Action: Medical malpractice
Injuries alleged: Wrongful death
Case name: Mary J. Pearson, as Administrator of the Estate of Frank Pearson v. Jennifer Humphreys, CRNA and Carolina Anesthesiology Associates, PA
Court/case no.: Guilford County Superior Court/No. 20-CVS-4668
Jury and/or judge: Judge William A. Wood, II
Date: April 3, 2023
Attorney: John C. Hensley Jr., John C. Cloninger and Jordan L. Hensley of Hensley Cloninger & Greer in Asheville (for the plaintiff)
On the recommendation of his family doctor, a 70-year-old African American male went to High Point Endoscopy Center for a screening colonoscopy.
A CRNA with Carolina Anesthesia Associates was the anesthesia provider. Deep sedation with Propofol was used for the procedure.
During the procedure, the man arrested. He regained pulses and was transferred to High Point Regional. He never regained consciousness and remained on life support for seven days until the decision was made to compassionately extubate.
The cause of death was hypoxic-ischemic brain injury second to cardiac arrest. The decedent was survived by his wife of 45 years and two adult sons. His wife sued the CRNA and her employer as the administrator of the estate.
The Anesthesia Record completed by the CRNA after the event stated that everything was normal until approximately four minutes into the procedure when the patient became bradycardic (heart rate of 40). The CRNA immediately administered a dose of Robinul and the heart rate increased to the 50s. She then administered another dose of Robinul.
The CRNA claimed that as she charts by exception, the absence of further noted abnormalities must be taken to mean her interventions resolved the problem.
Seven to eight minutes later, the CRNA noted that the procedure was finished and the scope was withdrawn. One minute after that, the CRNA noted O2 sats in the 30s and 40s with a heart rate “remaining” in the 50s.
The CRNA immediately began ventilation with AMBU bag and mask. One minute later, O2 sats were absent and the heart rate was in the 20s.
At this point, the CRNA said she inserted a laryngeal mask airway (LMA) and continued ventilation. Two minutes later, the patient was noted to be in PEA (pulseless electrical activity) arrest.
Code was called and atropine and epinephrine administered. Chest compressions were given. The crash cart was brought to the bedside, pads attached, shock advised and delivered.
Three minutes into the Code, the CRNA documented the return of strong pulses just before EMS arrived to assume care.
The defense called Dr. Louis DeBernardo from Duke to testify that stimulation of the colon during the colonoscopy caused a vagal reflex (temporary drop in HR and BP) which caused an arrythmia in this seriously diseased heart from which the decedent could not recover.
On cross examination, Dr. DeBernardo admitted there was no objective finding of vagal reflex in the autopsy. He also admitted that he was excluding other possible causes, such as hypoxia, based on the CRNA’s record.
The plaintiff argued that by a wide margin, hypoxia is the most common cause of PEA arrest and the most common complication of deep sedation with Propofol is airway obstruction. The decedent was at greater risk for airway obstruction due to his BMI, obstructive sleep apnea and large tongue.
The plaintiff’s theory was that the CRNA failed to recognize and effectively resolve an airway obstruction. The plaintiff’s experts (Dr. Art McCulloch and Dr. Andi Stamper, CRNA) agreed with this theory. Each had provided anesthesia for thousands of colonoscopies and neither had ever seen a vagal mediated cardiac arrest.
Through discovery, the plaintiff learned that another CRNA had been called into the room to assist during the Code. When deposed, the second CRNA revealed that she had gone home that evening and written a statement in the event she was asked to prepare an incident report, which described a different timeline and appreciation of what was going on when compared to the anesthesia record.
The timing of events on the EMS record also differed from the anesthesia records by as much as eight to nine minutes. Overall, the EMS record discredited the anesthesia record and his description of the airway and the patient’s improvement after removal of the LMA and placement of the King airway further supported that this was a respiratory issue.
The plaintiff also called the decedent’s treating cardiologist, the emergency room doctor and the critical care PA who had been tasked with completing the death certificate.