Colorado Jury Vindicates PPM Policyholder's Care
Unanimous defense verdict returned after 12 day trial.

Shawnee Mission, KS – March 9, 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 anesthesiologist in Pueblo County, Colorado.

The lawsuit involved a 58 year-old female patient who presented for parathyroidectomy surgery on August 1, 2005.  The patient's medical history was significant for obesity, gastric bypass, diabetes, below knee amputation, hypertension, bi-polar disorder, obstructive sleep apnea and hyperparathyroidism.  The patient had also been taking antidepressant medications for several years prior to this surgery.  The surgeon utilized methylene blue dye to assist in highlighting the parathyroid glands.  A PPM insured anesthesiologist performed the pre-anesthesia evaluation and determined the patient was a candidate for general anesthesia.  Another PPM insured anesthesiologist and CRNA administered the general anesthetic.

Following successful surgery and identification of an abnormal gland, the patient was returned to the recovery room.  There she was monitored by a third PPM insured anesthesiologist and the surgeon who performed the parathyroidectomy.  As she emerged from anesthesia, the patient had some unusual mentation and some abnormal muscular movements.  All of her vital signs were stable, including her pulse rate, blood pressure, respiration rate and temperature.  The unusual mentation and muscular movements continued so the PPM insured anesthesiologist kept the patient in recovery for a while longer.  Although the patient was still experiencing unusual mentation and muscular movements, she otherwise met PACU discharge criteria and was transferred to the medical/surgical floor.

The PPM insured anesthesiologist treating the patient in PACU recalled seeing an article that one of the other anesthesiologists had left for others to read. The article dealt with postoperative disorientation following parathyroidectomy surgery with methylene blue dye.  The physicians providing the case report felt that the patient's confusion was related to the methylene blue dye.  The PPM insured anesthesiologist felt that this was consistent and applicable to this patient, and so advised the surgeon and the other healthcare providers.

The patient continued to have abnormal behavior on the medical/surgical floor, which persisted until the following morning.  At that time, she had an extremely high temperature and was eventually admitted to the ICU.  The critical care physician felt that the patient's symptoms could be due to the methylene blue dye, but because of the high temperatures he felt that Serotonin Syndrome should also be considered.  At that time, none of the other treating physicians had ever heard of Serotonin Syndrome.  Despite aggressive supportive measures, the patient developed malignant hyperthermia and expired.

The patient's surviving husband and four adult daughters sued the PPM insured anesthesiologist who performed the pre-anesthesia evaluation, the PPM insured anesthesiologist and CRNA who administered the general anesthetic and the PPM insured anesthesiologist who treated the patient in PACU.  Plaintiffs also sued the surgeon and his partner who assisted him with the surgery, the hospital and the critical care physician.

Prior to trial, all parties participated in court-ordered mediation.  The three PPM insured anesthesiologists and CRNA remained committed to defending their care and did not consent to settlement; therefore, PPM made no settlement offers.  The three co-defendant physicians engaged in settlement negotiations but were unable to reach a settlement with plaintiffs.  The hospital settled with plaintiffs for a confidential amount.

Following the deposition of the defense anesthesiology expert, plaintiffs made a settlement demand for $85,000 to the PPM insured defendants.  This settlement demand was rejected and we continued to prepare for trial.  Prior to trial, plaintiffs dismissed the PPM insured anesthesiologist who performed the pre-anesthesia evaluation, the PPM insured anesthesiologist and CRNA who administered the general anesthetic and the critical care specialist.  The case proceeded to trial against the PPM insured anesthesiologist who treated the patient in PACU and the two surgeons.

Plaintiffs presented their anesthesiology expert, Kent Pearson, MD, from the University of Iowa.  Dr. Pearson testified that due to the patient's condition in the recovery room, she should have been sent to ICU where she would have had closer monitoring.  Dr. Pearson also testified that when the PPM insured anesthesiologist saw the patient at 1:15 a.m., he should have realized that her condition was something different from the case report in the article he located and should have elected to transfer the patient to ICU at that point.  Dr. Pearson testified further that the PPM insured anesthesiologist misled others by relying upon the article and placing it onto the patient's chart.

On cross examination, Dr. Pearson admitted there was no reported anesthesia literature concerning Serotonin Syndrome in 2005 and no reported literature concerning a potential for methylene blue dye to serve as a monoamine oxidase inhibitor (MAOI).  More importantly, Dr. Pearson had to admit that in spite of his claim that Serotonin Syndrome was widely known, he did not teach his residents, fellows or CRNAs about Serotonin Syndrome.  Dr. Pearson admitted further that he does not teach about Serotonin Syndrome unless it comes up as a potential portion of a differential diagnosis.  Dr. Pearson also admitted that in none of his informal discussions he has with fellows does he ever mention the issue of Serotonin Syndrome.  Dr. Pearson admitted further that the patient did not have any signs or symptoms consistent with Serotonin Syndrome until her temperature started to increase around 4:00 a.m. on August 2, 2005 – several hours after the PPM insured anesthesiologist last examined the patient.

The defense anesthesiology expert testified that it was reasonable based on the patient's clinical presentation not to transfer the patient from PACU to ICU.  The defense anesthesiology expert testified further that it was reasonable to rely on the article with the case report of confusion following administration of methylene blue dye.  The defense anesthesiology expert   also testified that there was no need to intubate and sedate the patient until she was in respiratory failure the morning of August 2, 2005.

During closing arguments, plaintiffs' attorney asked the jury to return $350,000 in favor of the plaintiffs.  The jury deliberated for approximately an hour and one-half before returning a unanimous defense verdict in favor of all three defendants.  PPM will aggressively pursue its cost judgment for approximately $25,000 against the plaintiffs.

The PPM policyholders were represented by Mike Jones, Esq. from the law firm of Hall & Evans, LLC in Denver, Colorado.  The file was managed on behalf of PPM by Brian Thomas, Senior Claims Attorney and Director of Risk Management.