|April 2011 · Vol. 23, No. 4
NOTABLE JUDGMENTS AND SETTLEMENTS
Misplaced intubation results in brain damage
A TIGHT NUCHAL CORD WAS DISCOVERED at delivery. The newborn had a 1-minute Apgar score of 1 and abnormal umbilical cord blood gas values. Resuscitation began but the endotracheal tube was misinserted in the esophagus. By the time the endotracheal tube was reinserted into the trachea, the infant had suffered a prolonged period of hypoxia. The child has severe cognitive delays and is totally disabled with spastic quadriplegia and cerebral palsy. She requires 24-hour care, is not expected to be able to walk without assistance, and cannot speak.
PATIENT’S CLAIM The ObGyn and resident knew that fetal distress was evident 1 hour before delivery; a breakdown in communication between these two physicians caused a delay in delivery. A first-year intern attempted to insert the endotracheal tube; 40 minutes later, the tube was properly repositioned in the trachea and the infant was stabilized.
PHYSICIAN’S DEFENSE Mother and child were properly treated. A life care plan for the child should be based on institutional placement, not home care.
VERDICT An $11 million Hawaii settlement was reached.
Postpartum respiratory distress
TWO DAYS AFTER GIVING BIRTH to her third child, a woman experienced shortness of breath. She was given oxygen and antibiotics for pneumonia.
The next day, she began coughing up pink-tinged foamy sputum. An emergency department (ED) physician ordered 2 mg morphine, additional testing, and increased her BiPAP to 100% oxygen. She began to improve and stopped coughing up frothy sputum, but her blood pressure remained high.
The ED physician transferred her to the ICU immediately after 25 mg promethazine was administered. On the way to the ICU, the patient suffered cardiopulmonary arrest. The ED physician attempted to intubate the patient, but had difficulty because frothy secretions were coming from her trachea due to chest compressions. An anesthesiologist was eventually successful at intubation, but the woman was pulseless for 17 minutes. She suffered brain damage, now requires 24-hour care, and is unable to speak or walk.