Excessive propofol caused death in dialysis patient — $850,000 settlement

Type of action: Medical malpractice

Injuries alleged: Wrongful death

Date resolved: 5/5/2023

Verdict or settlement: Settlement

Amount: $850,000

Attorneys for plaintiff: Lee Livingston and Anthony Greene, Charlottesville

Description of case: Plaintiff’s decedent was a 50-year-old dialysis patient who was in the early stages of screening for a kidney transplant, having been on dialysis for over two years with comorbidities including diabetes, hypertension and a recent stroke. Upon her gastroenterologist’s recommendation, she underwent a screening colonoscopy in the outpatient endoscopy suite of a nearby hospital related to abdominal pain and a change in bowel habits. The morning of the procedure, the patient was cleared for monitored anesthesia care by the defendant anesthesiologist. The defendant certified registered nurse anesthetist, or CRNA, administered 200 mg propofol in roughly eight minutes. In this interval, she became concerned about the patient’s dropping heart rate and blood pressure and administered multiple doses of ephedrine to improve the vital signs. However, at the same time, she continued to push large “maintenance” doses of the sedative propofol. The patient’s heart rate kept dropping until she entered cardiac arrest, at which point the defendant anesthesiologist was called in to supervise the code. One dose of a powerful resuscitative drug was administered early into the code, but defendants failed to comply with widespread guidelines and recommendations by waiting 10 minutes to administer a second dose. Directly after the second dose, the patient’s pulse was restored, but she had suffered an unrecoverable anoxic brain injury. She was released from life support three weeks later.

Both parties identified an anesthesiologist, CRNA and cardiologist as experts. The defendant CRNA testified that she based the propofol dosage solely on the patient’s weight, administering the maximum dose she would give to any patient. Plaintiff’s experts opined that dialysis patients are more sensitive to sedative agents and therefore require slow and careful administration of propofol. The FDA medication label for propofol supported plaintiff’s claim, as did the defendant practice’s own policies and procedures.

Defendants’ experts claimed the patient’s cardiac arrest was related to an adverse reaction to propofol, rather than an overdose of the drug, along with a vagal response to the colonoscope and low cardiac reserves. The patient’s life expectancy was also an issue, with many sources citing life expectancy in the single digits for dialysis patients who do not receive kidney transplants.

The case was resolved confidentially on the last business day before trial.

Lee Livingston, counsel for the plaintiff, provided case information.

[023-T-078]