The body needs oxygen. During surgeries and medical emergencies, doctors, surgeons, and anesthesiologists may have to take steps to ensure that a patient can receive oxygen. This often requires tracheal intubation.
Tracheal intubation is a common life-saving measure involving the placement of a plastic tube into the windpipe (trachea) to maintain an open airway or to deliver drugs. Most commonly, tracheal intubation allows for the protection of the airway, delivering oxygen to patients who desperately need it.
Tracheal intubation is a routine procedure in our hospitals, and it is typically life-saving. But life-threatening complications occur in too many intubation procedures, often as a result of medical malpractice. Our law firm handles intubation error malpractice lawsuits.
Endotracheal intubation is the most common form of intubation that is most typically instituted for acute respiratory failure. The procedure involves the insertion of a plastic tube (endotracheal tube) into the windpipe through the mouth or nose. The tube is typically less than 12″ long. The tube is attached to a breathing machine that applies positive pressure ventilation. Endotracheal intubation allows ventilation of the lungs by artificial means that allows the patient to continue with adequate oxygenation and elimination of carbon dioxide.Negligent or Improper Intubation
Intubation is a very skilled intensive procedure. If the health care provider performing the procedure has little experience, the risk of injury increases dramatically. While there are certainly unique challenges in some cases, most intubation failures are simple malpractice errors. These mistakes include failure to find the key landmarks. These errors include:
- failure to find landmarks, unnecessary delay in intubation;
- failure to properly assess the patient's airway needs;
- placing the tube in the esophagus as opposed to the airway;
- poor understanding of how to use a laryngoscope blade;
- lack of understanding about tracheal tube mechanics and delivery.
The human body can survive for many days without food or water. But oxygen has to be consistently delivered throughout the body. Without it, irreversible brain damage and death can occur rapidly. Common injuries from negligent intubation include stroke, hypoxia, and damage to the lungs, esophagus or trachea. Also, vocal cord paralysis and injuries to the teeth and mouth are also possible. There certainly are minor injuries that can occur from negligence, most notably a bruised esophagus. But the intubation malpractice cases that find their way to a Maryland courtroom, almost invariably involve a serious injury or death.Who Can Be Held Responsible
One of the main causes of injury is the failure to evaluate the patient’s anatomical features; to ensure that intubation will not result in complications. A lack of communication among medical personnel or a complete failure to follow emergency airway management guidelines can also lead to injury.
In a hospital setting, the blame for malpractice generally rests with the anesthesiologist. But doctors, surgeons, nurses, and EMTs in emergency situations all may have intubation responsibilities. Who is ultimately responsible for the injuries or death and the relative apportionment of responsibility really depends on the unique facts of the tragedy. Often it is more than one health care provider who is responsible. The answer to this question is generally getting a lawyer to collect all of your medical records and to review the claim with a medical expert; to sort through exactly who it was that breached the standard of care and caused the injury or death.Sample Settlement and Verdicts
Below are some sample airway management malpractice claim verdicts and settlements. Keep in mind these are the winners. There is no guarantee of success. Please do not let these verdicts mislead you into thinking that every case is successful. Every case is different and, at the end of the day, you will need a lawyer to review the medical records to give you some idea of your chances of success and how much money a jury might award (or an insurance company or hospital might pay).
- 2017, Colorado: $2,105,000 Verdict: This is a case where the intubation tube where the tracheal tube was misplaced in the woman esophagus. Regrettably, the mother needed the tube due to respiratory distress while she was 32 weeks pregnant. The child suffered permanent while in utero suffered white matter brain injuries and an anoxic hypoxic ischemic injury which lead to developmental delays, ADHD, gastroesophageal reflux disease, a hernia, hydrocele of the spermatic cord, and pneumatosis of intestines. The defendants claimed what they always do in these cases: the intubation of an esophagus is not a breach of the standard of care. But going into the esophagus was not the problem in this case. It was the failure to realize that the mistake had occurred. The defendant also argued that medical reports showed the mother's O2 saturation levels were never low enough for long enough before the child was delivered to have would have caused an anoxic hypoxic brain injury. The doctors also claimed -- and this probably offended the jury -- that the child's ADHD was probably a hereditary problem.
