A costly right main bronchus intubation

My first medmal consulting case was a doozy. An unfortunate anesthesiologist who couldn’t get a job because he hadn’t yet passed his boards was working for a small community hospital as an epidural jockey on the labor ward. He had the bad luck of being on call when the obstetricians admitted a woman in premature labor (somewhere around 30 weeks gestation), even though the hospital didn’t have neonatal capabilities. The obstetricians were confident they could stop the labor. Boy, were they wrong. The baby delivered precipitously, severely hypoxic, without spontaneous respirations and bradycardia. The delivery room nurses started CPR, and since the hospital had no pediatrician on site, they called our anesthesiologist, who hadn’t intubated a baby in who knows how long. He actually did a good job getting the kid intubated right away, and the oxygen saturation and heart rate improved. A blood gas reflected severe hypoxia with a significant metabolic acidosis. When a transport team from the local children’s hospital arrived, they noted that the endotracheal tube was taped too low and the CXR confirmed a right main bronchial intubation. The child developed severe cerebral palsy, and the family sued the obstetrician, the hospital, and the anesthesiologist.

By the time the case went to trial, the child was ten years old! (If you can’t believe how long these things take, read a great book called Damages by Barry Werth.) Anyhow, after a long trial, and testimony by many experts, the jury found all three defendants innocent. But, just when they stopped partying the next day, the judge on the case threw out the verdict on the anesthesiologist only and ordered a new trial! Yes, despite the consensus of a jury, a judge can actually do this. In this case, he reversed the verdict on the only truly innocent party.

I got involved seven years later, when the case was coming back to trial, and the defense wanted to cover all their bases by getting a pediatric anesthesiologist to testify that the right mainstem intubation didn’t cause the child’s CP. So, at this point, the child is now 17 years old, and the anesthesiologist has since died. But, since he was insured, his malpractice policy was very alive, and the poor parents wanted some compensation. In the end, the case settled the day before the trial, for undisclosed terms.

This case taught me several important lessons: 1) A judge can overturn a jury verdict (at least in some states); 2) A hospital without the capability of properly taking care of a premature newborn should never take a chance and admit a woman in preterm labor; and 3) despite your best efforts in a dire situation (the anesthesiologist was essentially acting as a Good Samaritan here) sometimes complications occur and innocent clinicians get sued. In another case discussion, I’ll go over some good ways to minimize your chances of being sued when complications occur.

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