An infant with numerous congenital defects, including hypospadia and developed ventricular septal defect, rapidly developed epilepsy and compartment syndrome during an operation. Expertise in both heart failure and compartment syndrome was needed to comment on the case, which was instigated by a hospital’s attempts to operate and remedy some of the infant’s congenital defects. Instead of alleviating them, however, the infant developed metabolic acidosis with cool extremities and poor pulses directly after the procedure. When the hospital attempted to counter his condition with attempts to intubate and chest compressions, he became bradycardic and lost palpable pulses; by the time the patient was intubated, he was suffering from multiple metabolic abnormalities, including acute kidney injury and a shocked liver. He quickly developed seizures, and the hospital’s attempts to place a new arterial line in his right arm instead developed ischemia and required fasciotomies of the forearm and hand. Overall a complex case stemming from congenital defects, the competency of the hospital in administering care was questioned in trial.