories fade. Begin your own review now.

Jim Higgins is the founding partner of The Higgins Firm in Nashville, Tennessee. The firm handles serious injury and wrongful death cases, including medication errors, pharmacy errors, hospital negligence, and nursing home neglect.

Prior results do not guarantee or predict a similar outcome. Every case depends on its own facts. This article is attorney advertising and general information about Tennessee law, not legal advice about your situation. No attorney client relationship is created by reading it.