OR Fire Lawsuit Shows Risk of Major Liability
March 1, 2025
By Greg Freeman
Executive Summary
A hospital is facing a malpractice lawsuit alleging injuries from a surgical fire. The liability from such an event is substantial.
- Remind staff that fires do happen in the operating room (OR).
- Enforce known strategies for OR fire prevention.
- Investigate all fire incidents and implement improvements.
A hospital in Oregon is facing a $900,000 lawsuit after a man’s face caught fire during surgery, highlighting the continuing risks of operating room (OR) fires and the substantial liability that can result.
The patient was undergoing a tracheostomy after being diagnosed with tongue cancer and was “awake and conscious” when a spark from a surgical tool ignited his skin, according to the lawsuit. The man’s face had been swabbed with alcohol, and the tool had a history of sparking, the lawsuit claims.
The 52-year-old man lived for six more months with disfiguring scars, swelling, and wounds to his face that never healed before dying of the disease.
Fire in the operative suite is not as unusual as one might think, says Andrew J. Rader, Esq., with the Rader Law Group in Coral Springs, FL.
“We recently handled a case in which a client was having [cauterization] redone to his mouth and a drape that was being used near the face caught fire,” he says. “This, of course, burned his face and caused significant damage to him.”
There are numerous causes of fire in the operative suite, he notes. Electrosurgery, where heat is used to close a vessel or coagulate tissue is a common one. While injury while using cautery is unusual, the case is handled the same way as any other medical malpractice case, Rader says. The question is whether the practitioner violated the standard of care associated with whatever is being done. In other words, would a reasonably prudent physician have done the same thing?
“The attorney looking at this case to determine whether it can be prosecuted will look at the standard of care and whether there was a departure from the acceptable standard of care. How exactly was the cautery being used? How close was the flammable material? Was there alcohol or some other type of accelerant close to the heat source?” Rader says. “Obviously, there are standards of care that require that certain procedures be used to avoid unexpected fire. In order to prove that the practitioner departed from accepted standards of care, the plaintiff’s lawyer must find an expert who is familiar with the standard of care and who is able to testify that the procedures used by the physician in question departed from those standards.”
For example, if there is a rule that no alcohol be close to the site, and medical records demonstrate that there was alcohol close by, Rader says the expert would testify that having the alcohol so close to the site was a departure from accepted standards of care. As in any other medical malpractice case, the loss of enjoyment of life, scarring, and disfigurement are common elements of damages. The amount of that damage often is up to a jury if the case cannot be settled prior to trial, he says.
Rader notes that OR fire prevention strategies are well known, and the cause of this fire appears to be typical with alcohol and an electrosurgical tool. The fire event almost certainly prompted an investigation into the cause, but these analyses sometimes do not lead to meaningful improvements, he says.
“Unfortunately, sometimes, the investigation is pro forma, with no real investigation and no real responsibility being doled out. Further, while some adverse incidents are required to be reported to the board of medicine, or the Agency for Health Care Administration, it is not always done and not all adverse incidents are required to be reported,” Rader says. “As a result, medical malpractice, including burn cases, frequently go unreported.”
A particular concern is the plaintiff’s claim that the surgical tool had a history of sparking, says John Shepperd, JD, partner at the law firm of Wilson Elser in Houston. The publicly available claims from the lawsuit raise important questions, he says.
Sheppard recounted a burn case about 30 years ago where the surgeon claimed a device was firing without the surgeon engaging it. “We couldn’t replicate it,” he says. “In the Oregon case, if the [device] had that kind of history, then it wouldn’t be in service.” The question also arises as to whether the surgeon provided the device, or the hospital did.
Shepperd also is skeptical about the claim that the patient’s skin was still wet from isopropyl alcohol when the electrosurgical device was fired. The alcohol would have been applied before the surgeon entered the room, he notes.
“Try a quick experiment. Put some isopropyl alcohol on a peach with a cotton swab. Then light a match next to it while the peach is still wet,” he says. “You aren’t going to see a fire. A thin layer of alcohol is a poor accelerant. Oxygen is a great accelerant if there is a lot present, but skin is a poor fuel source.”
Shepperd theorizes that surgery was in progress, and the patient was getting oxygen by mask or nasogastric (NG) tube, with the patient’s face covered with a surgical drape since the operative site was the neck. He suspects that it is possible that there was not a good seal on the mask or NG tube, so oxygen was leaking out and pooling under the drape.
“A large pocket of oxygen escaped from the drape just as the surgeon fired the [device],” Shepperd suspects. “The drape ignited, and the patient’s face was burned. The cautery is the flame, the oxygen is the accelerant, and the drape is the fuel source.”
When a surgical fire occurs, hospitals and physicians can face significant legal liability, especially if there’s evidence of negligence, says Linda Khoshaba, ND, CEO of Natural Endocrinology Specialists in Scottsdale, AZ. The key legal questions are whether safety protocols were followed, whether staff were properly trained to prevent and respond to such events, and whether equipment was maintained correctly, she says.
