Libby Zion was a nineteen year-old girl whose death in 1984 had a profound effect on regulations pertaining to the medical world. Her death caused outrage, and was deemed to be largely due to overworked intern physicians, whose decision to prescribe a cocktail of medicines was seen as the main factor of Libby’s death. In the aftermath of the case, several changes were made to applicable laws – which continue to be observed in the present day. In this article, we take a look at this harrowing case.
As mentioned, the new regulations came as a reaction to the death of Libby Zion. Libby Zion was born in 1965, and was the daughter of Sidney Zion – a lawyer, and his wife, a New York Times writer. Libby was diagnosed with depression during her teenage years, leading to her being prescribed the antidepressant Phenelzine – which she took daily. On March 4, 1984, Zion was admitted to the hospital due to her exhibiting mysterious jerking movements and a high fever.
The family physician – Raymond Sherman, set up a plan to keep Libby observed, and well-hydrated. This plan was assigned to two residents – Luise Weinstein and Gregg Stone. They were first and second-year residents respectively. The duo consulted with Dr. Sherman as to how to deal with Libby’s symptoms, leading to the fateful decision of Pethidine to be prescribed, in a bid to get her symptoms under control. Pethidine is a pain reliever, and is known better by the brand name Demerol.
Yet the two residents were also responsible for the care of many other patients. As they left Libby to check on other patients, Libby’s condition deteriorated. Weinstein was alerted via phone to this, leading to her ordering medical restraints to be placed on Libby. She then made another regrettable decision – deciding to prescribe the antipsychotic Haloperidol. This was done to try and sedate Libby, who as growing agitated. Weinstein made this decision despite not actually seeing Libby’s state in person.
Zion fell asleep following this concoction of medicines, which was inevitable given the sedation qualities of each of the drugs. Her temperature rapidly increased, and she soon went into cardiac arrest. Many attempts were made to resuscitate Libby, but they proved unsuccessful and she passed away. Libby had developed Serotonin Syndrome due to the combination of her prescribed antidepressant Phenelzine and the Pethidine given to her. This led to her agitation, which resulted in the physical restraints. Haloperidol was then given to relax her, but this would’ve only worsened her condition. While the exact cause of death was never known, the combination of drugs is seen as the leading cause.
Libby’s parents grieved over the loss of their child, though were convinced that her death was due to staff incompetence. This was due to the co-administration of Pethidine and Phenelzine, and the use of restraints. Her father Sidney suggested the hospital’s residents ‘tied her down like a dog’, before suggesting Libby had been ‘murdered’. Sidney also questioned the long shifts residents were working at the time. 36-hour shifts were normal, yet left residents – who were tasked with making such crucial decisions – ill equipped for work.
The State of New York conducted an investigation, and caused surprise by allowing a grand jury to consider murder charges against the residents. The two residents were charged with 38 counts of gross negligence and/or gross incompetence, though weren’t charged with murder. Medical experts testified at the hearing, with many stating they were unaware that the combination of Phenelzine and Pethidine could lead to Serotonin Syndrome. Thanks to this case, this is now common knowledge in the medical profession.
However, New York State law indicates that the final decision rests with a different body. The bod voted to ‘censure and reprimand’ the residents for gross negligence, though they were allowed to continue to practice medicine. The Hospital paid a $13,000 fine to the state. Two years later, under appeal, the residents were adjudged to have provided adequate care to Zion, having their records cleared as a result.
Meanwhile, Sidney Zion filed a civil case against the residents and the Hospital. The jury found that the two residents and a primary care doctor at the Hospital contributed to her death by prescribing the wrong drug – ordering them to pay $375,000 in damages to Zion’s family. Dr. Sherman was found to have lied on the witness stand after (falsely) stating he was unaware Zion would be given Pethidine. The Hospital was found not responsible, due in part for Libby’s apparent concealment of her past use of cocaine.
As mentioned in the introduction, this case had knock-on effects in the medical community. A panel of experts was formed to address systemic problems facing the industry. A range of recommendations were subsequently made – revolving around resident work hours, medication systems and usage of restraints on patients. These recommendations were ultimately accepted, meaning no resident could work longer than 24 hours consecutively, or more than 80 hours per week. Several other states followed suit.
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There have been countless cases in history when something bad has happened in order for improvements to be made. This was the case here, with a range of issues contributing to the unfortunate death of Libby Zion. Her death has left a strong legacy, and has surely saved countless others from a similar fate. Anyone working in the medical industry can be making life and death decisions at any point. This case, and the hard work and campaigning of Sidney Zion has ensured Hospital employees are better equipped for such decisions – helping save many, many lives.