New York Defense Verdict for PPM Insureds
Jury deliberated less than two hours before returning unanimous defense verdict.

Shawnee Mission, Kansas - February 17, 2010 - Preferred Physicians Medical (PPM), industry leading provider of professional liability insurance for anesthesia practices, announced today that a jury recently returned a defense verdict in favor of a PPM insured CRNA and anesthesia practice group in Onondaga County, New York.

The lawsuit involved a 72 year-old female patient who presented for a panproctocolectomy with general anesthesia.  The patient presented via the emergency room with a past medical history that included ulcerative colitis with rectal involvement, colon resection and hypertension.  In preparation for the procedure, the PPM insured CRNA placed a nasogastric (NG) tube.  Difficulty was noted due to coiling and the tube was changed from an 18 French to a 14 French NG tube. Placement of the NG tube was confirmed with return of gastric contents.  Prior to closing, the surgeon asked the CRNA to advance the NG tube.  Following the manipulation of the NG tube, the surgeon could not manually feel the tube; therefore, he ordered it be removed.  Following the procedure the patient was hypotensive and tachycardic.  An EKG and upright chest x-ray was performed and the patient reintubated.  The patient was transferred to ICU where the surgeon ordered the NG tube be replaced.  The attempted placement of the NG tube by the hospital staff was unsuccessful.

The following morning a CT of the chest demonstrated a pneumothorax in the right chest.  A thoracic surgeon evaluated the patient and placed a chest tube.  The patient continued to have problems with recurrent pneumothorax and was diagnosed with an esophageal injury on post-op day four.  A thoracotomy was performed and showed a perforation of the distal esophagus at the gastroesophageal junction.  The operative note indicated the tissues were edematous and boggy and the esophageal muscle layer was extremely friable.  The condition of the esophagus was attributed, in part, to the patient's long-term steroid use. The patient died approximately two weeks after the initial surgery.

The patient's estate sued the two PPM insured anesthesiologists involved in this patient's care, their practice group and the CRNA who placed the NG tube.  Before trial began the two PPM insured anesthesiologists were dismissed from the lawsuit leaving the CRNA and the anesthesia practice group as defendants.  Co-defendants in the litigation included the four physicians who provided surgical and post operative care and the hospital.  Plaintiff pursued the case on two theories: 1) the CRNA was negligent in perforating the esophagus; and 2) the post operative care provided by the other co-defendants was negligent as they failed to diagnose and treat the esophageal perforation in a timely manner.

Plaintiff's counsel made a global settlement demand of $1.4 million prior to trial.  The PPM insured CRNA and anesthesia practice group remained committed to defending this matter and did not consent to settlement; therefore, PPM made no settlement offers despite considerable efforts by the court to effectuate a settlement.  The co-defendants also took a no-pay position and made no settlement offers.

Plaintiff retained Dr. Thomas Gouge, a general surgeon at the Veterans Administration Medical Center in Manhattan, New York, to testify against the defendants.  Dr. Gouge opined that the esophageal perforation was caused by the CRNA exerting continued force on the NG tube when it would not advance.  In Dr. Gouge's opinion, reasonable care on the part of the CRNA would have prevented the perforation of the esophagus.  Dr. Gouge testified the CRNA should have stopped placing the NG tube when he felt resistance, informed the surgeon of the situation and looked for alternative methods of decompression.

The defense expert retained on behalf of the PPM insured anesthesia care providers testified the CRNA followed the proper practice for placing the NG tube.  The defense expert testified further that switching from an 18 French to 14 French tube is a common occurrence.  The defense expert also testified that experiencing coiling in the back of the throat during the insertion process is a common occurrence.  The defense expert noted that during the third attempt, the NG tube did not coil and 300cc of gastric contents was retrieved confirming placement of the NG tube in the stomach.  The defense expert testified the PPM insured CRNA appropriately documented the process.  The defense expert also pointed out the surgeon's testimony confirming the CRNA informed the surgeon of the number of attempts to place the NG tube at the end of the case.  The defense expert testified further there was no indication the CRNA pushed against resistance when placing the NG tube.  Based on the evidence presented, it was the defense expert's opinion that placement of the NG tube complied with the applicable standard of care.

Following a three week trial, the jury deliberated less than two hours before returning a unanimous defense verdict for all defendants in the case.

PPM policyholders were represented by Tom Prato, Esq. from the law firm of Brown & Tarantino in Syracuse, New York.  The file was managed on behalf of PPM by Wade Willard, JD, Claims Supervisor.