Welcome to the first ever Anesthesiology Malpractice newsletter!

This project is a collaboration between MedMalReviewer and a board-certified anesthesiologist who practices full time.

We’ve put a lot of work into finding and writing these cases, and we hope you’ll enjoy them as much as we have.

There are 3 subscription tiers: free (one case per month), paid (new case every other week), and CME (all cases plus 12 hours CME credit per year).

A 27 year old male was dropped off alone in the ambulance bay of a trauma center via private car.

There was a gunshot wound to his right thigh. He was unresponsive, with a thready pulse.

Upon immediate evaluation he was intubated and MTP started.

He soon lost pulses.

The trauma surgeon performed an ED thoracotomy with clamping of the descending aorta, intracardiac epi, and internal cardiac massage.

ROSC was obtained.

With suspicion of continued bleeding into the thigh the patient was rushed to the OR.

In the OR exploration of the thigh revealed complete transection of the SFA and laceration of the SFV with around 2L of blood and hematoma.

The vasculature was successfully repaired and a fasciotomy of the RLE then performed.

The patient continued to receive aggressive resuscitation with fluids and blood products, and was on pressors throughout.

An ABG just prior to closure revealed a pH of 6.57.

During closure the patient went asystolic. The team was unable to achieve ROSC and the patient was pronounced dead in the OR.

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The family sued the hospital and the physicians who cared for the patient.

The patient’s brother underwent a deposition and had much to say about the hospital and his experience there

The primary anesthesiologist for the case also underwent a deposition. Here is an excerpt.

The defense hired an anesthesiology expert. Below is the opinion of that expert.

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Outcome

The defense filed a motion to dismiss the lawsuit which was not contested.

The case was dismissed.

MedMalReviewer Analysis

1. I was surprised to see a lawsuit over a trauma case such as this one. Who would sue the doctors trying to save this man? It wasn’t until I read the brother’s deposition that it made sense. This occurred at an inner city urban hospital that does not have a great reputation. Then we have a lack of communication with the family. I can see how anger could develop. The brother made a comment how it was “just a wound to the leg..” and “how could that kill anyone?” The team who could speak with the family and give information is occupied in surgery, which is where they belong. I’ll take this case as a reminder that a lack of updates and poor communication turn into breeding grounds for litigation. In anesthesiology we are removed from the burden of supplying family updates and communication, but we are not removed from these cases, and we get pulled into litigation.

2. Lack of board certification can be a liability. The plaintiff’s attorney’s goal is to make you look like the worst doctor ever. This distinction make it easy for them, and opens the hospital up to “vicarious liability”.

   Vicarious liability: when one party holds some responsibility for the unlawful or reckless actions of another

   The attorney can point to the hospital and claim that they are hiring unqualified doctors who are not boarded. This puts the hospital, the entity with the deepest pockets, on the hook. Some hospitals or practices require board certification after a certain number of years. This case is a perfect example of why many hospitals have this requirement.

3. Further deposition questions for the anesthesiologist focused on the side effects of drugs that were used including cisatracurium and norepinephrine, and required the anesthesiologist to justify administering these meds. Any medication given may have to be justified. In a way reading this deposition felt like the back and forth of an oral boards examiner.

4. I’m not sure I’ve ever seen a pH that low. I’ll agree with the defense expert, this patient’s fate was determined in the back seat of the car.

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