Item: Miller & Zois, Attorneys at Law
Rating: 5
Author: Terry Waldron

Intubation injury and wrongful death lawsuits arise when doctors and nurses commit malpractice by breaching the standard of care in intubating a patient. Our lawyers handle intubation mistake injury claims.

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 a medical mistake. Our law firm handles intubation error malpractice lawsuits.

Airway management negligence claims generally

Endotracheal Intubation

Endotracheal intubation is the most common form of airway management 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, allowing the patient to maintain adequate oxygenation and carbon dioxide elimination.

Intubation Injuries

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, throat, esophagus, or trachea. Vocal cord paralysis and injuries to the teeth and mouth are also possible. (Our lawyers remember a case where all of the victim’s teeth were knocked out. Just brutal.)

There certainly are minor injuries that can occur from negligence, most notably a bruised esophagus. But the intubation error cases that find their way to a courtroom almost invariably involve a serious injury or death.

Negligent or Improper Intubation: Common Malpractice Errors

Intubation is a skilled, time sensitive procedure. When the provider is inexperienced or does not follow basic airway management steps, the risk of catastrophic injury rises fast. Most intubation malpractice cases come down to simple preventable errors like these:

Failure to identify key landmarks or poor technique during laryngoscopy
Unnecessary delay in securing the airway during a respiratory emergency
Failure to properly assess the airway and anticipate a difficult intubation
Esophageal intubation or failure to recognize a misplaced tube in time
Failure to confirm placement with proper monitoring such as capnography
Poor understanding of tube mechanics, including depth, cuff inflation, and ventilation delivery
Tube displacement after placement that goes unnoticed during transport or repositioning

When these errors result in oxygen deprivation, the injuries are often permanent. That is why so many serious cases turn into an intubation injury lawsuit.

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 airway management 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 which medical professional breached the standard of care and caused the injury or death.

How Intubation Errors Usually Happen

Tracheal intubation is performed thousands of times every day in hospitals nationwide. When it is done properly, it is a life-saving intervention that allows doctors to secure a patient’s airway and deliver much-needed oxygen to the lungs. But when airway management goes wrong, the consequences can be catastrophic. Many cases that eventually become intubation injury lawsuits involve breakdowns in fairly basic airway management steps that reasonable health care providers should have recognized and corrected promptly.

Esophageal Intubation That Goes Unrecognized

One of the most dangerous airway errors occurs when the breathing tube is placed in the esophagus instead of the trachea. This is called esophageal intubation. The initial placement mistake itself does not always amount to malpractice. The placement is not a problem if you catch it right away. Good doctors occasionally insert the tube incorrectly on the first attempt.

If the tube remains in the esophagus, oxygen is not reaching the lungs. Within minutes, oxygen levels fall and the patient can suffer catastrophic brain injury or death. Many airway malpractice lawsuits involve a delay in recognizing that the tube was in the wrong place.

Failure to Confirm Proper Tube Placement

Modern airway management requires doctors to confirm correct tube placement using monitoring tools such as capnography, which measures carbon dioxide in the patient’s breath. These verification steps help ensure that oxygen is actually reaching the lungs. When providers rely only on visual confirmation or basic observation instead of proper monitoring — clear shortcuts — a misplaced tube can go undetected. This type of mistake is often a central issue in an intubation malpractice case because confirming tube placement is a fundamental part of the procedure.

Multiple Failed Intubation Attempts

Some patients have difficult airways. But the standard of care requires doctors to recognize when an airway is becoming difficult and to switch quickly to alternative strategies. Many serious airway injuries occur when providers repeatedly attempt intubation while the patient’s oxygen levels are dropping. Multiple failed attempts can delay oxygen delivery long enough to cause severe hypoxia and permanent brain injury.

Delay in Calling an Airway Specialist

Another common issue involves delays in calling for help. You need to get the people in there who can do the job as fast as possible because every second counts. Emergency room physicians, surgeons, and other providers typically initially attempt to manage the airway themselves. But when intubation becomes difficult, the standard of care usually requires bringing in an anesthesiologist or another provider with advanced airway training. Delays in calling anesthesia can turn a manageable airway problem into a life-threatening emergency.

Failure to Perform an Emergency Surgical Airway

When traditional intubation attempts fail, doctors may need to perform an emergency surgical airway procedure such as a cricothyrotomy. This procedure creates an airway directly through the neck when the patient cannot be intubated through the mouth or nose. In some medical malpractice cases, providers waited too long to perform this life-saving procedure while the patient remained without oxygen.

Dislodged or Displaced Breathing Tubes

Even when the tube is placed correctly at first, problems can still occur. Breathing tubes can become dislodged when patients are moved, repositioned, or transported. If the medical staff does not recognize that the tube has shifted, oxygen delivery can stop. Many catastrophic airway injuries occur in intensive care units when a displaced tube goes unnoticed for too long. Keep an eye on the patient’s blood oxgyen can go a long way.

Tracheostomy Tube and Medical Device Injuries

Not all airway injuries involve traditional intubation. Some patients require long-term airway support through a tracheostomy tube. When these devices malfunction or are improperly managed, they can also cause severe oxygen deprivation. In some situations, families contact a trach tube injury lawyer after a tracheostomy tube becomes blocked, displaced, or defective. There have also been cases involving potential medical device lawsuits involving Bivona trach tubes and other airway devices.

