A court in Wyoming ruled in favor of the defendant in a medical malpractice lawsuit against an anesthesiologist accused of administering local anesthesia incorrectly during an outpatient wrist surgery, resulting in brain damage to the patient. The plaintiff had been seeking $800,000 in damages.
In 2015, the plaintiff suffered a wrist fracture when she fell from a horse. In March 2015 she underwent a wrist surgery during which she remained awake. Before the procedure, the anesthesiologist administered a regional nerve block. The drugs used for the local anesthesia entered the plaintiff’s bloodstream, and she suffered a cardiopulmonary collapse, in which she temporarily stopped breathing. Over the course of 15 minutes, she suffered several seizures.
After the surgery, the patient began having symptoms consistent with hypoxic brain injury, which is brain damage that occurs when the brain does not receive enough oxygen. Her balance, memory, and mental focus became impaired, and she had difficulty speaking and finding words. She was no longer able to engage in the activities that had once made her happy, such as horseback riding and conversing with friends.
The plaintiff filed a lawsuit against the anesthesiologist and the physicians’ group that employed him. She alleged that her neurological symptoms were the result of local anesthetic systemic toxicity (LAST) because of the nerve block she received during wrist surgery. She alleged that, because of the anesthesiologist’s negligence, she suffered a preventable, permanent brain injury that interfered with her daily life activities.
Meanwhile, the attorneys for the defendant anesthesiologist argued that the anesthesiologist’s error in administering the local anesthesia could not be the cause of the plaintiff’s brain injury. LAST as a result of a peripheral nerve block on a part of the body such as the wrist is extremely rare, occurring in less than one out of every 1,000 cases. Even if she did suffer from LAST during the wrist surgery, it is unlikely that it was the cause of her severe neurological impairment. They argued that her brain injury was more likely the result of the horseback riding accident that had caused her to need wrist surgery in the first place. In other words, the hypoxic brain injury was the result of a pre-existing condition, not from the wrist surgery or its local anesthesia.
Local anesthetic nerve block is a common form of pain control for minor surgeries. The procedure typically involves four drugs. A local anesthetic, usually lidocaine, blocks sensation in the affected nerve. Epinephrine caused temporary constriction of the blood vessels near the injection site, which prevents the anesthetic from traveling to other parts of the body. Steroids and opioids reduce inflammation and pain, respectively. Anesthesiologists use ultrasound, fluoroscopy, or computed tomography (CT) to help them determine where to inject the drugs.
LAST, which occurs in between six and nine of every 10,000 local anesthetic nerve block procedures, happens when the local anesthesia drugs pass into the patient’s blood stream and affect the central nervous system and the cardiovascular system. The central nervous system can be affected at lower doses of drugs than the cardiovascular system. Early symptoms of LAST often include ringing in the ears and numbness and tingling sensations in and around the mouth; seizures, like the ones suffered by the plaintiff in this case, often closely follow these symptoms.
A major issue in this case was determining the cause of the patient’s hypoxic brain injury. Prolonged or closely-spaced seizures (status epilepticus) can cause cerebral hypoxia. The plaintiff suffered at least two seizures in a 15-minute period, but they each lasted less than five minutes and were more than five minutes apart. It is possible that the wrist surgery was not the only time the patient ever suffered seizures. She may have had one or more episodes of status epilepticus after the horseback riding accident in which she also broke her wrist.
In a medical malpractice case, the plaintiff must show a preponderance of the evidence. In this case, the attorneys for the plaintiff needed to prove that it was more likely than not that the defendant anesthesiologist failed to uphold the standard of care and that his negligence was the cause of the plaintiff’s brain injury. In this case, it was not possible to exclude other possible causes for the plaintiff’s brain injury and resulting neurological symptoms. Thus, the attorneys for the plaintiff were not able to demonstrate a preponderance of the evidence. Most medical malpractice lawsuits do not go to trial, but this case resulted in a jury trial. The jury deliberated for over two hours, and they reached the conclusion that the court should rule in favor of the defendant.
The defendant anesthesiologist in this case was able to clear his name because of the help of medical expert witnesses. Expert anesthesiologists, neuropsychologists, and neurologists examined the patient’s records to see the exact time and duration of the seizures she suffered during the wrist surgery. They also examined MRI reports and images from before or after the wrist surgery to see whether she had already suffered a brain injury before the surgery.
Sources
https://www.jhnewsandguide.com/this_just_in/article_e94f5494-37ad-5b3c-8030-2685ed3016a3.html
