By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Los Angeles
David Vassalli, 2016 JD Candidate
Pepperdine University School of Law
Malibu, CA
News: In 2005, a woman entered a hospital with an existing infection in her mouth. Physicians determined that the woman needed an emergency tracheostomy to ensure no blockage to her airway would occur during treatment. The tracheostomy was successful, and her infection was treated with antibiotics. On the sixth day of her hospital stay, after her infection had subsided, her sister, a visiting guest, called for help because the tracheostomy location was bleeding and the breathing tube and blood were blocking the patient’s airway. The nurses did not have experience with tracheostomy tubes, and eventually an anesthesiologist cleared her airway, but the patient suffered brain damage from the lack of oxygen to her brain during the time her airway was obstructed. The brain damage resulted in the woman being disabled, unable to control the muscle functions of her body, confined to a wheelchair, and being in need of the care of others for the rest of her life. The woman filed a medical negligence claim against the hospital, and she alleged the hospital was negligent for the acts of employees that resulted in the tracheostomy tube obstructing her breathing and the employees’ failure to clear her airway in a timely manner. The hospital argued that the sister manipulated the tracheostomy tube, which caused the tracheostomy tube to be out of position and thus caused the ensuing injuries. The jury agreed with the woman and found the hospital was negligent for allowing the woman’s airway to be blocked and thus causing the brain injury that occurred before her airway was unobstructed. The jury awarded the woman more than $20 million in damages. It was determined the woman was entitled to approximately $1.7 million for past emotional distress and medical expenses; $4.5 million for disfigurement and loss of normal life; and more than $14 million for future medical expenses, emotional distress, and pain and suffering. In a lawsuit that lasted nearly a decade, the woman died the day prior to the jury verdict being reached in her favor, and her estate will receive the proceeds of the award.
Background: In February 2005, a woman suffering from a dental abscess that resulted in condition known as Ludwig’s angina, which is an infection of the floor of the mouth, went to the hospital seeking treatment for the infection. To treat the infection that threatened to obstruct her airway, the patient underwent an emergency tracheotomy. After the successful procedure, the patient remained in the hospital and was given antibiotics to treat the infection for the next few days. However, on the sixth day, she began bleeding from the tracheostomy site. Her sister asked nurses for help. At this point, the breathing tube and blood were mostly blocking the patient’s airways. The nurses on staff did not have experience with tracheostomy tubes, so a nearby anesthesiologist was summoned to successfully clear her airway.
By the time her airway was unblocked, the patient had suffered from a hypoxic brain injury from the extended period of time without adequate airflow to her brain. The lack of adequate oxygen caused the woman to suffer permanent brain damage. For the nine years following the incident, she was physically disabled, unable to control her muscle functions, confined to a wheelchair, and needed to be taken care of by medical professionals or her family on a daily basis. As a result, the woman filed a medical negligence claim against the hospital that alleged the hospital negligently allowed her airway to become obstructed and failed to clear her airway in a reasonable amount of time. The hospital maintained that the woman’s sister manipulated the tube, which caused the obstruction of her airway and led to the lack of oxygen to her brain and subsequent brain damage.
A jury verdict was rendered nearly a decade after the suit initially was filed, and it happened to be released the day after the woman died. The jury found the hospital was negligent for allowing the woman’s airway to be blocked and failing to get her airway unobstructed in a timely manner. The jury awarded the woman more than $20 million in damages, which consisted of approximately $1.7 million for past emotional distress and medical expenses; $4.5 million for disfigurement and loss of normal life; and more than $14 million for future medical expenses, emotional distress, and pain and suffering. Due to the woman’s passing, her estate will receive the proceeds of the award.
What this means to you: While the facts are in conflict regarding how the tracheostomy tube came to be blocking the patient’s airway, this case demonstrates how the act of a third party, not related to the healthcare of the patient, can lead to liability for the hospital (and physicians, depending on your venue) treating a patient. The hospital subject to the above-described litigation maintains that it was the patient’s sister who manipulated the tracheostomy tube when the area began to bleed and the patient complained of discomfort. Nevertheless, the facts that the patient was under the care of the hospital, had her airway obstructed, and the staff members were unable to clear the patient’s airway in a timely manner led to more than $22 million of liability and a traumatic injury for the hospital’s patient. Given the magnitude of the consequences that can arise from a simple action of a hospital guest, such as manipulating a tracheostomy tube, hospitals and physicians should take steps to ensure that the care they provide is not hindered by any third party. Possible steps to prevent this type of liability could include monitoring guest visits, limiting guest access for patients during sensitive times of their treatments, and providing explicit instructions to guests not to interfere with any medical treatments.
Note that every hospital is licensed under the Conditions of Participation in the Medicare and Medicaid programs. Those Conditions require that members of the nursing staff are assigned to patients for whom they have proven competencies to provide care. The hospital must provide nurses competent to handle tracheostomy tubes. Staff members must be able to recognize irregularities and respond emergently. Anything less is below the standard of care and raises the risk of harm to the patient and liability to the hospital. Physicians, as members of hospital medical staffs, can and should insist that hospital leaders provide experienced nursing staff members able to provide for the needs of their patients and the ability to teach family members and other visitors about precautions related to a patient’s particular medical need, as in this case.
This case also illustrates the need to proactively address the needs of patients before an emergency situation results. The patient in this case claimed that, while in the presence of her sister, she informed her nurse and attending physician that her tracheostomy tube was causing her discomfort, yet nothing was done until the tracheostomy tube was blocking the patient’s airway.
Had the patient’s tube been adjusted earlier by staff members or had an explanation been provided to the patient and her guest that the tracheostomy tube was to be removed shortly and was not to be manipulated in the meantime, the injury and resulting legal liability might have been avoided.
Liability in this case was imposed despite the hospital’s assertion that the patient’s guest created the circumstance that led to the patient’s injuries. As such, staff membesr should seek to proactively address the needs of uncomfortable patients before the situation is made worse by the patient or the patient’s guests attempting to address the issue themselves.
REFERENCE
Circuit Court of Cook County, IL, Case No. 06 L 5913 (Dec. 4, 2015).
