Facts

This was a wrongful death case arising out of the negligent care and treatment by cardiothoracic surgeon, defendant Dr. Frederick Howden, provided to Shane Skaggs, following an aortic valve replacement surgery on August 10, 2017.

In the immediate post operative period Mr. Skaggs showed signs of a serious and ominous complications, he was hypoxic, acidotic, he was in cardiogenic shock and his EKG showed signs of myocardial infarct. Dr. Howden recognized Mr. Skaggs recovery was compromised yet, he wrote it off as "typical post operative and expected findings." Mr. Skaggs died 7 hours after surgery.

At the time of this surgery, Shane Skaggs was only 49 years old. He was married to Bethany Skaggs and they had two young children, Hunter and Samantha. Mr. Skaggs was born with a bicuspid aortic valve, a congenital abnormality.

In 2004, Mr. Skaggs developed symptoms of aortic insufficiency. In aortic insufficiency, blood flows backwards into the heart instead of pumping out. This requires the heart to pump harder, which over time can lead to heart failure. Consequently, Mr. Skaggs underwent an aortic valve replacement surgery with Defendant Dr. Howden in 2004. Following surgery, Ms. Skaggs returned to Yuma Az. Where he had regular follow ups with his cardiologist. The replacement valves have a 10-15 year life expectancy.

In 2017, 13 years after his initial surgery, Mr. Skaggs developed aortic stenosis, a narrowing of the heart valve and he was referred back to Dr. Howden in July 2017. It was Dr. Howden's recommendation Mr. Skaggs undergo a redo aortic valve replacement. As part of his pre-operative work up Mr. Skaggs had an EKG performed on August 7, 2017. He was given clearance for surgery.

On August 10, 2017, Mr. Skaggs presented to Alvarado Hospital Medical Center for surgery. Surgery began at approximately 1047 and was completed without noted complication by 1530.

Postoperatively Mr. Skaggs was transported to the SICU at 1545. Immediately upon admission to the SICU he was noted to have problems with desaturation, his oxygen saturation rate was 77% and was acidotic. Dr. Howden came to the patient's bedside at 1600 and ordered an EKG which was performed at 1602. Dr. Howden interpreted the 1602 EKG as abnormal but determined that he did not need to consult a cardiologist. According to Dr. Howden the 1602 EKG did not show any significant changes from his pre-operative EKG. Dr. Howden did not note any marked changes in the ST elevation in V1 and V2. Although he did note ST depression in the lateral leads, it was his opinion that because the patient had just had heart valve surgery these findings did not "raise any alarms" in his mind. Dr. Howden took no action to further investigate any heart abnormalities. By 1640 the nurse noted Mr. Skaggs was in respiratory distress and Dr. Howden confirmed the patient was in cardiogenic shock.

At 1737 another EKG was performed and this time showed the patient was in atrial-fibrilation with a rapid ventricular response. Around that same time his cardiac index dropped, and his systolic blood pressure dropped from 110 to 80. Despite his worsening condition, Dr. Howden ordered no further tests to determine the cause of the patients hemodynamic instability and cardiac abnormalities.

Dr. Howden did recognize Mr. Skaggs was having difficulties on the ventilator and requested a consultation from pulmonologist/critical care specialist Edward Federman, M.D. Dr. Howden did not tell Dr. Federman about the 1602 EKG results or request he review same. Upon his arrival to the SICU Dr. Federman noted Mr. Skaggs blood pressure was 70/30, his respiratory rate was 17-18 and he was in rapid afib with a heart rate of140-150's. Dr. Federman's assessment was Mr. Skaggs was in cardiogenic shock. Dr. Federman ordered a stat 2D echocardiogram, he adjusted the ventilator settings and ordered fentanyl and propofol. Dr. Federman interpreted the 2D echo as ruling out tamponade (compression of the heart caused by fluid collecting in the sac surrounding the heart) and ordered no further tests to identify the cause of the patient's instability.

With no intervention to identify the cause of his problems, Mr. Skaggs continued to deteriorate. Despite increasing amounts of medication, his blood pressure continued to drop, he stopped making urine, and his cardiac index dropped. By 2340, Mr. Skagg's heart eventually failed and he went into cardiac arrest and died. He was pronounced dead on 8/11/17 at 0035.

An autopsy was performed and revealed the cause of death was a large acute myocardial infarction that was the result of dissection of the left main coronary artery. Both sides agreed the cause of the dissection was iatrogenic and that Dr. Howden caused the dissection during the surgery.

PLAINTIFF'S CONTENTIONS: Plaintiff contended Dr. Howden failed to appropriately respond to Mr. Skaggs post operative deterioration. Plaintiffs' experts testified the 1602 and 1737 EKG's were profoundly abnormal and failing to do anything to identify the cause of his deterioration was below the standard of care. The standard of care required Dr. Howden to recognize the ischemic changes seen on the 1602 EKG indicated something was going on with the heart muscle, and given the patients normal coronaries and the fact that no bypass was performed, these were not expected findings in the post-operative period. The standard of care therefore required Dr. Howden either consult with a cardiologist or interventional cardiologist or take Mr. Skaggs back to surgery to identify the cause of his instability.
Plaintiffs argued that upon seeing this patient's post-operative EKG's and hemodynamic instability a cardiologist or interventional cardiologist would have recommended a CTA be immediately performed. The CTA would have revealed the dissection of the left main which could have been stented in the catheterization lab. Plaintiffs' experts testified more likely than not, the stent would have been successful and saved Mr. Skaggs' life.

DEFENDANT'S CONTENTIONS: Defendant argued the patient's hemodynamic and cardiac instability was expected for a post-operative patient given the complexity of the re-do surgery and the patients underlying co-morbidity factors.

Insurer

The Doctors Company

Settlement Discussions

In October 2019 Plaintiffs served a 998 Offer for $1,000,000. Defendant rejected the offer. In October 2021, Plaintiffs served a second 998 Offer to Defendant in the amount of $850,000. Defendant rejected the offer. Defendant did not make any settlement offers.

Damages

The jury awarded $2,600,000 in general damages (reduced per MICRA to $250,000, and $1,329,198 in loss of financial support and household services.

Injuries

wrongful death

Result

Plaintiffs' verdict in the amount of $3,929,198.

Deliberation

one day

Poll

12-0

Length

eight days