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Missouri Unanimous Defense Verdict

March 05, 2019

Jury rejected contention that CRNA failed to properly recognize and respond to respiratory arrest.

Overland Park, Kansas – March 5, 2019 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that a jury in St. Louis County, Missouri, returned a defense verdict in favor of an anesthesia practice group insured by PPM.

A 59 year-old female presented for replacement of her biventricular ICD device. The patient had a history of diabetes, hypertension, hypercholesterolemia, chronic kidney disease, ischemic cardiomyopathy, coronary artery disease, peripheral artery disease and lower extremity neuropathy. A CRNA employee of a PPM insured group provided MAC with sedation for the procedure under the supervision of a PPM insured anesthesiologist.

The patient was administered supplemental oxygen, 20 mg of Propofol and two 50 mcg doses of fentanyl. The patient’s blood pressure began to drop five minutes after surgery start time. The CRNA was initially able to maintain the patient’s blood pressure by administering vasopressors. However, fifteen minutes after surgery start time, the patient’s blood pressure dropped precipitously and the supervising anesthesiologist responded to the OR to assist. The patient was noted to have PEA and a code was called. The patient was resuscitated within thirteen minutes and transferred to the ICU. Unfortunately, the patient experienced a hypoxic brain injury and never regained consciousness; she passed away fourteen days later.

The patient’s surviving children brought a wrongful death action against the PPM insured group. The plaintiffs alleged that the anesthesia practice group, through its CRNA employee, caused the patient’s death by failing to properly recognize and treat her low blood pressure and respiratory depression.

Plaintiff’s anesthesiology expert, Paul Loubser, MD, of Houston, Texas, testified that the “100%” oxygen saturations recorded by the CRNA were inconsistent with a hypoxic brain injury and incompatible with the patient’s outcome, and therefore, the anesthesia record was inaccurate. Dr. Loubser deduced the CRNA did not properly monitor the patient’s blood pressure and oxygen saturations, and that she failed to appreciate and respond to the patient’s respiratory distress. Dr. Loubser further surmised that the adverse event was caused by an excessive dose of Propofol, which he suggested the CRNA did not document in the anesthesia record.

On cross-examination, Dr. Loubser admitted his opinions regarding the Propofol dose were “conjecture and speculation,” and he had no proof to support his assertion that the anesthesia record was inaccurate. Dr. Loubser acknowledged the anesthesia plan was appropriate, and when pressed, he could not offer an example of what he would have done differently to avoid the outcome. He characterized the resuscitation as “flawless” and conceded a patient can still have a bad outcome despite receiving excellent care.

The defense anesthesiology expert testified that the anesthesia team responded appropriately to the patient’s falling blood pressure and diminished respirations. He described the medication doses as judicious and entirely appropriate. The defense expert strongly disagreed with Dr. Loubser’s opinion that the anesthesia record was incompatible with the patient’s outcome. He explained how a patient with 100% oxygen saturations can still experience a hypoxic brain injury, since vascular disease, poor cardiac function and low hemoglobin can also inhibit the transfer of oxygen to the brain.

During closing arguments, plaintiffs’ attorney asked the jury to award his clients $1,470,000; $1,250,000 in compensation for pain and suffering and $220,000 for medical expenses and funeral costs. The jury deliberated for less than an hour before returning a 12-0 defense verdict in favor of PPM’s anesthesia group.

Greg Minana, Esq. and Tanya Maerz, Esq. of Husch Blackwell LLP, St. Louis, Missouri, represented PPM’s insured. Brian Thomas, Vice President-Risk Management, and Paul Lefebvre, Senior Claims Attorney, managed the file on behalf of PPM.

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