Patient with history of gastric reflux died after surgery – Defense Verdict

Decedent was 47 years old when he was admitted to Danville Regional Medical Center on April 15, 2008, for a split thickness skin graft to his right forefoot. He never had been under general anesthesia. During his pre-operative assessment, the patient denied GERD, but listed Nexium as a current medication. He denied any other significant medical history. During induction of anesthesia, the patient vomited gastric contents and was immediately suctioned and intubated. The anesthesiologist performed bronchoscopy and gastric lavage while the planned skin graft was completed. The patient was then extubated and sent to the recovery room. While in recovery, the patient became tachypneic with low oxygen saturations. He was reintubated and sent to the ICU. Labs came back showing his potassium count was extremely elevated and his heart failed. Resuscitative efforts were unsuccessful.

Plaintiff’s evidence alleged that the pre-operative anesthesia work-up negligently failed to identify the patient’s history of active reflux, which would have warranted intubating the first-time general anesthesia patient and preventing aspiration. Moreover, it was alleged that defendants should have initiated pre-admission lab testing, which would have identified any potential kidney issues. Finally, for a simple grafting procedure, plaintiff alleged that regional anesthesia, not general, should have been used.

The defense position was that, even though the patient denied GERD during his pre-operative interview, the anesthesiologist was aware he was on Nexium and, therefore, reasonably concluded that he had well-controlled reflux. Every patient with reflux does not require intubation, nor was regional anesthesia a better alternative under these circumstances. Moreover, there was no suggestion that the patient had renal problems, even though plaintiff’s evidence was that decedent was followed by another physician for high potassium. Plaintiff argued that decedent (who left a wife and two children) came from an exceptionally close family and his tragic death following a minor procedure was easily avoidable. The defense argued that the defendant met the standard of care and none of the health care providers who treated him on that day could have predicted he suffered from hyperkalemia, which, ultimately, was responsible for his death. The court, over plaintiff’s objection, granted the defense request for a contributory negligence instruction.

After a four-day trial, the jury returned a verdict for the defense.

Type of action: Medical malpractice – wrongful death
Name of case: Burnett v. Nigam
Court: Danville Circuit Court
Case no.: CL13 -362
Tried before: Jury
Judge: Joseph W. Milam Jr.
Date resolved: April 9, 2015
Special damages: None were put into evidence
Demand: $1,925,000 (complaint and closing argument)
Verdict or settlement: Defense verdict
Attorneys for defendant: Robert F. Donnelly and Marshall H. Ross, Richmond
Defendant’s experts: Todd Lasher, M.D., anesthesiologist; Stevin Dubin, M.D., anesthesiologist
Plaintiff’s experts: Richard M. Watkins, M.D., anesthesiologist