Anesthesiologist found negligent in brain injury death case, $1.23M verdict
By Jonathan D. Rubin, Esq.
Partner
Kaufman Borgeest & Ryan
New York, NY
Elizabeth V. Janovic, Esq.
Associate
Kaufman Borgeest & Ryan
New York, NY
Barbara K. Reding, RN, LHCRM, PLNC
Clinical Risk Manager
Central Florida Health Alliance
Leesburg, FL
News: In the summer of 2008, a patient underwent thyroid surgery. She did not recover from the surgery, and she could not be revived in postanesthesia care. The patient's family brought a suit against the hospital, the anesthesiologist, and the anesthesiologist's medical group and alleged that during surgery, the anesthesiologist failed to correctly place the oxygen tube, thereby causing injury to the brain by depriving it of oxygen and leading to eventual death. An autopsy revealed that oxygen deprivation was the cause of death. The hospital was dismissed from the lawsuit. The jury found the anesthesiologist negligent and awarded the patient's family $1.23 million in damages.
Background: On Aug. 11, 2008, a 66-year-old mother of eight underwent surgery to remove the thyroid and parathyroid glands in her neck. Thyroid and parathyroid surgeries are common, although, the parathyroid surgery in particular is specialized due to the number of small nerves within the neck and surrounding the glands. The patient suffered from a severe lack of oxygen and extremely low blood pressure during the surgery. Doctors were unable to revive her in postanesthesia care, and she was placed on life support. Her family was forced to make the difficult decision to remove her from life support on Aug. 22, 2008.
The patient's family brought a suit against the hospital, the anesthesiologist, and the anesthesiologist's medical group. Plaintiff alleged that the anesthesiologist failed to recognize that the oxygen tube had moved after the patient was given general anesthetic. The misplacement of the oxygen tube made it impossible for the patient to breathe independently and resulted in brain damage and death. Plaintiff also alleged that the anesthesiologist was negligent in failing to monitor the breathing apparatus, after anesthesia was administered, and the patient's blood pressure during the surgical procedure. Both of these situations can result in oxygen deprivation. Plaintiff claimed the patient's blood pressure was extremely low during surgery and cited that monitoring of heart rate, breathing pattern, blood pressure, and all vital signs are responsibilities of the anesthesiologist. An autopsy was performed on Aug. 22, 2008, three days after the patient was removed from life support and died. The autopsy failed to show any cause of death other than lack of oxygen during surgery.
The named hospital was dismissed from the lawsuit in October 2011. The remaining defendants, the anesthesiologist and the anesthesiologist's medical group, denied negligence and contended that the anesthesiologist complied with all standards of care and properly monitored the patient.
The jury deliberated for three days and found that the anesthesiologist was "professionally negligent" in his care of the patient. The jury determined his negligence was the "proximate cause of death" of the patient. On March 1, 2012, the jury reached a verdict in favor of the patient's son, who filed the suit as a personal representative of the estate. The jury awarded $1.2 million in non-economic damages and $34,274 in economic damages.
Defendants were not satisfied with the verdict and have yet to decide whether they will seek an appeal of the decision.
What this means to you: Cerebral hypoxia, a condition that occurs when there is insufficient oxygen to the brain, is an emergency condition that requires immediate intervention. Brain cells are extremely sensitive to a decrease in or absence of a life-sustaining supply of oxygen and will begin to die within minutes. The sooner the oxygen supply is restored, the lower the risk of severe brain damage or death. The longer a person is exposed to oxygen deprivation, the higher the risk for brain death and the lower the opportunity for recovery.
Administration of anesthesia in current healthcare settings requires in-depth technical training and extensive biological, anatomical, and physiological education. Due diligence, excellent assessment skills, and a constant and consistent vigilance are requirements, not options, when administering paralytic or anesthetic agents to patients.
To be deprived of oxygen in a healthcare setting might occur as the result of an unanticipated trauma, cardiac, hematologic, or birth event. In general, a state of hypoxia is an unexpected occurrence. Given the technical support of today's diagnostic monitoring equipment, failure to adequately assess patient status during a treatment or procedure, resulting in an anoxic or hypoxic outcome, is unacceptable and inexcusable. In addition to monitoring blood pressure status, oxygen saturation and perfusion rates must be closely observed to ensure the patient remains stable under the effects of anesthesia. If the assessment indicates otherwise, immediate intervention is not only prudent; it is mandatory.
Although defendants in this case denied any deviation from anesthesia standards of care, the inability to revive a 66-year-old patient post-procedure raises the question as to the type and quality of assessment and monitoring the patient received during the period of anesthesia. In this case, the postmortem found no cause of death other than a lack of oxygen during surgery. Signs and symptoms of oxygen deprivation, such as a decrease in blood pressure, heart rate, and oxygen saturation levels, would have been evident due to incorrect endotracheal intubation (ET tube) placement, especially because the patient was unable to breathe on her own for a prolonged period under anesthesia. If blood samples were drawn perioperatively, abnormal blood gas readings such as a decrease in PO2 levels and an increase in CO2 levels, or other variant blood chemistry results also would serve as indicators of an oxygen flow problem. One can only conclude such warning signals were ignored or not observed at all.
It is interesting to note the hospital was dismissed from litigation several months prior to trial. Hospitals are frequently considered to be ultimately or vicariously liable for the care rendered within their organization. The hospital's dismissal in this case appears to indicate appropriate policies, procedures, and protocols were considered to be in place to ensure a reliably safe outcome for patients undergoing surgical procedures. At the least, it is assumed the evidence presented did not support responsibility on the part of the hospital.
Based on the verdict, the jury found culpability to rest solely on the anesthesiologist's failure to adhere to the standard of care. The anesthesiologist was deemed to own the duty to continuously monitor patient status and intervene when and if necessary. The anesthesiologist was responsible for correctly inserting the ET tube, assessing and reassessing the tube's placement as needed, and diligently monitoring the patient throughout the procedure. The outcome for this 66-year-old mother of eight might have been different had suitable and correct assessment and intervention measures been identified and implemented in a timely manner.
Reference:
State of Michigan Circuit Court, JAS MI Ref. No. 268411 WL (Mich.Cir.Ct.), 2012 WL 1799084.
News: In the summer of 2008, a patient underwent thyroid surgery. She did not recover from the surgery, and she could not be revived in postanesthesia care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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