$5,250,000 RECOVERY - MEDICAL MALPRACTICE - INAPPROPRIATE ADMINISTRATION OF TRANDATE - CARDIOPULMONARY ARREST DURING SURGERY - HYPOXIA/ANOXIA - MASSIVE IRREVERSIBLE BRAIN DAMAGE - WRONGFUL DEATH TWO YEAR POST-SURGERY.
Notable Settlements
CASE TYPE: Medical Malpractice Plaintiff vs. Defendants. Case no. n/a; Judge n/a, 3-99.


County Withheld
This medical malpractice action involved allegations against the defendant anesthesiologist and hospital where the decedent underwent elective surgery. The plaintiff claimed that the defendant anesthesiologist and a nurse anesthetist employed by the hospital negligently administered the drug Trandate so as to cause a cardiopulmonary arrest, which resulted in massive irreversible brain damage. The decedent never regained consciousness after the surgery and resided in a nursing care facility for nearly two years before his death.

The decedent, a 53-year-old male, underwent elective surgery to correct a jaw deformity, which had caused him to experience facial pain. During the course of the surgery anesthesia care was provided to him by the defendant anesthesiologist and a nurse anesthetist employed by the defendant hospital. At an early stage in the procedure, the nurse anesthetist observed that the decedent's condition had become unstable with evidence of decreased oxygen saturations, hypotension and bradycardia.

The decedent's condition continued to deteriorate until he suffered a cardiopulmonary arrest and a code blue was called. Although cardiopulmonary resuscitation was successful, the decedent was subsequently found to have suffered massive, irreversible brain damage as a result of hypoxia/anoxia during surgery. He died approximately two years later, without ever having regained consciousness.

The plaintiff alleged that the decedent's cardiopulmonary arrest was caused by severe hypotension (low blood pressure) as a result of the inappropriate administration by the defendants of Trandate, a hypotensive drug used to lessen the blood level at the operative site in order to assist the surgeon with surgical visibility of the site. Trandate has a shelf life of 10 to 12 hours and a half life of 5-6 hours (half of the dose is still in the system 5-6) hours after administration. The plaintiff contended that Trandate is, therefore, difficult to regulate and inappropriate for use in a surgical procedure with little arterial bleeding such as the plaintiff's surgery.

Hypotensive technique (intentional lowering of the blood pressure during surgery) should only be used in surgery involving heavy arterial bleeding and of long surgical duration due to its inherent danger, according to the plaintiff's claims. The plaintiff alleged that in this case, the decedent's blood pressure was regulated by giving Trandate to lower the pressure (long life) and Ephedrine and Epinephrine to raise the pressure (1/2 life of 5-10 minutes). As the Ephedrine and epinephrine wore off, the Plaintiff alleged that more Trandate was given until, finally, the decedent went into cardiac arrest due to the overdose.

The plaintiff maintained that the defendant anesthesiologist was present when the initial dose of Trandate was given to the decedent by the nurse anesthetist. However, the defendant anesthesiologist claimed that he was unaware that the nurse anesthetist had administered the dug. Records showed that the defendant anesthesiologist was not present in the operating room for most of the procedure and elected to allow the nurse anesthetist to monitor the decedent. The defendant anesthesiologist contended that he was supervising another procedure during most of the time in question.

The nurse anesthetist claimed that she was following the defendant anesthesiologist's directive, but admitted that she was unaware of the appropriate dosage and half life qualities of the drug, Trandate. The nurse anesthetist testified that she attempted to contact the defendant anesthesiologist on several occasions prior to the code to advise him that she was having trouble regulating the decedent's blood pressure.

The defendant anesthesiologist denied that he had been contacted prior to the code. The decedent was survived by his wife and four children. Two of the children are adults and two are minors living at home. The decedent's medical bills, which have been covered by insurance, were $519,000. The decedent was retired for several years prior to the surgery, but had allegedly planned to reenter the job market as a human resources consultant. His lost earning capacity was calculated to be $400,000.

The defendant hospital settled with the plaintiff for a present value of $4 million prior to suit being filed. Two weeks before the scheduled trial against the defendant anesthesiologist and his professional association, these defendants tendered their policy limits of $1 million. In addition, the defendant anesthesia group agreed to pay an additional $250,000 from its corporate assets to settle the case. The total present value of the settlement is $5,250,000.

REFERENCE
Plaintiff vs. Defendants. Case no. n/a; Judge n/a, 3-99.

Attorneys for plaintiff; Wil H. Florin and H. Dennis Rogers of Florin Roebig, Huddlestun & Rogers, P.A. in Palm Harbor and Clearwater.

COMMENTARY: This medical malpractice action presented strikingly different versions of the events leading to the decedent's cardiopulmonary arrest. Critical issues, involving the anesthesiologist's knowledge of the administration of the drug Trandate and his availability during the surgery, emerged from the testimony of the anesthesiologist and the nurse anesthetist. Neither the operating surgeon nor the other nurses present in the operating room recalled specific details in that regard and provided inconsistent testimony to ascertain whose version was correct. The settlement is believed to be one of the largest ever obtained in the county of venue for a B>medical malpractice claim. The terms of the settlement, County of venue, parties involved and other identifying details of the case must remain confidential pursuant to an agreement between the parties.