This case involves a male patient in Missouri, who presented to the hospital with complaints of chronic coughing, congestion, fever, chills, weakness and dizziness. His medical history shows that he suffered from a number of chronic medical conditions, mostly related to his circulatory system. As a result of lab testing done in the hospital, the doctor ordered a blood transfusion thinking the patient was suffering from internal bleeding. The next day, a surgical consult was requested. Despite acknowledging the fact that the patient suffered from a history of medical problems, the doctor scheduled an endoscopy for the following day, during which the patient would be put under general anesthesia. The patient was cleared for the procedures. During the procedure, he became severely hypotensive and hemodynamically unstable. He was taken to the PACU where an hour after the procedure, he went into pulseless electrical activity. Medical records show a 15-minute, unaccounted for gap in monitoring and treatment of the patient during the time that he was non-responsive. The patient never regained consciousness and passed away shortly after the procedure.