Verdicts & News

PPM Obtains 20th Consecutive Defense Verdict in Arizona, 3rd within 4-Month Period

April 1, 2024

Jury returns unanimous defense verdict for anesthesiologist accused of neglecting to postpone emergent laparoscopic cholecystectomy.

Overland Park, Kansas – April 1, 2024 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that a jury in Yuma County, Arizona, returned a unanimous defense verdict in favor of a PPM-insured anesthesiologist at the conclusion of a two-week wrongful death trial.

A 44-year-old female presented to the emergency department with acute calculous cholecystitis. The patient’s history was significant for sleep apnea, diabetes, hypertension, extreme morbid obesity, anemia, and thrombocytopenia.

After she was admitted to the hospital, a general surgery consult evaluated the patient and recommended that she undergo an emergent laparoscopic cholecystectomy. The anesthesiologist performed a pre-anesthesia evaluation and classified the patient as an ASA 3E. The patient’s platelet count was low but near her baseline, and the anesthesiologist entered an order for the patient to receive a unit of platelets prior to surgery. Notwithstanding her significant medical history, the anesthesiologist felt the patient was appropriately optimized for the procedure and there was no reason to delay the emergent case from an anesthesia standpoint.

Upon inserting the camera through the port, the surgeon informed the other members of the surgical team that the patient’s liver appeared very cirrhotic, and he asked the circulating nurse to turn the monitor to show the anesthesiologist. The procedure was completed without incident, and the surgeon noted intraoperative blood loss was less than 50 ml. There were no anesthesia-related complications during surgery, and the patient was transferred to the PACU in stable condition. There, the patient experienced a brief period of diaphoresis secondary to hyperglycemia, which improved after the anesthesiologist ordered insulin. The patient also developed hypotension in PACU. The anesthesiologist evaluated the patient bedside and asked the nurse to administer 500 ml of normal saline. The patient responded to the fluids, and the PACU nurses determined she met discharge criteria approximately an hour later.

The patient was transferred to the medical-surgical floor, where she was lifted from the gurney to a bed. Fifteen minutes later, a nurse informed the attending hospitalist that the patient became hypotensive and tachycardic. The surgeon was called to the floor, and when he arrived, the patient’s abdomen was distended, and the surgical drain was full of frank blood. As arrangements were being made to take the patient back to the OR for emergent exploratory laparotomy, she went into cardiac arrest and a code was called. The code team attempted to resuscitate the patient for the next forty-five minutes, but she ultimately passed away. The cause of death was cardiac arrest due to hemorrhagic shock from postoperative bleed.

The patient’s daughter filed a lawsuit against the PPM-insured anesthesiologist, the general surgeon, and the facility. The surgeon and the facility reached confidential settlements with the plaintiff before trial. Plaintiff’s anesthesiology expert, Eric Harris, MD, of Weston, Florida, testified that the anesthesiologist departed from the standard of care by failing to properly perform his role as the “patient safety advocate” and “gatekeeper to the OR.” Specifically, Dr. Harris contended the case was not truly emergent, and therefore, the anesthesiologist should have ordered a hematology consult before clearing the patient for surgery. Furthermore, Dr. Harris was critical of the anesthesiologist for not encouraging the surgeon to abort the procedure upon observing the patient’s cirrhotic liver.

On cross-examination, Dr. Harris conceded that he had the benefit of hindsight when reviewing the patient’s medical records. Moreover, he acknowledged surgical patients can experience serious complications, even death, absent negligence. When asked if he reviewed photos of the patient’s cirrhotic liver, Dr. Harris stated he is not qualified to comment on the severity of the patient’s liver disease, thereby undermining his earlier criticism that the anesthesiologist should have recommended stopping the procedure once the surgeon discovered the patient had cirrhosis of the liver.

The defense’s anesthesiology expert testified that the anesthesiologist’s decision to proceed with surgery was entirely appropriate. He informed the jury that it is the surgeon’s responsibility to determine whether a surgical procedure is emergent or elective. The defense expert conceded that anesthesiologists have an independent obligation to delay or cancel procedures when they feel the risk of the patient experiencing an anesthesia-related complication is too great; however, in this instance, the anesthesiologist’s decision to proceed was consistent with the standard of care as evidenced by the fact that the patient tolerated the anesthetic and was discharged from the PACU in stable condition. He concluded that the patient simply experienced an unanticipated surgical complication, which likely occurred when she was moved from the gurney to her bed on the medical-surgical floor.

During closing arguments, the plaintiff’s attorney asked the jury to award his client $1,000,000. The jury deliberated for 90 minutes before returning a unanimous verdict in favor of the anesthesiologist.

Jim Goodwin, Esq. of J. Goodwin Law, PLLC, Buckeye, Arizona, represented PPM’s insured. Paul Lefebvre, Lead Claims Professional & Risk Advisor, managed the file on behalf of PPM.

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