How Lawyers Prove Intubation Malpractice

Most airway malpractice cases ultimately come down to whether the medical team followed accepted airway management guidelines. Determining this usually requires a careful review of the medical records by an intubation expert witness who can analyze how the airway was managed and whether the providers met the standard of care. When doctors fail to recognize airway problems quickly enough or fail to take the steps necessary to restore oxygen to the patient, the results are usually devastating. These failures often become the foundation for serious intubation malpractice lawsuits.

Estimated Settlement Value of Intubation Malpractice Lawsuits

Intubation malpractice cases can lead to very large settlements or verdicts because the most common injury is catastrophic brain damage caused by oxygen deprivation. But case value varies widely depending on the severity of the injury and the circumstances surrounding the airway management failure:

Minor injury cases (vocal cord damage, throat trauma):
$50,000 to $300,000
Serious injury cases (permanent airway damage or extended ICU stay):
$300,000 to $2,000,000
Wrongful death cases involving delayed recognition of esophageal intubation:
$1,000,000 to $7,000,000+
Catastrophic brain injury cases involving oxygen deprivation:
$10,000,000 to $35,000,000+

The largest intubation malpractice verdicts tend to involve patients who suffer anoxic brain injury after doctors fail to recognize that the breathing tube has been placed in the esophagus instead of the trachea. When oxygen is not delivered to the brain for even a few minutes, the results can be devastating.

But value in these cases depends on many factors, including:

how long the patient went without oxygen
whether the error was quickly recognized
the patient’s age and life expectancy
the level of permanent disability
the jurisdiction where the lawsuit is filed

Because of these variables, two cases involving similar mistakes can result in very different settlement outcomes.

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 intubation error 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).

- 2024, California $28,724,350 Verdict. A 56-year-old man suffered catastrophic brain damage during a surgical procedure after doctors failed to properly manage his airway. The anesthesiologist struggled to intubate the patient because of anatomical challenges that should have been identified during the pre-operative evaluation. Despite repeated failed attempts, the surgical team continued the procedure instead of waking the patient or switching to alternative airway techniques. The prolonged oxygen deprivation caused an anoxic brain injury that left the patient permanently disabled and dependent on others for daily care. A Los Angeles jury returned a verdict of $28.7 million in favor of the plaintiff.
- 2023, Pennsylvania $14,000,000 Verdict. A four-year-old child died after multiple failed intubation attempts during a respiratory emergency at Einstein Medical Center. A pediatric transport team from Children’s Hospital of Philadelphia was called to assist but arrived without a supervising physician. The providers attempted intubation several times and failed to secure the airway in time. The child suffered cardiac arrest and died. The jury concluded that the medical providers failed to provide appropriate airway management and awarded $14 million in damages.
- 2023, Florida $31,900,000 Verdict. A patient suffering from sepsis required emergency airway management after developing respiratory failure. Hospital staff administered a paralytic drug that prevented the patient from breathing on his own but then failed to successfully intubate him for an extended period. Multiple unsuccessful attempts were made before an anesthesiologist finally secured the airway. The prolonged lack of oxygen caused severe brain damage, and the patient later died. A jury returned a verdict of approximately $31.9 million in favor of the patient’s family.
- 2022, Pennsylvania $300,000 Verdict. Einstein Medical Center discharged a four-year-old with complaints of fever and abnormal vital signs. The following day, the child returned to the hospital with worsened symptoms, prompting Einstein to call for assistance from a CHOP transport team. Upon arrival, two CHOP nurses were dispatched to the scene. They directed the Einstein providers to initiate the intubation procedure, which was deemed critical. The jury awarded $9.4 million, attributing 67% of the liability to them for failing to provide adequate medical care, especially the absence of a qualified physician during the intubation attempt. Einstein Medical Center was held 33% liable.
- 2019, Pennsylvania $3,000,000 Settlement: A 56-year-old male, dies from improper endotracheal intubation 1 day after being admitted to Einstein Medical Center in Philadelphia. The anesthesiologist mistakenly inserts the breathing tube into the esophagus instead of the trachea, then fails to timely identify and correct the misplacement until it is too late. The wrongful death action brought by his estate is eventually settled for $3 million.
- 2018, Pennsylvania $225,000 Settlement: An 84-year-old patient at a nursing home suffers from respiratory difficulty. The staff at the nursing home made several unsuccessful attempts to intubate her. After the intubation efforts fail, the patient stops breathing and dies on the way to the hospital. His estate file wrongful death action alleging that the staff negligently perforated her trachea during the numerous intubation attempts. The case settle
  s for $225,000.
- 2017, Colorado: $2,105,000 Verdict: This is a case where the intubation tube where the tracheal tube was misplaced in the woman’s esophagus. Regrettably, the mother needed the tube due to respiratory distress while she was 32 weeks pregnant. The child suffered permanent white matter brain injuries while in utero and an anoxic hypoxic-ischemic injury, which led 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 the 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: An 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 used 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 led to ischemia of 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 wrongful death 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 case, it is surprising this claim was brought, and it is 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 wrongful death suit against the medical professionals at the hospital, alleging 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 in failing 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.

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Getting a Lawyer for Your Claim

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.

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