Case Study: Anaesthetic Death

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The MIPS member anaesthetised the patient for a routine colonoscopy and gastroscopy procedure at a private endoscopic centre. The patient was a 64 year old electrician, and presented with a history of “heartburn” and a family history of colon cancer. He was a Type 2 diabetic, and blood test one week previously was 12.8mmol/l. He was also under current treatment for ischaemic heart disease, hypertension and hyperlipidaemia.

He was assessed for the anaesthetic three days prior to the procedure, and the general examination of the CVS, RS and abdomen were unremarkable. On the day of the procedure, his BP was raised (158/99mm Hg) and his pulse was 110 bpm. The patient advised the anaesthetist that he was nervous, and had recently taken an Anginine tablet despite admitting to no chest pain at that time, or at the time of the assessment.

The patient was induced with Midazolam and Fentanyl, however within 10 minutes he started to rouse. Additional Fentanyl in combination with Propofol was administered. The patient again showed signs of arousal about five minutes later, and an additional dose of Propofol was given with some Buscopan. Oxygen saturations and the ECG were continuously monitored throughout.

The procedures were completed within 20 minutes of induction, and the patient showed signs of arousal. The patient suddenly made a “jerky movement in the chest” and arrested. Immediate resuscitation was commenced and an ambulance was summoned. An ECG showed ventricular fibrillation, and multiple attempts at defibrillation were attempted.

One hour after the patient’s arrest, with non stop CPR and multiple defibrillations, the pupils were fixed and dilated, the ECG showed no activity, and the patient was pronounced dead.

The autopsy identified significant underlying cardiac degeneration in the form of ischaemic and hypertensive disease. No complications from the procedures were evident. 

Despite this, the Coroner found that the procedure should have been deferred, at least until the patient’s BP and pulse were more under control. He believed that the anaesthetist should have obtained a more detailed medical history, was not confident that the patient did indeed meet his assigned “ASAII” status, and felt the anaesthetic documentation was inadequate.

MIPS arranged for legal representation at the Inquest, and the Coroner’s findings (notwithstanding the foregoing) were that the evidence before him did not permit a finding that the patient’s demise would have been prevented had the procedure been deferred or undertaken at a major centre.

The widow of the deceased patient subsequently issued a Writ for loss of dependency. In claims of this nature, the plaintiff only needs to establish 1% negligence for the claim to succeed in full.

The plaintiff sought in excess of $250,000 by way of Damages. The plaintiff’s assessment was based on a projection of the deceased working until the age of 75 and contributing significantly to the domestic upkeep of the widow.

MIPS argued strongly that this was extremely contentious, and the patient could have died at any time, regardless of the anaesthetic intervention. All issues advanced by the plaintiff in relation to the economic impact of the patient’s death were actively disputed, and the claim was ultimately settled for significantly lower amount.

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