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New York Wrongful Death Defense Verdict

June 04, 2018

Jury agreed the risk of postponing an emergency surgery for a critically ill patient outweighed the risks of proceeding.

Overland Park, KansasJune 4, 2018 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that a Queens County, New York jury returned a defense verdict in favor of PPM’s insured anesthesiologist

A 52-year-old male with a medical history significant for uncontrolled Type II diabetes, peripheral vascular disease, chronic renal insufficiency and osteomyelitis, presented to the emergency department with complaints of a right foot infection, fever, and diaphoresis. The emergency physician ordered labs, a chest x-ray and EKG. Based upon his physical exam, the emergency physician concluded the patient was septic. Labs revealed an elevated troponin at .66, elevated creatinine and an abnormal EKG demonstrating sinus tachycardia. IV fluids and a broad spectrum antibiotic were ordered and vascular surgery was consulted. The surgeon examined the patient and noted a “big, open abscess” on the plantar aspect of the right foot with pus. The surgical plan was to debride the infected tissue, drain and culture the pus.

The anesthesiologist first assessed the patient while he was in the emergency department in order to develop an anesthesia plan. General anesthesia was preferred due to the fact that the patient was morbidly obese with presumed sleep apnea, thus ruling out sedation for fear of airway obstruction. Additionally, a regional block was contraindicated due to the streaking on his leg and risk of spreading the infection. The anesthesiologist classified the patient as an ASA PS 4E. The surgeon deemed this surgery an emergency due to the fact the patient was septic with a serious foot infection, and had a history of a prior foot infection with necrotizing fasciitis.

Standard monitoring was utilized, and an arterial line and central venous catheter were placed. The patient was judiciously induced, notwithstanding his weight, with Fentanyl 75 mcg, Ketamine 50 mg, Propofol 20 mg, Midazolam 2 mg, Phenylephrine 50 mcg and Rocuronium 100 mg. Induction was noted to be smooth and he was intubated with a Glidescope. Shortly thereafter the patient’s blood pressure dropped and a code was called. Chest compressions were started, and vasopressin and epinephrine were administered. The code continued for 40 minutes but the patient did not survive.

The patient’s wife filed a lawsuit against PPM’s insured anesthesiologist, the emergency physician, the vascular surgeon and the hospital. The plaintiff alleged that the anesthesiologist failed to appreciate and react to the elevated troponin and abnormal EKG, which revealed the patient was experiencing an acute myocardial infarction. Plaintiff further alleged that the anesthesiologist should have consulted a cardiologist prior to taking the patient to surgery to rule out any cardiac concerns. Finally, the plaintiff alleged that general anesthesia was contraindicated and that the patient should have been administered a regional block. The case proceeded to trial. The hospital and vascular surgeon were voluntarily dismissed by the plaintiff mid-way through trial.

Plaintiff anesthesiology expert, Ronald Burt, MD from Farmington, Connecticut, testified that PPM’s insured anesthesiologist departed from the standard of care by proceeding to surgery without a cardiac evaluation. He contended that in view of the troponin level and the abnormal EKG, the patient was experiencing an acute myocardial infarction that required evaluation. Dr. Burt also testified that the patient should have been given a beta blocker prior to surgery. He further testified that administering general anesthesia as opposed to a regional block was a violation of the standard of care. Dr. Burt testified that the cardiac arrest occurred immediately following induction, and thus administration of general anesthesia was the proximate cause of the patient’s death.

The anesthesiologist testifying on behalf of PPM’s insured anesthesiologist stated that a block was contraindicated due to the fact the patient demonstrated streaking, and use of sedation for placement of the block raised concerns of an airway obstruction. The expert also testified that the anesthesia plan developed and executed by the insured anesthesiologist was very prudent and safe. Induction agents were in very small doses and an arterial line was placed to closely monitor blood pressure. Regarding the elevated troponin, the expert testified that such a finding was not an impediment to going forward with the case. He agreed with the PPM anesthesiologist and the vascular surgeon that they faced an emergent situation with the patient’s foot wound, and the risk of postponing the surgery for further cardiac evaluation was outweighed by the risk to life or limb by not proceeding as soon as possible.

After a ten-day trial, the jury deliberated for a full day and returned a verdict in favor of both the insured anesthesiologist and the emergency physician.

Vincent Nagler, Esq. with the law firm of Koster, Brady & Nagler in New York, New York, represented PPM’s insureds. Tracey Dujakovich, Senior Claims Attorney, managed the file on behalf of PPM.

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