Medical Malpractice - Anesthesia Complications, Severe Infant Brain Injury
On January 17, 2001, the minor plaintiff was a healthy five-week old baby, who underwent elective surgical repair of an umbilical hernia at the Columbia MetroWest Medical Center. At the beginning of the anesthesia case, the baby experienced a complication which caused aspiration of blood and diminished breathing capacity. This was evidenced by rapid respiration rate, the need for supplemental oxygen, and a chest x-ray at which demonstrated bilateral pulmonary infiltrates.
Plaintiffs contended that the treating anesthesiologist abandoned the baby in the recovery room for a period of hours. During this time, the recovery room nurse gave the baby a water bottle, in violation of a doctor's order for nothing by mouth, which caused the baby to choke, gag, and spit up blood, worsening her complications.
After the baby turned blue and became unresponsive, the recovery room nurse had to summon help from the emergency department, since the anesthesiologists responsible for the baby, including one of the defendant physicians, were not responding to her call. The emergency room physician stabilized the baby by having her intubated, and she arranged a transfer of the baby to Children’s Hospital in Boston.
Several hours later, a transport team arrived consisting of a nurse, an anesthesiology fellow (one of the defendants), and a pediatric resident (another of the defendants). An x-ray taken at that time demonstrated that the tip of endotracheal tube was located dangerously low in the trachea, close to the tracheal bifurcation.
Following intubation, the baby was stable and her oxygen saturation levels were around 100%. However, when the baby was moved by the transport team from the Columbia MetroWest bed to the transport team stretcher, her oxygen saturation levels plummeted and she suffered cardiac arrest.
When an intubated patient suffers sudden diminished oxygen saturations, the Pediatric Advanced Life Support protocols, require checking the position of the endotracheal (ET) tube. Tube assessment is made by visualization of the tube between the vocal cords, by listening with a stethoscope for breath sounds, and by observing chest movement during ventilation.
Instead of checking the position of the tube, the defendant anesthesia fellow from Children's Hospital squeezed the resuscitation bag with excessive pressure, which caused air to leak from the baby’s lungs into the chest cavity, and then into the sac which surrounds the heart. The presence of air around the heart caused the heart to stop beating. During the approximately 45 minute arrest, the chief of the anesthesia department at the Columbia Hospital did little to assist in the resuscitation effort, despite his duty to do so under the hospital policy manual.
The pneumopericardium (air around the heart) and the right mainstem intubation were both evident on the first post-code x-ray taken eleven minutes into the arrest. The air was removed by another doctor who had come down from the emergency department. (This physician was initially named as a defendant, but was dismissed shortly before trial.) However, the tube position was not addressed until over one hour after the Code Blue began.
After the baby was transferred to Children’s Hospital, there were no further problems maintaining proper oxygenation and blood gasses. However, the plaintiff was left with severe personal injuries, including anoxic ischemic brain damage, resulting in spastic quadraparesis.
The parents of the minor plaintiff were Guatemalan immigrants who had not graduated from high school and who spoke little English. They both worked, on opposite shifts, and took care of their baby at home, despite the overwhelming demands of her care.
Plaintiffs' lawyers conducted extensive pre-trial discovery, including approximately fifty depositions, since many of the defendants were blaming others for the baby's severe personal injuries.
The case settled in several stages. The first settlement was reached with the attending anesthesiologist, who paid the limits of his $1 million policy. The next settlement was with Columbia Hospital. Theories of liability against Columbia included the negligence of the recovery room nurse, the negligence of the anesthesiologists, who were not employees, but who were, plaintiffs claimed, agents of the hospital. Columbia paid $4.5 million. The next settlement was with the Chairman of the Anesthesia Department, who paid $500,000. The final settlement, reached on the morning the case was called for trial, was with the anesthesia fellow on the transport team from Children's Hospital. $1.5 million was paid on her behalf. The other claims, against the pediatric resident and the emergency room physician, were dismissed shortly before the scheduled trial date.
The case was aggressively defended. Daubert motions were brought to disqualify the experts selected by plaintiff's attorneys on life expectancy, which was a hotly contested issue. The motions were denied. Shortly before trial plaintiffs moved to disqualify defense counsel from representing any non-party physician witnesses. This motion was allowed to the extent the attorneys had not represented them prior to the filing of the amended complaint.
This case was specially assigned to Regional Administrative Justice Catherine White. A trust was established for the management of the child’s funds, $2 million of which will be received through structured settlements.