Sommers Schwartz attorneys Dina Zalewski and Judith Susskind filed a medical malpractice and wrongful death lawsuit on behalf of the estate of a 48-year-old woman who died three days after elective bowel surgery when her surgical and anesthesia teams failed to manage her steroid medication before, during, and after the procedure.
The decedent had lived with Crohn’s disease since her teenage years and had undergone three bowel surgeries for the condition over the course of her life. For years, she managed the disease with long-term prednisone therapy, a corticosteroid medication that helps control inflammation. She and her husband of 20 years were an active, health-conscious couple who exercised regularly and worked hard to maintain her health despite a chronic condition.
In the spring of 2023, the decedent’s Crohn’s disease flared significantly. Her colorectal surgeon recommended an elective exploratory laparotomy with ileocolic resection, a surgery to explore the abdomen and remove a portion of the diseased small intestine and colon. She agreed and was admitted to the defendant hospital on June 12, 2023. Her chronic prednisone use was well-documented throughout her medical records and was explicitly noted during her pre-operative anesthesia evaluation. Her last dose of prednisone was the morning of surgery. Despite this documentation, no stress-loading dose of steroids was ordered before the procedure.
The surgery initially appeared to go well. But beginning the day after the operation, the decedent was in severe, uncontrolled pain that did not respond to medication. Nursing notes described her as crying, distraught, and anxious. Over the following 24 hours, her condition worsened: her lab work became increasingly abnormal, and she developed the hallmark signs of adrenal insufficiency, including uncontrolled abdominal pain, nausea and vomiting, unexplained low blood pressure, weakness, and dangerously low blood sugar. The decedent was never restarted on prednisone after her surgery. Neither the surgeon, the surgical residents, nor the anesthesia team included adrenal insufficiency in their differential diagnosis or connected her deteriorating condition to the absence of steroid therapy.
On the evening of June 14, imaging revealed concerning findings, and the decision was made to return the decedent to the operating room. An emergency exploratory laparotomy was performed at 2:30 a.m. Again, no steroids were ordered. Following the surgery, she was confused, restless, and persistently hypotensive. She suffered acute hypoxic respiratory failure and had to be re-intubated. The decedent was transferred to the intensive care unit. A critical care doctor documented that she was “extremely critical to the point of imminent death” and identified adrenal insufficiency, caused by her chronic prednisone use in the setting of surgery, as the underlying cause. Stress-dose steroids were finally administered that afternoon, but by then the damage was irreversible. She had suffered severe anoxic encephalopathy (brain damage caused by oxygen deprivation), ventricular fibrillation, multi-organ failure, and permanent loss of neurological function. A code blue was called at approximately 5:00 p.m. She was pronounced dead at 5:21 p.m. on June 15, 2023, three days after checking into the hospital for an elective procedure.
The complaint alleges that the standard of care required each member of the decedent’s care team to account for her steroid dependency before moving forward with surgery. The surgical team should have reviewed her medication history, recognized the risk of adrenal suppression, and obtained a consultation with an internal medicine or endocrinology doctor to determine the appropriate perioperative steroid regimen. Her cortisol and adrenocorticotropic hormone (ACTH) levels should have been assessed before the first operation. She should have received a stress-loading dose of steroids before surgery and been promptly restarted on her regimen afterward. The anesthesia team carried an independent obligation to ensure these measures were in place and to flag the surgical team if they were not.
When signs of adrenal insufficiency appeared postoperatively, any member of the care team should have recognized and treated the decedent’s condition. With proper and timely steroid management, she would be alive today.
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