Defending against these claims can be challenging, since it often requires proving that all appropriate precautions were taken and that the incident was unforeseeable or outside of their control, she says.
“Responsibility for a surgical fire often depends on identifying its cause. Investigators will look at whether flammable materials were handled properly, if oxygen levels were managed safely, and whether equipment malfunctioned,” Khoshaba says. “They will also consider whether the surgical team followed standard safety practices to minimize risks.”
Preventing Surgical Fires
Preventing surgical fires involves a team effort and a focus on safety at every step, she says. These steps are crucial:
- Educate all operating room staff about fire risks, including how the combination of heat sources, oxygen, and flammable materials creates potential hazards.
- Use flame-resistant materials whenever possible, carefully control oxygen levels, and avoid bringing unnecessary heat sources near flammable substances.
- Ensure that everyone in the operating room is trained to recognize and respond to fire risks before they become dangerous.
If a fire does happen during surgery, the team must act immediately to protect the patient, she says. The team should stop the procedure, remove anything flammable from the patient, and turn off oxygen or other gases that could fuel the fire. Depending on the size of the fire, it might be extinguished with saline or a surgery-grade extinguisher, Khoshaba says.
“Quick, decisive action can make all the difference,” she says.
After the fire is extinguished, a thorough investigation is critical, she says. This involves documenting what happened, interviewing everyone involved, and examining equipment to identify any failures. The goal is not just to understand what went wrong but to create better safety protocols and improve training to prevent similar incidents in the future, she says.
“Surgical fires are a stark reminder of how important it is to prioritize safety and communication in healthcare,” Khoshaba says. “By working together and staying proactive, we can reduce risks and ensure that patients receive the safest care possible.”
Legal Implications of a Surgical Fire Lawsuit
Surgical fires can lead to significant injuries and lawsuits, targeting both hospitals and individual practitioners, notes Sean Ormond, MD, of Atlas Pain Specialists in Glendale, AZ.
Hospitals may be held responsible under respondeat superior, which attributes staff negligence to the employer, he says. They also can face direct liability for failing to implement adequate safety protocols, staff training, or equipment maintenance.
Providers may be personally liable if their actions contributed to the fire, such as mishandling ignition sources, failing to follow surgical prep solution instructions (e.g., the wait time after an alcohol prep is completed before a patient can be draped), or failing to manage oxygen properly, Ormond says. Times should be documented on the patient’s record.
Defense challenges include proving adherence to safety protocols and staff training, addressing patient-related factors that may have contributed to the incident, and demonstrating clear intraoperative communication, especially regarding oxygen use and ignition sources, he says.
The key factors in determining responsibility include whether a fire risk assessment and safety protocols were followed, the speed and effectiveness of the fire response, and proper documentation of training, communication, and equipment maintenance.
Best Practices for Prevention
Ormond says surgical teams must conduct fire risk assessments for each procedure, minimize oxygen concentration when clinically appropriate, and allow alcohol-based antiseptics to dry completely before draping.
It also is important to regularly maintain and inspect equipment, train staff on fire prevention and emergency response, and ensure team members discuss fire risks and coordinate oxygen and ignition source management, he says.
Once a fire begins, the surgical team must immediately stop the procedure, remove any burning materials, and extinguish any flames using saline, water, or an appropriate extinguisher, Ormond says. The team also must shut off oxygen and other oxidizers. The entire team should follow evacuation protocols if the fire cannot be contained.
The patient’s burns or smoke inhalation injuries must be treated promptly, Ormond says. A thorough investigation should follow, including careful documentation of the events, preserving burned items (drapes, sponges, tubings, etc.), and including statements from staff. Identify the ignition source, fuel, and oxidizer. Pinpoint any lapses and then implement solutions by updating protocols, providing additional training, and enhancing monitoring systems.
“Preventing surgical fires requires vigilance, teamwork, and adherence to established protocols,” Ormond says. “By fostering a culture of safety and responding effectively to incidents, healthcare providers can minimize harm to patients and reduce legal exposure.”
Sources
- Linda Khoshaba, ND, CEO, Natural Endocrinology Specialists in Scottsdale, AZ.
- Sean Ormond, MD, Atlas Pain Specialists, Glendale, AZ. Telephone: (602) 492-9821.
- Andrew J. Rader, Esq., Rader Law Group, Coral Springs, FL. Telephone: (954) 913-2273. Email: [email protected].
- John Shepperd, JD, Partner, Wilson Elser, Houston. Telephone: (713) 353-2010. Email: [email protected].
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
A hospital in Oregon is facing a $900,000 lawsuit after a man’s face caught fire during surgery, highlighting the continuing risks of operating room fires and the substantial liability that can result.
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