Swimming Pool Near-Drowning Case Study: Neurological Recovery and Pharmacy Lien Coverage

James Wong — Founder & CEO, LienScripts | March 4, 2026 | 8 min read

A near-drowning incident at a residential pool left a patient with hypoxic brain injury requiring extensive neurological medications. This case study examines how a pharmacy lien covered 18 months of cognitive and psychiatric medications while the premises liability claim against the property owner proceeded.

Swimming pool near-drowning incidents can produce severe neurological injuries that require extensive and prolonged pharmaceutical management. The combination of hypoxic brain injury, post-traumatic seizure risk, and psychiatric sequelae creates a medication profile that is both complex and expensive.

Note: This is a fictionalized case study based on composite facts. Names and identifying details are not real. The clinical details represent typical medication patterns for this injury type.

• Near-drowning with hypoxic brain injury requires anti-seizure medications, cognitive enhancers, and psychiatric medications that may be needed long-term
• Premises liability claims against pool owners involve duty of care, barrier requirements, and supervision obligations
• An 18-month pharmacy lien documented the full neurological recovery trajectory
• LienScripts' MERIT (Medication Evaluation & Rationale for Injury Treatment) report provided the clinical evidence connecting cognitive decline to the drowning event
• The defense argued the patient's symptoms were psychological, not neurological; the pharmacy record refuted this

Case Background

Patient: Diane S. (name changed), 28-year-old female, elementary school teacher

Incident: Diane attended a barbecue at a friend's rented home. The rental property had an in-ground pool without a compliant safety barrier — the gate latch was broken and the pool alarm was non-functional. While guests socialized in the yard, Diane slipped on the wet pool deck and fell into the deep end. She struck her head on the pool edge during the fall, lost consciousness, and was submerged for an estimated three to four minutes before other guests pulled her out and initiated CPR.

Injuries: Hypoxic-ischemic brain injury (mild-to-moderate), post-concussive syndrome from the head strike, aspiration pneumonia from water inhalation, and a laceration on the left temporal region requiring sutures.

Initial Treatment: EMS transported Diane to the nearest hospital. She was intubated in the emergency department due to respiratory distress from aspiration pneumonia. She regained consciousness within hours but exhibited confusion, short-term memory deficits, and significant anxiety. After three days in the ICU and two additional days of inpatient observation, she was discharged with neurological follow-up.

Insurance Situation: Diane had an ACA marketplace plan with a high deductible. The plan covered the acute hospitalization but denied ongoing outpatient neurological and psychiatric treatment as "not medically necessary" pending further clinical documentation.

Attorney: Rafael D. (name changed), a premises liability attorney.

The Pharmacy Lien: 18 Months of Neurological Coverage

Rafael enrolled Diane in the LienScripts pharmacy lien program immediately after her discharge. With her insurance denying outpatient neurological medications, the lien program became essential for uninterrupted treatment.

Medication Timeline

Acute Recovery: Months 1-3

Levetiracetam (Keppra) 500mg twice daily — prophylactic anti-seizure medication. Post-hypoxic and post-traumatic brain injuries carry elevated seizure risk, and neurological guidelines recommend prophylactic anti-epileptic therapy during the acute recovery period.

Amoxicillin-clavulanate 875mg twice daily for the aspiration pneumonia, followed by a course of levofloxacin 750mg daily when initial antibiotic response was incomplete.

Ondansetron 4mg as needed for persistent nausea related to the head injury and vestibular dysfunction.

Acetaminophen 1000mg every 6 hours for headache management. NSAIDs were avoided due to the head trauma and theoretical risk of bleeding in the acute post-concussive period.

Cognitive and Psychiatric Management: Months 4-10

As the acute injuries resolved, Diane's cognitive deficits became the primary clinical focus:

Donepezil 5mg daily — a cholinesterase inhibitor used off-label for post-hypoxic cognitive impairment. Diane's neuropsychological testing at month 3 showed deficits in short-term memory, attention, and processing speed. Her neurologist initiated donepezil to support cognitive recovery.

Sertraline 50mg daily, titrated to 100mg at month 6 — for post-traumatic depression and anxiety. Diane had developed significant anxiety about water, difficulty sleeping, intrusive memories of the incident, and depressive symptoms related to her inability to return to teaching.

Zolpidem 5mg at bedtime for insomnia. Sleep disruption is common after brain injury and was compounding Diane's cognitive difficulties. The prescribing neurologist documented that the insomnia was directly related to the hypoxic event and not a pre-existing condition.

According to James Wong, PharmD, founder of LienScripts, "Neurological medication regimens after near-drowning events are some of the most clinically complex cases we manage. The combination of anti-seizure prophylaxis, cognitive support, and psychiatric management requires careful documentation that connects every prescription to the specific mechanism of injury."

Long-Term Recovery: Months 11-18

Levetiracetam was tapered and discontinued at month 12 under neurological supervision, after an EEG showed no seizure activity. The pharmacy record documented the controlled taper and the clinical rationale for discontinuation — important evidence that the prescribing was appropriate and time-limited.

Methylphenidate 10mg twice daily was added at month 11 for persistent attention and processing speed deficits. Diane was attempting to return to teaching but found she could not manage the cognitive demands of her classroom. The methylphenidate was prescribed by her neurologist with specific documentation of the post-hypoxic etiology.

Sertraline continued at 100mg daily. Zolpidem was replaced by trazodone 50mg at bedtime for a longer-term sleep solution with less dependence risk.

By month 18, Diane had returned to teaching part-time with accommodations. Her neuropsychological testing showed improvement but persistent deficits in processing speed and multitasking capacity.

How Pharmacy Documentation Supported the Case

The defense argued that Diane's cognitive symptoms were psychological — a stress reaction — not neurological. Rafael used the pharmacy record to refute this:

• The sequential medication timeline showed a neurologically-driven treatment plan: anti-seizure prophylaxis, then cognitive enhancers, then stimulant medication for attention deficits
• The prescribing pattern was consistent with hypoxic brain injury management, not anxiety treatment
• The MERIT report connected every medication to the specific injury mechanism documented in the hospital records

Settlement Outcome

The case settled before trial. Rafael's damages presentation included hospitalization costs, the pharmacy lien balance, neuropsychological evaluation costs, projected future cognitive medication needs, lost wages during the 18-month recovery, diminished earning capacity due to residual cognitive limitations, and pain and suffering. The comprehensive pharmaceutical documentation made it difficult for the defense to characterize the injuries as minor or psychological.

Related Resources

• Brain Injury Cognitive Medications Case Study
• What Is a MERIT Report?
• Demand Package Pharmacy Records