Anesthesiology expert witness advises on brain damage from excess anesthesia

An anesthesiology expert witness advises on a case involving a woman who suffered brain damage due to excess anesthesia. The plaintiff went to the hospital for an esophagogastroduodenoscopy (EGD), which required anesthesia. She alleges that she was given too much anesthesia and suffered a cardiac arrest that resulted in permanent brain damage.

The plaintiff sued to nurse, doctor, anesthesiology group and hospital for negligence, alleging that they breached the standard of care.

Question(s) For Expert Witness

1. Was the standard of care breached by the medical professionals in this case?

2. How were those standards breached?

Expert Witness Response

I am familiar with the standards of care for the nurse anesthetist, her supervising anesthesiologist, the anesthesiology group and the hospital. Based on the information available to me at this time, it is my professional opinion, to a reasonable degree of nursing anesthesia certainty, that the care and treatment provided by the nurse anesthetist was unacceptable and deviated from the standards of care for a Certified Registered Nurse Anesthetist (CRNA). It is my medical opinion that the acts and omissions of the defendant CRNA, according to the records, demonstrate deviations from the standard of care and as such constituted negligence.

The conduct of the CRNA caused the oversedation, hypoventilation, respiratory/cardiac arrest, and brain injury suffered by the plaintiff. She failed to:

• Adequately and timely monitor, assess, and evaluate the plaintiff during and following the EGD

• Timely identify an excessive intraprocedural sedation level

• Timely correct an excessive intraprocedural sedation level

• Timely identify acute changes consistent with an excessive level of sedation, including concomitant hypoventilation, hypercarbia/hypercapnea, and/or oxygen desaturations

• Timely and properly prevent/correct the plaintiff’s hypoventilation, hypercarbia/hypercapnea, and/or oxygen desaturations, and all the effects therefrom.

She also allowed the foregoing conditions to occur for a prolonged period of time such that, with reasonable medical certainty, the plaintiff experienced respiratory/cardiac arrest and hypoxic/ischemic brain injury.

The defendant doctor failed to:

• Properly ensure adequate and timely monitoring and assessments of the plaintiff by the nurse anesthetist

• Have timely and properly observed, supervised, directed and/or evaluated anesthesia care and treatment rendered by the nurse

• Have timely and properly intervened, if necessary, in the anesthesia care and treatment rendered by the nurse so that hypoventilation, hypercarbia/hypercapnea, oxygen desaturations, and/or arrest would have been prevented/timely corrected, and a large degree of hypoxic/ischemic brain injury would have been prevented.

It is my further opinion, with reasonable medical certainty, that the foregoing medical conditions experienced by the plaintiff (e.g. oversedation, hypoventilation, hypercarbia/hypercapnea, and/or oxygen desaturations) were substantial factors and causes, along with acute bleeding/blood loss, of the respiratory/cardiac arrest and hypoxic-ischemic brain injury that she suffered that day.

The expert is a medical doctor with an active anesthesiology and critical care practice. The expert is board-certified in anesthesiology, has been an anesthesiology professor and regularly supervises CRNAs.