$405,000 RECOVERY -ANETHESIOLOGICAL MALPRACTICE – NEGLIGENT FAILURE TO TIMELY DEAL WITH EXCESSIVELY HIGH FEVER FOLLOWING OTHERWISE SUCCESSFUL SURGERY TO CORRECT CONGENITAL SPINAL ABNORMALITY – PATIENT ALLEGEDLY DEVELOPS RARE CONDITION OF MALIGNANT HYPERTHERMIA WHICH IS GENERALLY FATAL UNLESS TIMELY TREATED WITH BOTH DANTROLENE AND ACTIVE COOLING AGENTS – DEATH OF 62-YEAR-OLD DIALYSIS PATIENT WITH PRIOR FAILED KIDNEY TRANSPLANT
Monmouth County, NJ
This was a medical malpractice action involving a 62-year-old patient who several hours after surgery to correct a congenital spinal defect developed a rapid increase in temperature from 99 º to 103.8.º . The plaintiff contended that the defendant anesthesiologist negligently failed to take any action, despite the fact this rise took place in a half hour, and negligently failed to monitor the high temperature, not checking it again for approximately one hour, by which time the fever had risen to 107 º Critical care physicians summoned to help suspected malignant hyperthermia, a condition caused by a reaction to anesthesia, which unless timely treated with the medication Dantrolene, is generally fatal. The critical care physicians administered Dantrolene and instituted active cooling measures. The temperature quickly dropped to 105º after reaching a high of 108.5º . Although the temperature quickly dropped to 105º and continued to decrease, the patient suffered multi-organ failure and cardiac arrest, dying the day following surgery.
The plaintiff’s expert anesthesiologist maintained that although rare, the most likely cause of the extremely high fever was malignant hyperthermia. The plaintiff’s expert would have related that factors such as a rapid increase in temperature, respiratory acidosis involving the pH factor in the blood , elevated carbon dioxide, tacytenia, or rapid respiration and a precipitous drop in temperature upon the administration of Dantrolene reflected that the decedent probably had this condition and that the timely administration of Dantrolene, together with active cooling measures such as the use of a cooling blanket and an ice lavage, would have saved the patient’s life.
The defendants asserted that malignant hyperthermia is exceedingly rare, is not seen by most anesthesiologist’s in the course of their careers. The defendants maintained that it was likely that the high temperature and death were caused by septic shock, a bacterial infection, which occurred in the absence of negligence and that the earlier administration of Dantrolene would not have had any effect on the patient. The defendant further pointed out that post mortem blood cultures reflected bacterial counts that were consistent with septic shock. The plaintiff ‘s infectious disease expert countered that post mortem cultures are frequently contaminated and that it was likely that a false positive occurred. The plaintiff further contended that the cultures conducted before the death were negative eliminating septic shock as a likely cause of the fever. The defendant’s infectious disease experts asserted that the administration of antibiotics resulted in a false negative of these blood cultures.
The plaintiff would have argued at trial that irrespective of the cause of the high fever of over 103.8º, 1/2 hour after it was 99º, the defendant’s failure to immediately institute active cooling measures and the failure to monitor the patient’s temperature until an hour after this temperature was recorded (at which time the the fever had risen to 107º), were clearly egregious.
The plaintiff contended that the patient had been doing well on dialysis and that if he successfully received a new kidney, would have had an approximate 10 year life expectancy. The decedent was a part time college instructor. He left a wife and one adult child. The plaintiff’s economist would have projected economic damages of approximately $100,000 per year, including lost income and Green/Bitner damages.
The defendant contended that the decedent’s co-morbidity factors would have prevented him from obtaining a new kidney and contended that he would have had a two year life expectancy.
The case settled prior to trial for $405,000.00.
Ciani vs. Andreas Xagoraris, M.D.. Docket No. MON-L-1667-13
Attorney for plaintiff : Randolph H. Wolf
Plaintiff’s Expert Anesthesiologist: Albert Ferrari, M.D., West Berlin, NJ
Plaintiff’s Expert Infectious Disease Specialist: Louis Weiss, M.D., Albert Einstein Medical School, Bronx, NY
Plaintiff’s Expert Economist: Stan V. Smith, Ph.D., Chicago, IL