An anesthesiology expert witness advises on a case involving a patient in Vermont with diaphragmatic nerve injury who died post-operatively following opiod administration. The patient was a forty-two-year-old female patient with a past medical history of severe abdominal trauma following a motor vehicle accident requiring multiple surgeries. The accident left her with diaphragmatic nerve injury. She was advised by her pulmonologist to avoid general anesthesia due to her decreased ability to properly ventilate resultant from the injury she sustained. Aside from the residual nerve damage, the patient made a good recovery. The patient was later diagnosed with severe and intractable endometriosis after presenting to her primary care physician complaining of chronic menorrhagia and abdominal pain. Her physician referred her to a gynecologist who recommended that she undergo a hysterectomy after medical management failed to resolve her symptoms. Given the patient’s age and the fact that she already had three children and did not plan to have any more a hysterectomy was considered. The patient was placed under general anesthesia for the procedure despite her medical records showing that she had suffered a diaphragmatic nerve injury and alternative anesthesia should be used in any future surgical procedures she was to undergo. The hysterectomy was performed without any complications however the patient suffered respiratory arrest shortly after the procedure due to respiratory depression resulting from administration of large doses of opioids. The treating surgeon failed to place orders for post op C-PAP to assist the patient’s breathing and neglected to use spinal thoracic analgesia as an alternative to general anesthesia. The patient did not recover and died shortly thereafter.