An Alabama jury has awarded $20 million to the family of a woman who died hours after aspirating bile into her lungs during anesthesia induction at a Mobile, Ala. hospital.
Paulett Pettaway Hall, a 32-year-old wife with two young children, was admitted to Springhill Memorial Hospital on Jan. 11, 2006 for exploratory gastrointestinal surgery. Because of her weight, gastrointestinal and other health problems at the time of the surgery, Hall was at high risk for pulmonary aspiration.
But the anesthesia team failed to take proper aspiration risk precautions, according to David Cain, co-plaintiffs' trial counsel. Instead, a routine induction was used and Hall choked to death on her own bile.
After a nine-day trial, a jury of eight women and four men deliberated only an hour and 20 minutes before unanimously finding Coastal Anesthesia, anesthesiologist Dr. Randall Boudreaux and nurse anesthesiologist Don Ortego liable for Hall's wrongful death.
Under Alabama law, wrongful death damages are entirely punitive.
Mike Worel, lead plaintiffs' trial counsel, said that the case revealed a "very troubling patient safety issue related to the provision of anesthesia service."
During the trial, testimony from the defendants and their experts indicated that although national standards require anesthesia personnel to conduct certain evaluations to ensure patient safety, these standards "are not being followed, and in some instances are being ignored, in what can only be an effort to complete more surgeries," Worel charged.
Risk factors ignored
Plaintiffs' experts testified that Hall had more than 10 factors placing her at risk for pulmonary aspiration, including abdominal extension, severe abdominal pain and a record of nausea and vomiting since she was admitted to the hospital five days prior to the surgery.
In addition, Cain said, Hall was overweight, had a history of gastrointestinal problems and was on narcotic pain relievers, all of which increased the risk of pulmonary aspiration.
Neither Boudreaux nor Ortego, however, examined Hall's abdomen. They didn't even evaluate her medical records, Cain said.
"If they had bothered to do a physical exam, they would have found she had abdominal extension, severe abdominal pain and fluid in her abdomen," Cain said.
Because the risk factors were ignored, he added, Boudreaux and Ortego used a routine induction to administer the anesthesia, rather than what's called a "rapid sequence induction," which is used for patients with a high risk of aspirating stomach contents into their lungs.
Hall aspirated bile into her lungs during the anesthesia induction, and died a few hours later.
"They didn't take the proper precautions in assessing her to identify risk factors that would have indicated she needed a different type of induction technique to prevent her from aspirating," Cain said.
Cain said a physician who testified for the defense acknowledged the standard of care required a rapid sequence induction in a patient at risk for aspiration, but said that Hall was not at risk.
"Our response was: 'You never looked,'" Cain said.
Medical experts for the plaintiffs testified during the trial that national standards require "a complete assessment of the patient, including a review of the patient's medical records and a physical examination, which neither defendant did," Cain said.
Time constraints blamed
During cross-examination, a defense expert said that while the standard of care requires a complete pre-anesthesia assessment, anesthesia physicians and nurses often don't have time to perform such assessments because of the time constraints associated with scheduled surgeries.
The verdict, Cain said, was "particularly important to protect the public, considering these defendants indicated they would continue to treat future patients the same way they treated Mrs. Hall, despite admissions that their treatment fell below the accepted standard of care."
The plaintiffs' lawyers used a variety of demonstratives, including medical books, diagrams and charts, to help jurors understand how drugs are administered during anesthesia, and the risk factors for aspiration.
Medical experts for the plaintiffs included Ronald Wender, co-chair of the department of anesthesiology at Cedars-Sinai Hospital in Los Angeles, and Lawrence Repsher, a pulmonologist in Wheat Ridge, Colo.
Cain said his firm attempted numerous times to settle the case prior to trial, but that all offers were rejected by Mag Mutual, the insurance company for Coastal Anesthesia, Boudreaux and Ortego.
An appeal is planned. Defense attorney Wesley Pipes declined comment for this article.
Plaintiffs' attorneys: Mike Worel and David Cain of Cunningham Bounds in Mobile, Ala.
Defense attorney: Wesley Pipes of the Wesley Pipes Law Firm in Mobile, Ala.
The case: Hall v. Coastal Anesthesia; Dec. 9, 13th Judicial Circuit, Mobile, Ala.; Judge Robert Smith.
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