Facts

Decedent, a 62-year-old retiree, was morbidly obese and had a history of respiratory problems including obesity, hypoventilation syndrome, obstructive sleep apnea, and chronic obstructive pulmonary disease, which had necessitated his intubation on two previous occasions in the year prior to his passing.

On the evening of Aug. 28, 2007, decedent was brought to the Kaiser South San Francisco emergency room via ambulance complaining of shortness of breath that had been becoming increasingly worse over the previous several days. On arrival, his oxygen saturations were noted to be 88 percent on room air. Emergency physicians at Kaiser evaluated the decedent and placed him on BiPap. When oxygen saturations did not improve on BiPap and the patient became progressively more obtunded, a decision to intubate was made by Kaiser emergency room physicians.

Two separate physicians made multiple attempts at intubation. The last intubation was placed tracheally, however, immediately following that intubation, yellow fluid was seen coming from the endotracheal tube. The respondents alleged that their post-intubation examination confirmed tracheal placement of the endotracheal tube.

Although the medical record did not contain any recordation of oxygen saturation following the intubation, the respondents claimed that the patient's oxygen saturations were in excess of 90 and remained so following the intubation. Then, 13 minutes after the intubation, respondent's physicians claimed that the patient suddenly became bradycardic and ultimately asystolic. They immediately removed the endotracheal tube and began CPR. During the CPR process, Kaiser's emergency room physicians did not attempt to re-intubate the patient and instead called for an anesthesiologist to perform the intubation. The anesthesiologist arrived seven to 10 minutes later and re-intubated decedent. Following re-intubation, decedent regained perfusing cardiac rhythm within less than one minute. Decedent suffered a severe anoxic insult to his brain and never regained consciousness. He died several weeks later.

CLAIMANT'S CONTENTIONS:
Claimants, the decedent's adult children, contended that the original intubation was placed esophageally, not tracheally, and that respondent's claim that decedent was saturating in the 90s and then suddenly became bradycardic was untrue and physiologically impossible.

Claimants also contended that respondents' failure to monitor decedent following intubation allowed his oxygen saturations to progressively drop to the point where he could no longer sustain cardiac function and went into cardiac and respiratory arrest; that following the cardiac and respiratory arrest, respondents fell below the standard of care in failing to attempt to re-intubate decedent and instead attempting to ventilate him via bag valve mask ventilation.

Settlement Discussions

Claimants offered to mediate the matter and made an opening demand of $329,920. Respondents declined mediation and offered zero dollars.

Result

Award of $267,328 ($250,000 non-economic damages; $5,528 future economic damages; $11,800 funeral expenses).