- 2014, Illinois: $35,000,000 Settlement: An infant presented for surgery. During the procedure they undergo intubation, but at some point during the procedure, the tube was occluded. As a result, the child is a quadriplegic and requires 24-hour care. The parties settled for $35,000,000.
- 2013, Virginia: $1,375,000 Verdict: A pregnant woman presents to deliver her child. The OB/GYN orders an emergency C-Section. When complications arise, the anesthesiologist needs to secure the woman’s airway; however, after several failed intubations, the patient dies. Her estate sued the anesthesiologist, who claimed that they acted within the standard of care. Regardless, the jury awarded $1,375,000.
- 2013, Massachusetts, $1.5 Million: Elderly patient with health problems had breathing problems in the hospital. A blood test revealed respiratory acidosis consistent with respiratory failure. Instead of intubation, the doctors dried BiPAP, probably because it was less invasive. When that did not work and the patient’s respiratory acidosis worsened, a crash intubation was attempted The intubation efforts failed and the man had too much air in his esophagus and stomach, which leads to ischemia to his intestines. Ultimately, they were unable to save him.
- 2013, Massachusetts, $500,000: The 50-year-old female plaintiff had a heart attack. She was intubated with a seven mm endotracheal tube. She underwent the catheterization procedure and had a stent placed in her right artery. When she was extubated, she experienced some difficulty breathing. She was later intubated again but the doctors had trouble because of her short thick neck and the narrowing of her trachea. So they performed an open tracheotomy and inserted a Bivona tube because it was longer. The doctors thought it worked. But the nurses apparently knocked the tube out while turning her on her side. They allegedly did not notice what they had done, causing the patient to die from lack of oxygen. The family’s medical malpractice lawsuit against the hospital’s nursing staff claimed that they were negligent in moving the patient and failing to protect the ventilator and notice the mistake they had made.
- 2011, Maryland: $10,000 Verdict: When a woman presented for surgery, she required intubation. However, the surgeons did not rinse a chemical used for sterilization from the tube before inserting it. After the surgery, she suffered severe throat discomfort that resulted from irritation from the chemical. The jury awarded her $10,000. From reading the facts of this cases, it is surprising this claim was brought and surprising that it did not settle for a similar amount before trial.
- 2011, Florida: $200,000 Settlement: A 26-year-old woman suffers a severe asthma attack. When EMTs arrive, they attempt to intubate but they place the tube in her esophagus instead of her trachea, which results in her death. The young woman’s family contended in a malpractice suit that X-rays taken in the emergency department showed that the decedent's intubation was in the esophagus and stomach instead of the trachea. Why such a small amount for a death case? Here, the defendant was a state employee which has immunity beyond $200,000 for tort claims.
- 1988, Maryland: $800,000 Settlement: The fact that we are reaching back to 1988 for a verdict demonstrates that not a lot of these cases make it to trial in Maryland before settlement (or being dismissed). In this case, a 31-year-old woman died of respiratory arrest after undergoing surgery. She went in for surgery for a herniated disc which is certainly a surgery that comes with real risk, but you do not expect to die from the procedure. St. Agnes’ anesthesiologists had a difficult time intubating the woman who later had difficulty breathing. She went into respiratory arrest. Her doctors tried a tracheotomy to no avail. The family’s malpractice lawsuit contended that the doctor was negligent in failing to ensure an adequate drain at the surgical site and failure to intubate the patient properly. The family’s attorney – who is now an Anne Arundel County judge – also offered expert testimony to argue delay: the St. Agnes staff failed to respond to the respiratory arrest quickly. Time is safety in these cases.
All medical malpractice cases are complex. Further, these cases can be particularly complex, as you have probably surmised if you have read this entire page. If you need a lawyer to fight for you in your claim, call Miller & Zois at 800-553-8082 or get a free online consultation to determine whether you have a viable claim that you should pursue.