A 54-year-old woman underwent a valve sparing repair of an ascending aortic aneurysm.

The surgery lasted 4 hours and 40 minutes.

She was brought to the ICU and on the 3rd post operative day documented to have numbness, tingling and weakness in her right hand.

Years later her hand still never regained full function, and her brachial plexopathy was diagnosed as permanent.

She claimed the defendants including the anesthesiologist improperly monitored the blood pressure cuff during surgery, and failed to safely use wrist restraints in the ICU.

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The patient wrote an affidavit herself.

The cardiac anesthesiologist Dr. F did not use the noninvasive cuff during the case.

Standard routine documentation of positioning, pressure points, and padding were filled out.

An expert neurologist was hired by the defense for the anesthesiologist Dr. F.

Here is an excerpt from the plaintiff’s neurology expert who is also the patient’s own neurologist.

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Outcome

The lawsuit had been initiated against the cardiac surgeon, anesthesiologist, and hospital system.

The judge dismissed the surgeon.

The judge also dismissed the anesthesiologist.

The BP cuff was not used, positioning was appropriate, and the anesthesiologist does not place wrist restraints.

That left only the hospital as a defendant.

The patient also had cervical spine issues that the neurology expert commented on, and the judge made note of.

There was also criticism of the plaintiff’s expert affidavit

For these reasons the case was dismissed.

MedMalReviewer/Anesthesiologist Opinion

1. There is sometimes a perceived narrative by the patient of when and how an injury happened. Here the patient was convinced that upon awakening in the ICU she struggled against a restraint or noninvasive cuff and that is where the mechanism of injury occurred. In the patient’s story she felt helpless and scared, intubated, restrained, and struggling to communicate. We’ve read patient affidavits and deposition testimony in other cases that are similar. The theme therein being a feeling of helplessness, being ignored, and nobody seeming to care. In reality it appears she suffered a cardiac surgery positioning related injury. Brachial plexopathy is the most common peripheral nerve injury in cardiac surgery, with effects ranging from temporary dysfunction to permanent deficits.

2. There did seem to be some scouring of the chart looking for where the negligence may have occurred. They could not find it in the operating room when it became clear the cuff was not even used. There was reliance by the defense on nursing/ICU documentation and assessments including extremities being warm and well perfused, how restraints were used, and when the cuff was being used versus the radial A-line. The pages and pages of nursing notes and assessments were actually important in this case in defending the hospital. The plaintiffs also appeared to be arguing “res ipsa loquitur” (the thing speaks for itself) yet couldn’t seem to make their minds up when the injury may have even happened.

3. The patient’s own treating neurologist wrote the expert opinion used in this case. This document got criticized as he “does not state he has reviewed the pleadings, hospital records, or the EBT testimony (examination before trial).” The court is unsure if he is considered an expert, but the plaintiff states since he is arguing res ipsa loquitur, an expert is not needed. I can see how if an expert is hard to find, asking your own treating physician could be one path forward. Still there is procedure to writing an expert opinion and ideally your expert should have familiarity with this.

4. When there are other risk factors or causes for disease or complication it typically serves the physician defendants well. Here the patient had known C-spine issues that affected the same level as her brachial plexopathy. Her risk was certainly increased for a peripheral nerve injury by a “second hit” that appeared to occur in the perioperative period. Once again res ipsa loquitor doesn’t seem like a great argument in this case due to her pre existing and well documented C-spine problems, but was still used by the plaintiff’s attorney.