Mamon v. Anonymous Physician/Medical Center

Dr. Fagel achieved a settlement of $5,000,000 on behalf of a child who now has cerebral palsy after doctors failed to properly respond to post-surgery complications, leading to respiratory arrest and hypoxic brain injuries. The plaintiff was born with Down’s syndrome and a atrioventricular (AV) canal defect in his heart. The plaintiff was admitted to the defendant hospital on May 13, 2002, for cardiac surgery to repair the AV canal defect. The surgery was successful and there were no complications. When the ET tube was removed the next day, there was an upper airway obstruction so the plaintiff was the reintubated and then started on medication to treat fluid accumulation in his lungs. On May 15, the ET tube was removed but the patient continued to have respiratory troubles so he was placed on a respiratory machine. The next day, there was dramatic improvement so the edema medication was stopped and feedings were advanced as tolerated. His condition continued to increase and all the IV’s were removed except one in his hand. On May 19, a cardiologist noted that his respiratory status was satisfactory and ordered that his feedings continued to be advanced. However, during the early morning of May 20, the plaintiff began to have trouble breathing and an elevated pulse. An intern saw the patient but did not make a progress note or contact the attending physician; instead, the intern ordered IV fluids and placed a hold on all oral feedings. Later on, nurses noticed that the IV was not working and unsuccessfully tried to re-start the IV over the next two hours before calling the attending physician. The physician ordered that the patient be given oral feedings and for the nurses to re-start the IV at a later time. At noon, nurses noticed that the plaintiff was lethargic, but a clinical nutritionist noted that he was tolerating oral feeds at the time. At 1:45 p.m., a nurse noted that the plaintiff had a weak pulse and shallow aspirations. He then went into a full respiratory arrest and a Code Blue was called. The plaintiff was intubated and a large amount of vomit was noted in his mouth and nose. He was resuscitated over the next 50 minutes and was found to have hypoxic brain injuries on a CT scan. Due to lack of oxygen, the plaintiff now has cerebral palsy and requires 16 hours of LVN care per day.

The defense contended that all care was within the standard of care and that the cause of the arrest was a sudden, unpredictable aspiration. The defense continued by claiming that the plaintiff was promptly treated and that his underlying cardiac disease caused him to be more susceptible to hypoxic brain injuries; therefore, his arrest was likely cardiac in origin, not respiratory. However, Dr. Fagel was able to prove that the arrest was caused by dehydration and respiratory difficulty, resulting in a prolonged period of oxygen deprivation to the brain. Had the defendants properly responded to the plaintiff’s condition after the IV line was lost, at a time when the plaintiff was not yet taking oral feedings, the tragic outcome could have been avoided.