News

New York Defense Verdict

November 21, 2018

Jury rejected theory that medications were contraindicated and caused cardiac arrest.

Overland Park, Kansas – November 21, 2018  Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that a Rockland County, New York jury returned a defense verdict in favor of PPM’s insured anesthesiologist and her practice group.

A 34 year-old female was scheduled for reconstructive rhinoplasty. Two days prior to the procedure, the patient presented to the hospital and met with nursing staff for completion of her pre-anesthesia assessment form. On the day of the surgery, PPM’s insured anesthesiologist and CRNA met with the patient and performed the pre-anesthesia evaluation. At that time it was noted the patient was taking Diflucan. The patient was taken to the operating room for the procedure.

Approximately 10-15 minutes after the start of the procedure, the plastic surgeon placed topical cocaine on pledgets and inserted them into the patient’s nose. The patient immediately had a cardiac arrest and was appropriately resuscitated. Cardiac testing was performed and no heart damage was noted, although she subsequently underwent placement of a defibrillator/pacemaker due to supraventricular tachycardia. PPM’s insured anesthesiologist thought the patient had an idiosyncratic reaction to the topical cocaine.

The patient filed a lawsuit naming the plastic surgeon, his practice group, PPM’s insured anesthesiologist and her practice group as defendants. The plaintiff alleged PPM’s insured anesthesiologist was negligent by failing to appreciate the potential dangers and contraindications inherent in the concurrent administration of Diflucan and topical cocaine. The plaintiff also alleged the anesthesiologist failed to alert the plastic surgeon to the fact that plaintiff was taking Diflucan prior to the surgery wherein she knew that topical cocaine pledgets would be utilized for nasal packing. Plaintiff further alleged the anesthesiologist should have cancelled the surgery or prevented the plastic surgeon from using the topical cocaine. Failure to do so resulted in plaintiff sustaining QT wave elongation leading to cardiac arrest.

Prior to trial the plaintiff made a demand of $950,000. PPM’s insured anesthesiologist believed her care was appropriate and did not consent to settlement. The case proceeded to a twelve day trial lasting over a four week period.

Plaintiff’s anesthesiology expert, Dr. Ronald Burt, Farmington, Connecticut, testified that the standard of care requires the anesthesiologist to know what effect medications will have on the patient. He testified that the anesthesiologist was aware that topical cocaine would be utilized by the plastic surgeon. He opined that Diflucan, topical cocaine and the anesthetic medications all cause prolongation of the QT intervals. This constellation of medications increased the risk of cardiac issues. The surgery could proceed without the use of cocaine or be postponed until the Diflucan was out of the patient’s system. The expert testified that failure to choose either of these options was below the standard of care and caused the patient’s cardiac arrest.

The defense pharmacology expert testified that topical cocaine is not generally recognized as causing prolongation of the QT interval. He also testified that there is no known interaction between topical cocaine and Diflucan and the combination is not reported to increase the QT interval. It was his opinion the plaintiff had an idiosyncratic reaction to the topical cocaine.

The defense cardiology expert testified that the cardiac arrest was minimal and very likely transient. He added that the chronology of plaintiff’s alleged cardiac injury did not fit with a Diflucan-cocaine induced injury. He opined that the event was consistent with cardiac stunning or Takotsubo cardiomyopathy. It was his opinion the plaintiff’s subsequent treatment, including pacemaker placement, did not fit with an acquired injury.

Given the pharmacology and cardiology experts’ testimony, no anesthesiology expert testified on behalf of PPM’s insured anesthesiologist.

During closing arguments the plaintiff asked the jury for $3.5 million for past pain and suffering, $360,000 for future medical expenses, and left to the jury to determine an appropriate dollar amount to compensate the plaintiff for future pain and suffering. The jury returned a defense verdict in favor of the anesthesiologist and her practice group after deliberating for approximately three hours. The jury also returned a favorable verdict for the plastic surgeon and his practice group.

Charles D. Lohrfink, Jr., Esq. with the law firm Voute, Lohrfink, Margo & McAndrew, LLP, White Plains, New York represented PPM’s insureds. Shelley Strome, Senior Claims Specialist, managed the case on behalf of PPM.

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