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Child with sleep apnea died of cardiac arrhythmia after surgery – Defense Verdict

On Oct. 31, 2013, plaintiff’s decedent, a 5-year-old male with history of chronic severe obstructive sleep apnea underwent a tonsillectomy and adenoidectomy surgery (T&A) to seek relief from the ongoing obstructions in the airway. The patient tolerated the procedure well, it was uncomplicated and the patient discharged after appropriate post-anesthesia care unit observation and evaluation. Several hours later, the plaintiff, decedent’s mother, found him unresponsive on the family room couch and 911 was called.  Despite significant resuscitative efforts, the decedent was pronounced dead at the hospital. The Commonwealth of Virginia Medical Examiner death investigation found that the decedent died of a cardiac arrhythmia of unknown etiology.

Plaintiff filed suit in the Fairfax County Circuit Court, alleging that the decedent was not an appropriate patient for outpatient T&A because he had severe obstructive sleep apnea. Plaintiff claimed that the anesthesia given that morning, pain medication given later in the day and the decedent’s history of obstructive sleep apnea led to a respiratory/pulmonary compromise and arrest that led to his death.  Defendant denied the allegations and the case was tried on Nov. 30, 2015.

Plaintiff’s standard of care expert, Patricia Yoon, M.D., a pediatric otolaryngologist from Denver, testified that the defendant breached the standard by not scheduling the T&A surgery as inpatient, per American Academy of Otolaryngology literature suggesting that patients like the decedent should be admitted for overnight monitoring. Plaintiff’s cause of death expert, Jonathan Arden, M.D., a forensic pathologist, testified that his review of the records and post-mortem investigation led him to conclude that the decedent had a respiratory compromise that led to respiratory/pulmonary arrest and ensuing death.

Defense standard of care experts, Gregory Zachmann, M.D., a general otolaryngologist from Roanoke, and Joseph Hutchison, M.D., a general otolaryngologist from Lynchburg, testified that the defendant physician’s care and plan for the T&A surgery were appropriate and reasonable for the patient in that case. They also testified that the Virginia standard of care for general otolaryngologist practice is not set by a piece of literature that has a recommendation that physicians consider doing such procedures as inpatient, and that this patient’s situation did not indicate the need for inpatient admission following the surgery. Defense causation expert, Anthony Casalaro, M.D., a pulmonologist, testified that there was no evidence in the medical records or the medical examiner’s report (nor the autopsy) that showed evidence of a pulmonary or respiratory cause of death.  Defense causation expert, Simeon Boyd, M.D., a pediatric geneticist from the University of California, Davis, testified that genetic testing from DNA samples kept by the medical examiner’s office found gene mutations that show the decedent had a rare inheritable cardiac conduction disorder called Brugada Syndrome, which is known to cause sudden cardiac death, even in individuals who have no prior evidence of cardiac pathology. The geneticist also testified that the genetic disorder uncovered through the DNA testing was consistent with the findings of the medical examiner’s investigation.

After a five-and-a-half day trial, the jury deliberated for approximately 90 minutes and returned a verdict for the defendant.


Type of action: Medical malpractice – wrongful death
Court: Fairfax County Circuit Court
Tried before: Jury
Judge: Brett Kassabian
Date resolved: Dec. 9, 2015
Verdict or settlement: Defense Verdict
Demand: $2,200,000
Offer: None
Attorneys for defendant: Richard L. Nagle and James N. Knaack, Fairfax
Insurance carrier: The Doctors Company

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