Type of action:
Hypoxic brain injury, major neurocognitive disorder, seizures, and dissociative amnesia as a result of allegedly extubating a patient too soon following a septoplasty procedure.
City of Chesapeake Circuit Court
September 26, 2023
Verdict or Settlement:
Attorneys for defendant:
Rodney S. Dillman, Esq. & Brett M. Saunders, Esq.
Description of Case:
This lawsuit was brought by a patient who had a septoplasty procedure performed at a local surgery center to address sleep apnea and migraine headaches. The procedure itself was without complications, however following extubation, the patient suffered a laryngospasm (vocal cords shutting abruptly), which prevented her from being ventilated, and she eventually suffered Negative Pressure Pulmonary Edema (lungs filling with fluid). This resulted in the patient having large amounts of pink froth coming from her throat requiring re-intubation. The patient was subsequently put into a medically induced coma for nearly two weeks.
After the patient was brought out of her coma, she spent a total of thirty-four days in the hospital before receiving many additional months of rehabilitation treatment. The patient had no memory of her life prior to her surgery and continued to have frequent seizures following her hospitalization. The patient eventually moved back in to live with her parents for support and continued to have issues with memory, concentration, problem-solving, and almost daily seizures. The patient’s friends and family members described her as a completely different person than before the surgery.
The plaintiff-patient alleged that the CRNA defendant extubated her too soon from surgery and her ventilatory data (tidal volume, respiratory rate, and oxygen saturation levels) showed that she was not appropriate for extubation at the time. During litigation, it was discovered that the CRNA defendant had altered numerous values of the ventilatory data both before and after the extubation making the patient appear more stable and her condition less severe. No note was made indicating that these changes were made, and they were only discovered after the patient’s audit trial for the procedure was produced in response to a subpoena duces tecum from plaintiff’s counsel. Plaintiff argued that the changing of these numbers showed that the CRNA knew that the patient should not have been extubated at the time because all of the changes were made to make the patient’s condition look better than it actually was at the time. At the videotaped deposition of the CRNA defendant, plaintiff confronted him regarding these changes. The CRNA initially did not recall making any changes but later explained that he updated the ventilatory data because the patient was coughing on the endotracheal tube and moving her arms, both before and after extubation, creating inaccurate readings in the medical chart.
The plaintiff-patient alleged that the anesthesiologist defendant should have been present for the extubation and stopped the extubation from occurring.
The plaintiff’s standard of care experts testified that there was no doubt that the patient was not ready for extubation based on both the ventilatory data that was recorded and the values that were changed by the CRNA. They further testified that extubating her too soon directly caused her laryngospasm and negative pressure pulmonary edema. Each expert also testified that the patient’s ventilatory data was updated to make her appear appropriate for extubation when she was not and that they had not ever seen a medical provider alter medical data in this way in their entire careers. Plaintiff’s audit trial expert testified regarding how unusual the CRNA’s changes to the records were as well.
Plaintiff’s standard of care experts testified that the defendant anesthesiologist should have been present for the extubation based on the patient’s various comorbidities noted prior to surgery. If he had been present, they explained that the standard of care would have required him to prevent the CRNA defendant from extubating the patient.
Plaintiff’s causation and damages experts testified that the patient undoubtedly suffered a hypoxic brain injury as a result of her lacking oxygen following extubation. This could be seen on the patient’s MRI imaging taken while she was in a coma. The plaintiff further suffered a permanent major neurocognitive disorder, dissociative amnesia, and frequent seizures all secondary to her hypoxic brain injury. Plaintiff’s experts testified that the plaintiff required 24-hour supervision for the rest of her life and that she was not capable of competitive employment for the rest of her life.
Defense experts countered that the plaintiff’s ventilatory data was impacted directly by her coughing and moving her arms. It was not unusual for a patient who was coughing to have aberrant values entered with the ventilatory data. They testified that based on the patient’s overall condition prior to extubation, including her being able to open her eyes and respond to commands, she was appropriate for extubation. They also explained to the jury that a laryngospasm is a known complication that can occur without any negligence and that the patient survived her complications due to the quick reaction from the CRNA and anesthesiologist.
Defense expert explained that the patient had a hypoxic event, but did not suffer a hypoxic brain injury. He further explained that the patient’s current seizures and cognitive disabilities were not related to any complications from her surgery.
After a six-day trial, on the seventh day, the jury deliberated for over four hours before returning a verdict in favor of the defendant CRNA, anesthesiologist, and their employer.