A 41-year-old woman with a history of bronchiectasis presented to the hospital with hemoptysis.
The following day she underwent a bronchoscopy with moderate sedation (fentanyl + versed) given by an RN.
The procedure began uneventfully but as it continued the patient desaturated to 80%.
The bronchoscope was removed and the patient sat upright.
After watching her for 10 minutes she had no improvement, and anesthesia was called to assist.
She was intubated with immediate improvement of her oxygen saturation.
About 20 minutes later the team transported her to the ICU.
Upon arrival in the ICU the anesthesiologist was struggling to bag the patient.
The critical care team was nearby.
She coded soon after arrival and ACLS was started.
At some point in the code a needle decompression was attempted.
It was roughly 30 minutes into the code that chest tubes were placed and the patient stabilized.
The patient suffered an anoxic injury and never regained neurological status.
She died a week later leaving behind 5 children and a husband.
Become a better doctor by reviewing stressful situations other doctors have faced, so that you are mentally prepared to take action and don’t get paralyzed by indecision.
Her husband sued all those involved.
A defense expert was hired for anesthesiology.
Outcome
The pulmonologist and the hospital settled the case for $3,500,000.00
Other defendants including the anesthesiologist were dismissed.
MedMalReviewer/Anesthesiologist Opinion
We have published another pneumothorax case here that resulted in a code, and a delay in diagnosis that led to a poor outcome. In both cases there was no anesthesiologist initially present and they were called to assist. Both cases resulted in large settlements with the anesthesiologist dropped. A significant criticism of the pulmonologist as laid out in an affirmation by the plaintiff’s attorney was that there was no anesthesiologist.
Proceduralists who take on the anesthesia themselves take on the liability. This is true for gastroenterologists, pulmonologists, cardiologists, and anyone else supervising RN given sedation. When it does not go well it is an easy criticism. The pulmonologist was responsible for a portion of this settlement.
I routinely include snippets from the “bill of particulars” in these cases. The bill of particulars in med mal will detail the specific facts, injuries, and damages being claimed. As the bill of particulars gives these details it gives insight into how the plaintiff’s attorney will approach the case and enables your lawyer to prepare a defense. Trial arguments are confined to what was pleaded in the bill of particulars, so the list of negligent actions can be exhaustive as the plaintiffs do not want to miss anything. It will feel awful to read if it is your own case. I include these snippets so you can get used to reading them too. You are not the worst doctor ever, even if there are 12 pages that seem to say otherwise.
As stated, the patient was 41-years-old with 5 children. She died from an unanticipated iatrogenic complication. She did not work but provided household services which data from the U.S. Bureau of Labor Statistics puts a value on. In 2018 these services were valued at $30,000 with an expected 3.0% increase every year. These values are added over the life expectancy of her husband which puts the loss of household services alone at $1,100,000.00. The husband is a sympathetic plaintiff. A large settlement value is not surprising here.
