Verdicts & News

Virginia Unanimous Defense Verdict

January 15, 2020

Jury found PPM insureds’ testimony compelling over out-of-state expert’s nitpicking of code records

Overland Park, Kansas – January 15, 2020 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that a jury in Norfolk County, Virginia, returned a defense verdict in favor of an anesthesiologist, CRNA and anesthesia practice group insured by PPM.

A 33 year-old male with a history significant for end stage renal disease, congestive heart failure, asthma and steroid-induced diabetes mellitus presented for a renal transplant. An electrocardiogram taken three months prior showed an ejection fraction of 25%. The patient was designated an ASA III. Allergies included Benicar, lisinopril and shellfish. The patient was induced at approximately 0939 and an endotracheal tube was placed uneventfully, followed by placement of an arterial line (A-line). Approximately thirty minutes after induction, but prior to the start of surgery, the patient experienced a dampening in the A-line tracing, bradycardia, a loss of ETCO2 and pulseless electrical activity (PEA). A code was called at approximately 1010. The anesthesiologist, who had left following induction, was called back to the OR by the CRNA who had been managing the case.

Prior to the code cart arriving in the OR, 1 mg of epinephrine was administered sometime between 1010 and 1012. At 1011 the patient’s blood pressure was 47/14. The table was lowered, the patient was manually ventilated and compressions were started at 1012. The code scrivener arrived at approximately 1015 and documented that 1 mg of epinephrine had been administered at 1015. Four additional doses of epinephrine were administered at 1016, 1020, 1024, and 1039. Benadryl and Solu-Medrol were administered at 1042. The code continued for over 30 minutes with a return of spontaneous circulation at approximately 1046. The patient was taken to the ICU with phenylephrine, norepinephrine and vasopressin infusions. Blood gases were corrected, but over the next 36 hours the patient became more acidotic. The patient did not tolerate dialysis in the ICU. Two days post event, the patient’s wife designated the patient DNR and he expired soon thereafter.

The patient’s wife filed a lawsuit against PPM’s insured anesthesiologist, CRNA, anesthesia practice group, the surgeon, a surgical resident, and the hospital. The plaintiff alleged that the anesthesia team failed to timely recognize that the decedent was experiencing an allergic reaction, failed to recognize and properly treat anaphylaxis on a timely basis, and specifically failed to timely administer epinephrine. The surgeon, surgical resident and the hospital were dismissed from the suit, and the case proceeded to trial against the anesthesia providers and their practice group only.

Plaintiff’s anesthesia expert from San Francisco, California, testified that the patient experienced an allergic reaction resulting in PEA. His sole criticism at the time of trial was that the anesthesia providers failed to timely administered epinephrine. Plaintiff’s anesthesia expert looked to the medical record to support his theory that the epinephrine was not given timely; that it was administered at 1015 according to the time recorded by the code scrivener. He testified the standard of care required that epinephrine be administered after the code was called, at or about 1010. He disregarded testimony of the anesthesia providers that the epinephrine was indeed administered sometime between 1010 and 1012 around the time the code was called, in compliance with ACLS protocol, and prior to the time the code scrivener entered the room.

The defendants’ anesthesia expert testified that the anesthesia providers complied with the standard of care in recognizing the complication and responding appropriately. He further testified that there was no possibility that the epinephrine was not given until 1015. The anesthesia providers had epinephrine at their disposal in the anesthesia cart, they testified that they administered epinephrine immediately as part of ACLS protocol, and vital signs reflected that both the heart rate and the patient’s blood pressure had increased by 1015.

After a four-day trial, the jury deliberated for approximately three hours before returning a unanimous verdict in favor of the PPM insured anesthesiologist, CRNA and anesthesia practice group.

Ed McNelis, Esq. and Grace Morse-McNelis, Esq. of Sands Anderson, PC, Richmond, Virginia, represented PPM’s insureds. Tracey Dujakovich, Senior Claims Attorney, managed the file on behalf of PPM.

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