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$________ INCLUDING $________ PUNITIVE AWARD - MEDICAL MALPRACTICE - ASSAULT AND BATTERY - FRAUD - TREATING OTOLARYNGOLOGIST ASSURES PLAINTIFF PATIENT THAT HE WILL PERFORM SURGERY TO CORRECT DEVIATED SEPTUM - SURGERY NOT PERFORMED BY TREATING OTOLARYNGOLOGIST, BUT INSTEAD, PERFORMED BY MEDICAL RESIDENT - SUBSTANDARD CARE RENDERED BY ANESTHESIOLOGIST, NURSE ANESTHETIST, RESIDENT AND TREATING OTOLARYNGOLOGIST IN PERMITTING PLAINTIFF TO BE PREMATURELY EXTUBATED - ASPHYXIA - PERSISTENT VEGETATIVE STATE.

Cuyahoga County, Ohio (28345)

This action was brought on behalf of the female plaintiff, age 57 at the time of the events in question, against the defendant Cleveland Clinic where the plaintiff underwent surgery performed by her treating otolaryngologist (ENT specialist) to correct a deviated septum. It was contended that the plaintiff was prematurely extubated by the defendant’s employee nurse anesthetist and that the defendant’s employee medical resident performing the surgery failed to prevent the premature extubation. Neither the treating ENT, nor the anesthesiologist in charge of the anesthesiology aspect of the plaintiff’s care (both employees of the defendant hospital), were present at the time of the premature extubation. It was additionally alleged that the plaintiff was assured by the treating ENT that he would be performing the procedure. The plaintiff alleged that the treating ENT committed a fraud as well as a battery by operating on the plaintiff without informing her that a resident would be performing the surgery. The plaintiff’s cause of action proceeded on theories of negligence (medical malpractice), fraud and battery. The plaintiff asserted a claim for both compensatory and p 7 3 punitive damages.

The plaintiff was diagnosed by the treating ENT as suffering from a deviated septum. He characterized the severity of the condition as moderate to severe and recommended surgery. The plaintiff contended that the defendant assured her that he would be performing the surgery. The plaintiff was never advised that a medical resident would actually be performing the operation, according to the plaintiff’s evidence.

The surgery was, in fact, performed by a medical resident. The evidence indicated that the plaintiff’s anesthesia was being administered and monitored by a nurse anesthetist. The nurse anesthetist was overseen by the attending anesthesiologist, who was not present in the room when the plaintiff was extubated. The evidence demonstrated that the plaintiff was prematurely extubated by the nurse anesthetist, resulting in asphyxia and permanent brain damage.

The medical resident performing the surgery testified that he was unaware of the parameters within which a patient could be safely extubated and that he left this aspect of the patient’s care to the anesthesiologist. The treating ENT testified that he was knowledgeable concerning the extubation parameters and could safely determine when a patient was ready or not ready to be extubated. Based upon this testimony, the plaintiff argued that if the defendant had performed the surgery as he assured the plaintiff he would, he would have determined that the plaintiff was not ready to be extubated and the asphyxia and resulting brain damage would have been avoided. The plaintiff additionally argued that the attending anesthesiologist was also negligent in failing to be present during the extubation to ensure the well- being of the patient.

The plaintiff alleged that the failure of the treating ENT to advise the plaintiff that a medical resident would be performing the procedure and the ENT’s actions in falsely assuring the plaintiff that he would be performing the surgery when such was not the case constituted medical battery and fraud.

The defendant clinic admitted liability for the medical negligence aspect of the plaintiff’s claims at the start of the trial. The defendant denied, however, that fraud or medical battery had occurred and maintained that because Cleveland Clinic was a teaching institution, medical residents routinely substituted for treating surgeons or other physicians. The defendant maintained that this practice was appropriate and reasonable and that the clinic could not be found liable on a battery or fraud theory of liability.

On the issue of damages, the evidence established that the plaintiff suffered profound brain damage as a result of the premature extubation and will remain in a persistent vegetative state for the remainder of her life expectancy. The plaintiff presented past medical specials of $________ and future medicals of $________. The plaintiff additionally claimed lost income of $________.

The plaintiff contended that the evidence establishing medical battery and fraud demonstrated a conscious disregard of the plaintiff’s rights which rose to the level of maliciousness such to substantiate an award of punitive damages against the p 7 3 defendant clinic. On this issue, the plaintiff elicited testimony from the defendant clinic’s financial officer regarding the clinic’s net worth. Net worth of the clinic in the amount of $________ was presented to the jury.

The plaintiff’s last demand prior to trial was $________. The defendant’s highest offer was $________. The jury found for the plaintiff and returned a verdict of $________ in compensatory damages and $________ in punitive damages.