News

Arizona Wrongful Death Defense Verdict

February 17, 2017

Jury rejects plaintiffs’ arguments that anesthesiologist’s heroic rescue efforts were negligent.

Overland Park, Kansas ­February 17, 2017 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that a Maricopa County, Arizona jury returned a defense verdict in favor of PPM’s insured anesthesiologist and the anesthesia practice group.

 The case involved a 16 month-old male patient who was taken by Air Evac to a hospital’s pediatric intensive care unit. The child had previously been seen at a free-standing emergency center for a croup-like bark and a temperature of 100.2° F. He was treated with small volume nebulizer with albuterol and dexamethasone and discharged. His parents were instructed to return if their son’s condition worsened. Two days later the child was taken to the same emergency center at 2:36 a.m. At that time, he was having difficulty breathing with heart rate of 188, afebrile with a respiratory rate of 32. The patient was evaluated by the emergency center physician. The patient’s respiratory and hemodynamic status soon deteriorated with stridor, retractions, grunting and dropping oximetry readings into the 70’s.

The emergency center physician made at least four unsuccessful intubation attempts. Air Evac was called to transport the child to a local hospital. Air Evac paramedics also made at least two unsuccessful intubation attempts. The paramedics noted they were unable to visualize the epiglottis due to redness, swelling and irritation at the tracheal entry. The child was transported to the hospital with an unsecured airway.

The patient arrived at the hospital at approximately 5:00 a.m. and was seen by the pediatric critical care specialist. The pediatric critical care specialist attempted to stabilize and intubate the child several times, but was unsuccessful. PPM’s insured anesthesiologist responded to the page at approximately 5:50 a.m. When the anesthesiologist arrived, the child had become bradycardic and then pulseless. There were obvious signs of trauma to the child’s mouth with avulsed teeth and bruising/bleeding of the oral mucus membrane. The anesthesiologist was able to visualize the cords and epiglottis, but could not pass the tube through the glottic opening. Ultimately, the anesthesiologist was able to pass a stylet that allowed the pediatric critical care specialist to intubate and auscultate breath sounds. Following intubation, the anesthesiologist left the code room. Resuscitation attempts continued until 6:53 a.m. at which time the child was pronounced. The autopsy report was consistent with moderate bronchitis, acute bronchopneumonia, intra-alveolar hemorrhage and pulmonary edema.

The plaintiffs filed a lawsuit against the emergency room physician, the emergency center, the receiving hospital, the pediatric critical care specialist, the anesthesiologist and the anesthesia practice group. Prior to trial, plaintiffs settled with all defendants except the pediatric critical care specialist, the anesthesiologist and the anesthesia practice group. Plaintiffs demanded $500,000 from each remaining defendant. Nominal settlement offers were made by the remaining defendants, which were rejected by plaintiffs. Thereafter the case proceeded to trial.

Plaintiffs’ anesthesiology expert, Daniel Lee, M.D., San Diego, testified the anesthesiologist could have successfully intubated this child had she prepared a series of endotracheal tubes, descending in size and started with a size smaller than used during the previous attempts. He also testified succinylcholine was not appropriate to use and carried with it too high a risk of bradycardia. Dr. Lee was critical of the anesthesiologist leaving the code before securing the ETT and believes it became dislodged during the efforts to resuscitate the child. He also testified, as the final step in the algorithm for establishing a difficult airway, the anesthesiologist should have performed a needle cricothyrotomy.

The defense anesthesiology expert testified the care provided by PPM’s insured anesthesiologist met or exceeded the standard of care. By the time the child arrived at the hospital he was unresponsive. The pediatric critical care specialist assumed care of the child and attempted intubation multiple times. The defense expert noted the child was in PICU for 50 minutes before the call for anesthesia help was made. When the anesthesiologist arrived the child was in extremis. The defense expert also testified using succinylcholine was not below the standard of care.

Following a six-week trial, plaintiffs asked the jury to return an award to each parent in the range of $7,500,000 to $10,000,000. The jury returned a defense verdict in favor of PPM’s insured anesthesiologist, the anesthesia practice group and the pediatric critical care specialist.

Gary Fadell, Esq. with Fadell, Cheney & Burt, PLLC in Phoenix, AZ tried the case. Brian Thomas, JD, Vice President of Risk Management and Shelley Strome, Senior Claims Specialist, managed the file on behalf of PPM.

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