A 52-year-old woman came to the hospital for a left total hip arthroplasty.
She received a spinal anesthetic for her procedure with anesthesiologist Dr. U.
Intraop bleeding was encountered and a vascular surgeon was called in. He assessed the patient and determined no intervention was needed.
The surgery finished and the patient was brought to PACU.
Two days later the vascular surgeon took the patient to the OR for a left iliofemoral embolectomy, external iliac patch closure and stent placement due to an iliac artery thrombosis.
For this anesthetic the patient received a GA with an LMA.
The patient recovered but had hoarseness that persisted as well as numerous orthopedic complaints.
The patient had suffered vocal cord paralysis, vocal cord weakness, and a vertical mismatch between vocal cords.
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The hospital and surgeons were all named in a lawsuit, but only the first anesthesiologist involved with her hip procedure was named.
The allegations claim injury from endotracheal intubation.
An ENT evaluated the patient:
As far as her orthopedic complaints:
As stated only the first anesthesiologist Dr. U was named in the lawsuit.
The plaintiff did not seek deposition testimony from this anesthesiologist, nor anyone else involved in the anesthesia care.
An expert anesthesiologist was hired by the defense.
Outcome
In a motion for summary judgment the anesthesiologist Dr. U was dismissed from the case.
The hospital was also dismissed which left the medical group, orthopedic surgeon, and vascular surgeon on the caption.
The parties met for a settlement conference and 6 months later the case came to a conclusion.
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MedMalReviewer/Anesthesiologist Opinion
This case was interesting to me as I was not entirely sure where it was headed based on the bill of particulars. I suspected the claim of airway injury would be at the forefront of this case and was surprised when I could not locate the depositions of either anesthesiologist. I then learned they didn’t give any testimony in this case, and only one was even named. This reads to me that the patient came to her lawyer with numerous complaints. Everything was then listed when the lawsuit began, and as the entire records were more closely examined the plaintiff’s attorney decided to focus on the orthopedic complaints as a successful path forward. Trying to argue multiple injuries from different specialists is less likely to be successful for the plaintiff.
This defense opinion was an easy one to write. The allegations were of damage during intubation and laryngoscopy which was not performed. All that has to be written then is explaining the allegations are against something that didn’t even happen. Although the incidence is less LMAs can of course cause airway injury and complications along with endotracheal intubation. Inappropriate sizing and prolonged use are implicated in LMA related airway injuries. It doesn’t appear either was a factor in this case.
While it is never fun to be sued the anesthesiologist was not the target of the lawsuit here. In a way the anesthesia teams lucked out that the patient had worse problems than whatever airway injury she sustained. They get to learn some of the med mal process, relatively free from consequences aside from the stress of being involved.
