Patient Suffers Brain Damage Due to Inadequate Post-Operative Monitoring

Joseph O'Neill

Written by
— Updated on January 5, 2018

Neurosurgery ExpertThis bariatric nursing case takes place in South Dakota and involves a woman in her mid-30s who had a history of obstructive sleep apnea, obesity and cigarette smoking who underwent surgery on her cervical spine. She also used a CPAP at home. After discharge from the surgery sometime after 3 pm, she was placed in a regular neurosurgery floor room while on a PCA pump (morphine), which was increased due to her pain. No CPAP or continuous pulse oximetry was ordered. Furthermore, Oximetry was checked only when the nurses came to do vital signs, and this was not frequent. On the date of this patient’s incident post-surgery, there is a set of vital signs logged in the early evening and then none until her unwitnessed event later that night, where she was found snoring and lying across the bed with a faint pulse and subsequent PEA. The patient suffered severe brain damage, which was likely caused by hypoxia or hypoventilation, and she now remains in a vegetative state.

Question(s) For Expert Witness

  • 1.) Do you perform surgery on patients with multiple comorbities?
  • 2.) What is the standard of care for post-operative monitoring of these patients?

Expert Witness Response E-007368

I do perform anterior cervical fusions and supervise residents. In terms of comorbidities, we do not perform elective spinal fusions on patients that smoke due to the non-union risk. Obese patients are managed conservatively unless there are neurological deficits. With an obese, cigarette smoking patient, if surgery was necessary, post operative management would have utilized a step down unit with one to one nursing care. I would be happy to review records. This is a high risk patient in which informed consent should have included the risks of death, stroke, and paralysis.

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