Malpractice Case: Taking on Too Much Work Can Cause Patient Tragedy

With Dr A at the cesarean section, the GI patient desaturated and staff called the ER physician, who arrived at 10:05 AM. According to his records, the ER physician noted no breath sounds or chest rise. The ER physician asked the staff to call Dr A back to the PACU stat to reestablish an airway and to call any other available anesthesiologist, as well as a general surgeon in the event of a cricothyrotomy.

The ER physician made several unsuccessful attempts to intubate the patient and began an emergency cricothyrotomy when Dr A returned to the PACU. The ER physician asked Dr A to assist in establishing an airway, but Dr A stated that he did not think he could do that successfully, as he had previously been unable to reintubate the patient, and that he needed to return to the cesarean delivery.

The ER physician unsuccessfully attempted the cricothyrotomy and a code blue was called at 10:22 AM. Another anesthesiologist arrived at 10:40 AM and successfully intubated the patient. The patient remained pulseless, however, and was declared dead at 11:07 AM.

In a subsequent lawsuit, the family sued Dr A for medical negligence and for patient abandonment. Dr A and the family resolved the litigation without going to trial.

In his deposition, Dr A testified that he advised the OB surgeon to speak to the GI surgeon regarding whether the cesarean delivery could be performed first. No such change occurred. Dr A also testified that staff were unable to get another anesthesiologist to take the cesarean section or to get a surgeon for a possible cricothyrotomy.

Jurors expect physicians to make more than just technical medical decisions: When a situation puts patient safety at risk, they will look for a physician's assertiveness. These are the times for the "patient's advocate" to be heard.

This case comes from the "Case of the Month" column featured in the member newsletter published by the Cooperative of American Physicians, Inc. The article was originally titled "Attending Surgeries With Limited On Call: Who Will Have Your Back?"

This case comes from Medicine on Trial, originally published by Cooperative of American Physicians, Inc., to provide risk management lessons from litigated case histories.

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.