Child Suffers Brain Damage During Surgery

Doctors failed to plan for predictable complications

Minor was 3 years old when he had a tonsillectomy performed by ENT A for chronic infections. Surgery was uneventful; however, four days later, he coughed up some blood clots.

His mother took him to the hospital's emergency room, where the "on-call" ENT B was consulted over the telephone.

After learning there were some small clots in the pharynx, but no active bleeding, ENT B advised the child be hydrated and sent home to follow-up with ENT A.

Two days later, his mother spoke with ENT A, who was out of town, advising him about the ER visit, that there were no further signs of bleeding, but Minor seemed lethargic. No follow-up was ordered.

Several days after that, Minor coughed up approximately 1/2 cup of blood. He was taken back to the ER, where a physician observed fresh clots in the back of the throat and contacted ENT C, who was on-call. He advised that Minor be kept for the evening, and if his hemoglobin was low in the morning, he should be transfused with a unit of packed red cells. ENT C did not come to the ER to personally examine the patient.

The following morning ENT's progress note indicates there were no clots present at that time. Because the hemoglobin had dropped further, Minor was transfused and sent home late that afternoon.

Around 1:30 a.m. that night, Minor coughed up copious amounts of clotted and fresh blood. He was rushed back to the ER a third time, and ENT C, who was again on-call, was urgently summoned to the hospital.

The operating room was prepared, and an anesthesiologist examined Minor just before he was taken into surgery.

He saw no active bleeding, and prior to the operation, ENT C and the anesthesiologist did not discuss a game plan in the event a difficult airway were to develop due to rebleeding.

At about the time rapid sequence induction was commenced, Minor started to bleed. The CRNA, with the anesthesiologist's supervision and approval, attempted oral intubation and failed at least twice.

Despite ENT C being in the room, the anesthesiologist attempted a very difficult cricothyroidotomy procedure with a "Quick Trach" kit. He had never before attempted a cricothyroidotomy on a human being.

Unable to gain access to the trachea with the Quick Trach needle device, Minor's oxygen reserves fell. He desaturated and his blood pressure fell. When the anesthesiologist finally abandoned the cricothyroidotomy, ENT C was asked to do a cut-down to gain access to the trachea. However, the emergency tracheotomy tray was not in the operating room and had to be obtained from central supply.

Shortly thereafter, Minor arrested. Resuscitation efforts began just as the blood pressure bottomed out; without adequate pressures, the bleeding stopped. Just as ENT C entered the trachea with a scalpel, anesthesiologist was able to orally intubate.

With intubation, Minor's pulse, oxygen saturation and blood pressure quickly rose to normal levels. The bleeding in the tonsil fossa vessel was easily cauterized and tied off. After the procedure, it was evident Minor had suffered a significant hypoxic insult. He was transferred to a regional center. Within 48 hours of arrival, Minor developed seizure activity and had to be sedated.

Today, Minor can walk with the assistance of a reverse K walker. He attends second grade in a private Catholic school near his home. He is enrolled in several special-needs programs and receives physical therapy, occupation therapy and speech therapy three times at week. He has good communication skills for his age and mental impairments.

However, recent neuro-psychological testing indicates that under the best of circumstances, he may progress to the level of fourth or fifth grade, but certainly not beyond.

Per his treating physicians and the Life Care Plan, Minor will always need supervision at home or in a residential facility.

Type of action: Medical malpractice

Type of injuries: Hypoxic brain damage

Name of case: Confidential

Court/Case no./Date: Confidential; Confidential; December 2007

Tried before: Settlement

Name of judge: Confidential

Settlement amount: $5.335 million

Insurance carrier: Confidential

Attorney for plaintiff: Robert B. Sickels and Norman D. Tucker