Verdicts & News

Missouri Unanimous Defense Verdict

April 4, 2022

Jury rejects out-of-state prolific plaintiffs’ expert’s unsupported opinions and testimony

Overland Park, Kansas – April 4, 2022 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that in our first trial since the pandemic began, a jury in the United States District Court for the Eastern District of Missouri returned a defense verdict in favor of an anesthesiologist and anesthesia practice group insured by PPM.

A 41-year-old woman presented for an elective total laparoscopic hysterectomy due to abnormal uterine bleeding attributed to fibroids. Two days before her procedure, the patient underwent routine pre-operative blood tests. The test results revealed a minimally low (2.7) potassium level. The anesthesiologist, a CRNA, and the surgeon reviewed the patient’s medical record on the morning of surgery. The anesthesia team and surgeon recognized the lower potassium level but noted that the patient had been taking a diuretic for several years, which is known to lower potassium levels. The physicians discussed the patient’s potassium level and decided to proceed with the procedure given the potassium level was only minimally low.

The procedure began without complications. Immediately after the surgeon placed the trochars and began insufflating the patient’s abdomen, she became bradycardic. She did not respond to medication the anesthesia team administered. She then went into ventricular fibrillation, and CPR was initiated. Despite the use of additional medications, chest compressions, and multiple defibrillations for approximately forty minutes, the surgical team was unable to resuscitate the patient and she died. The suspected cause of death was cardiac arrest caused by a CO2 embolism.

The patient’s two adult children sued the surgeon, the anesthesiologist, his anesthesia practice group, and the hospital. The surgeon settled for a confidential amount and the hospital was dismissed prior to trial.

Plaintiffs’ theory of the case was that the anesthesia team did not perform the proper pre-anesthesia evaluation and testing, and that the procedure should have been delayed until the potassium level could be raised. Plaintiffs also claimed that the anesthesia team responded improperly to the patient’s intraoperative cardiac arrest.

Plaintiffs’ anesthesia expert, Dr. John Schweiger from Tampa, Florida criticized the anesthesia team’s failure to obtain a pre-procedure ECG and chest x-ray, and their failure to delay the procedure until the patient’s low potassium could be addressed and resolved. Dr. Schweiger also opined that after the patient went into bradycardia, the anesthesia team acted below the standard of care in initially administering Robinol (which delayed the administration of Atropine), and ephedrine (which delayed the administration of epinephrine) and delaying the defibrillation for six minutes from the onset of ventricular fibrillation.

Defendants challenged Dr. Schweiger’s criticisms and were able to use the patient’s medical record to show the inaccuracies in his opinions. Dr. Schweiger admitted the medical literature he attempted to use to support his opinions did not contain the statements upon which he claimed to rely, thereby weakening his credibility and the weight of his opinions. Defendants also used Dr. Schweiger’s extensive prior testimony (over 400 cases in 23 years) and income from testifying against anesthesia professionals (estimated to be over $9 million) to impugn his credibility and challenge his criticisms at trial. Dr. Schweiger couldn’t overcome or explain away his prior testimony, including a prior deposition in which he gave a contrary opinion.

Defendants’ anesthesia expert testified that everyone on the anesthesia team acted appropriately and within the standard of care. He disagreed with plaintiffs’ expert and testified there was no need to perform a pre-procedure ECG or chest x-ray. He also disagreed that the patient’s surgery should have been postponed due to the potassium level, especially because safely correcting the potassium level was not a quick or simple process. The defense anesthesia expert also testified the anesthesia team’s response to the patient’s bradycardia was appropriate and met the standard of care, including the administration of Robinol and ephedrine. He also demonstrated, based on the anesthesia record, that the anesthesia team did not delay in defibrillating the patient, as Dr. Schweiger had suggested. The expert also agreed that the patient likely experienced a CO2 embolism, thereby causing her death.

Plaintiffs requested $1.3 million in damages from the jury during closing arguments. After a four-day trial, the jury deliberated approximately two hours and returned a unanimous defense verdict. The Court denied plaintiffs’ motion for a new trial, and plaintiffs did not appeal. The Court awarded $4,908.91 in costs to the defense. PPM collected the entire cost judgment against the plaintiffs and their attorneys.

Greg Minana, Esq. and Tanya Maerz, Esq. of Husch Blackwell, LLP, St. Louis, Missouri represented PPM’s insureds. Brian J. Thomas, Vice President – Risk Management managed the file on behalf of PPM.

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