News

Directed Verdict in Virginia Wrongful Death Trial

June 28, 2017

Court orders a directed verdict after finding no reasonable jury could reach a decision to the contrary

Overland Park, Kansas – June 28, 2017 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that following a four-day jury trial, a judge in Virginia Beach, Virginia recently ordered a directed verdict in favor of a PPM insured anesthesiologist and his practice group.

A 39 year-old female patient had been receiving conservative treatment for uterine fibroids with little relief. After discussion with her OB-GYN surgeon, the patient elected to undergo surgery to remove the fibroids. The surgery was a two-part procedure - a hysteroscopy followed by laparoscopy. During the hysteroscopy, the surgeon used 1.5% glycine for infusion into the uterine cavity. PPM’s insured anesthesiologist and two CRNAs provided general anesthesia for the procedure. Before the end of the hysteroscopy, the patient had a drop in blood pressure and the CRNA had difficulty ventilating.

The anesthesiologist was called to the room to try to determine the cause of the changes in vital signs. The drapes were removed to begin the laparoscopy. At that time, it was discovered the patient’s abdomen was grossly distended to the size of a 9-month pregnant female and hard as a rock. Labs were ordered by the anesthesiologist and the patient was given a diuretic. The OB-GYN surgeon inserted a trocar into the patient’s abdomen and copious amounts of fluid, presumed to be the glycine, were drained resulting in immediate improvement in ventilation and blood pressure. Within 20-30 minutes the lab results were received and revealed significant hyponatremia (105 MMol/L). The surgeon was made aware of this value and told to complete the procedure as soon as possible.

The IV fluid was changed to normal saline. The anesthesiologist also contacted a critical care specialist and made arrangements for the patient to be taken to the ICU. The medical records revealed that approximately 30,000 ccs of glycine had been instilled into the uterine cavity. Despite the anesthesiologist telling the OB-GYN surgeon numerous times to stop the procedure, the surgeon completed the laparoscopy.

The patient was taken to ICU and an intensivist assumed care. At the time of arrival, the patient’s sodium level had increased. The patient was initially alert and oriented and was successfully extubated. However, she developed an alteration in mental status and required re-intubation. A stat CT was ordered that showed significant cerebral edema. She was treated with medications and a hypothermia protocol was initiated, but the patient subsequently expired.

The patient’s mother filed a lawsuit against PPM’s insured anesthesiologist and his practice group alleging failure to timely conduct appropriate testing to diagnose and treat the complications from glycine uterine intravasation. The patient’s mother also sued the OB-GYN surgeon, the hospital and the intensivist. Prior to trial, the OB-GYN surgeon and hospital settled for confidential amounts. The case proceeded to a four-day trial against PPM’s insured anesthesiologist, his practice group and the intensivist.

Plaintiff’s anesthesiology expert, Michael Hurt, MD from Clarion, Iowa, testified that PPM’s insured anesthesiologist failed to have a plan in place to treat the worst case scenario. He testified further the anesthesiologist failed to timely diagnose and treat the patient. He testified treatment should have been initiated earlier without waiting for the lab results. Dr. Hurt also testified that waiting for the lab results before starting treatment may or may not have changed the outcome, but every minute counted.

The anesthesiologist testifying on behalf of PPM’s insured anesthesiologist stated the pre-anesthesia evaluation and anesthetic plan were within the standard of care. The expert testified that an anesthesiologist is always prepared for what could happen, but doesn’t assume the worst case scenario will happen so there was no way to know labs would be needed in this case. He testified further that labs were ordered in a timely manner and when the results were returned, the appropriate treatment was administered. He also testified the sodium level was critically low and not compatible with life.

At the close of evidence, the judge ruled the patient’s mother had not met the causation burden and issued a directed verdict in favor of PPM’s insured anesthesiologist and his practice group. The case proceeded with the intensivist as the only defendant. The jury ultimately returned a defense verdict in favor of the intensivist.

Edward McNelis, III, Esq. and Grace Morse-McNelis, Esq. with the Rawls, McNelis law firm in Richmond, Virginia defended the case on behalf of PPM’s insureds. Shelley Strome, Senior Claims Specialist, managed the case on behalf of PPM.

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