Respiratory arrest after surgery: What happens and when it is medical malpractice
When a patient stops breathing, there are only a few short minutes to start appropriate resuscitation brain damage occurs
As a Houston, Texas medical malpractice attorney, I have represented many clients in cases where patients developed permanent brain injuries after a surgery.
This type of medical negligence case came to mind as I recently reviewed a March 2018 appellate opinion out of the Houston First Court of Appeals. As I delved into that case, I encountered facts that are remarkably similar to those in different cases that I have handled. The case, by the way, is styled Armenta v. Jones, Case No. 01-17-00439-CV, and was on appeal from the 240th District Court of Fort Bend County.
Hospital respiratory complications after surgery
In the Armenta case, the patient had a bilateral mastectomy and later went to a hospital for reconstructive surgery. There were complications that required a return to the operating room the next day to restore blood circulation. About 10 minutes after the second surgery, while the patient was still intubated (had a breathing tube down her throat), her oxygen level dropped and her breathing decreased.
Despite these bad signs, she was extubated (her breathing tube was removed) and arrived in the intensive care unit (ICU) seven minutes later. In the ICU, she was immediately noted to be unresponsive and hypoventilating (breathing in an abnormally slow rate), and later experienced respiratory and cardiac arrest that caused severe, permanent brain damage.
The criticism in the Armenta lawsuit is basically that everyone in the operating room and ICU was slow to react to the patient’s clear respiratory crisis. The plaintiffs allege that, in the operating room, the anesthesia providers (an anesthesiologist and certified registered nurse anesthetist, or CRNA) should not have removed the breathing tube (extubation). In addition, the plaintiffs and their medical expert believe that the breathing tube should have been reinserted immediately, along with efforts to resuscitate and ventilate the patient.
Surgical centers respiratory complications after surgery
In my experience, this type of adverse complication is bungled more frequently in surgical centers. In fact, I am getting ready to file a lawsuit now involving the death of a man, under similar circumstances, who had shoulder surgery at a surgical Center in Houston.
At the end of the surgery, the anesthesiologist and CRNA attempted to bring him out of general anesthesia (called emergence) and removed his breathing tube. Although still under the effects of anesthesia, he immediately became agitated. Our anesthesiology medical expert who reviewed the medical records believes that the surgeon and anesthesia providers should have immediately re-intubated him. Instead, they took him to the post-anesthesia care unit (PACU).
Once he arrived in the PACU, his oxygen saturation level was noted to be low, yet the providers waited five minutes to even start cardiopulmonary resuscitation (CPR), and an astounding 18 minutes before re-inserting a breathing tube.
Based on this slow response of the physicians and nursing staff, it is no surprise that this well-liked, young school teacher passed away after what was supposed to be a routine surgery. Any decrease in ventilation causes accumulation of carbon dioxide in the blood, which can lead to a cascade of events starting with dangerous acidosis and ending with respiratory arrest and death.
Once we file the lawsuit and get discovery underway, there are several things that I want to investigate. First, I want to look into how many surgeries were scheduled that day at the surgical center. In my experience, surgical centers and hospitals often line up patients one after another and can get a bit too hurried to get the patient out of the operating room so they can start billing for the next patient. Second, some surgical centers have inadequate policies and procedures, and even supplies, to handle respiratory or cardiac arrest situations.
In this case, over 20 minutes after the patient was transferred to the PACU, someone called 911 for help. By then, it was too late to save him. We will, of course, give careful scrutiny to why that decision took so long.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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