$________ – MEDICAL MALPRACTICE – OTOLARYNGOLOGY – FAILURE TO PERFORM AWAKE TRACHEOSTOMY/USE PULMONARY BYPASS – INTENTION TREMORS – COGNITIVE DEFICITS – AXTAXIC GAIT.

Union County, NJ

This was a medical malpractice action involving a female plaintiff, age in her late 60s, who underwent a thyroidectomy after the finding of a very large thyroid mass. Non-party physicians ultimately confirmed the absence of cancer. A CT-scan was performed and the report noted the large mass and tracheal displacement, but did not mention tracheal narrowing. Neither the surgeon nor the anesthesiologist reviewed the CT-scan images themselves. The anesthesiologist, who was responsible for coming up with an anesthesia plan, including a method to ventilate the patient during surgery, relied upon information he received from the surgeon and a review of the records including the CT-scan report.

A plan was for an "awake oral intubation" after the patient was partially sedated. After medications were given to the patient, the anesthesiologist was unable to pass an endotracheal tube due to the severe tracheal narrowing. The plaintiff maintained that during the attempt at awake oral intubation, the patient became hypoxic and that it became apparent that an emergency tracheostomy was necessary. The plaintiff contended that she had reduced oxygen for approximately 45 minutes until the emergency tracheostomy was accomplished.

The plaintiff contended that because of the extent of the tracheal narrowing, it should have been evident to the defendants that intubation would be impossible, and that the danger should have been addressed by either the performance of an awake tracheostomy or the use of cardiopulmonary bypass, which is similar to the technique used during a CABG. The plaintiff also contended that the defendant radiologist did not report the tracheal narrowing. The plaintiff maintained that the defendant ENT surgeon had an independent obligation to review the CT-scan images himself, and was negligent in advising that intubation was feasible.

The surgeon indicated that he did not read the CT-scan images, but was well aware of the size of the mass and the extent of the displacement. The defendant surgeon maintained that an attempt at an awake tracheostomy carried great risks of causing extensive bleeding and should not be contemplated. The defendant anesthesiologist contended that he had the right to rely on the surgeon and the CT-scan report.

The plaintiff contended that because of the difficulties with intubation, she was deprived of sufficient oxygenation for approximately 45 minutes. The plaintiff was in a comatose state for a day or so and required approximately three weeks of an in-patient stay. The plaintiff contended that because of the hypoxic insult, she was left with permanent residuals that include tremors when she attempts to move her arms. The plaintiff does not suffer tremors when at rest. The plaintiff also maintained that she suffered moderate deficits involving memory and concentration that are permanent in nature.The jury found the defendant ENT physician causally negligent and awarded $________. The jury also determined that although the radiologist was negligent, there was an absence of proximate cause. The plaintiff and radiologist had entered into a $________/$________ high/low agreement and $________ was added to the $________ award. The jury also found that the anesthesiologist was not negligent.