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Heart Patient Dies after Revascularization; Causation Issue


A man with a history of ischemic heart disease, congestive heart failure, decompensated heart failure, severe vascular disease, diabetes, atrial fibrillation, and stroke underwent a revascularization procedure, a surgical procedure performed to restore an adequate blood supply. Immediately after anesthesia was administered, the man experienced an acute drop in blood pressure. The anesthesiologist inserted a Swan–Ganz catheter and began treating the man with vasopressors to increase blood pressure. The man’s blood pressure stabilized. The surgeons chose to proceed with the revascularization procedure.

 

After the surgery, the man exhibited cardiac instability and was admitted to the intensive care unit. The man died three days later. The cause of death was listed as cardiogenic shock, insufficient blood flow throughout the body resulting from primary failure of the heart in its pumping function.

 

The man’s estate sued the anesthesiologist and the anesthesiologist’s practice group for medical malpractice. The complaint alleged the anesthesiologist and the practice group departed from the applicable standard of care when failing to properly and adequately perform a presurgical history and physical examination of the man and failing to fully review the man’s medical history or to appreciate the seriousness of the man’s ongoing heart conditions. The complaint also alleged that the man’s blood pressure dropped acutely immediately after the general anesthesia had been administered, that a discussion on whether to proceed with the surgery lasted twenty-five minutes, and that this failure to act in a timely manner was negligence.

 

The anesthesiologist and the practice group filed a motion for summary judgment. The motion argued that the estate failed to provide a qualified causation opinion to support its prima facie claim for medical negligence. Specifically, the motion asserted that neither of the estate’s identified experts could state to a reasonable degree of medical certainty that the anesthesiologist’s failure to conduct an adequate pre-surgical physical examination and to terminate the procedure after the man’s acute drop in blood pressure immediately following the induction of anesthesia proximately caused the man’s death.

 

The Pulaski County Circuit Court, Sixth Division, granted summary judgment in favor of the anesthesiologist and the practice group.

 

The Court of Appeals of Arkansas, Division I, affirmed. The court held the estate failed to demonstrate a genuine issue of material fact as to causation.

 

The estate failed to demonstrate a genuine issue of material fact as to causation. The estate’s experts’ testimony failed to clearly articulate that the anesthesiologist’s negligence was the proximate cause of the man’s death. The court noted that the estate’s expert anesthesiologist opined that the man’s awakening from the anesthesia was more likely if the surgery had been stopped, but the issue was whether the man would have lived, not whether he would have awakened. Additionally, the court noted that the estate’s expert cardiologist opined that continuing with the procedure contributed to the cardiogenic shock, but the presence of a contributing factor is not synonymous with proximate cause. The court concluded that the estate’s expert testimony failed to establish proximate cause and was therefore insufficient to defeat summary judgment.

 

The Court of Appeals of Arkansas, Division I, affirmed the trial court’s grant of summary judgment in favor of the anesthesiologist and her practice group.

 

See: Thomas v. Meadors, 2017 WL 3881887 (Ark.App., September 6, 2017) (not designated for publication).

 

See also Medical Law Perspectives Report: Anesthesiology Errors: Complications, Malpractice, and Catastrophe

 

See also Medical Law Perspectives Report: Mending a Broken Heart: Malpractice Risks in Diagnosing and Treating Heart Disease

 

See also Medical Law Perspectives Report: Stroke: Challenges, Risks, and Liability Issues

 

See also Medical Law Perspectives Report: Diagnosis and Treatment of Heart Attacks: Liability Issues

 

 

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