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Hypoxic Brain Injury - Dislodged Breathing Tube

CATEGORIES: Brain Injuries CASE LOCATION: Allegheny Co., PA. CLASSIFICATION: Substantial Recoveries

The Geiger Case

After a fall when building a deck at his house, Justin Geiger, age 25, a father, and a former Marine, went to a community hospital emergency room where x-rays taken of his right arm and left leg were negative. After discharge, his arm and leg remained painful, so he returned to the ER the next day and was admitted and diagnosed with compartment syndrome in his left leg and right forearm. After undergoing surgeries (fasciotomies) at that hospital, the next day, the patient was transferred to a tertiary care hospital in Pittsburgh.

At that hospital, the patient underwent multiple surgeries for the compartment syndrome as well as skin grafting of his leg. Twelve days into this admission, the patient was taken for a CT-guided procedure to drain fluid from his lungs. The patient was sedated and had a breathing tube placed, and for the transport to the radiology department, a nurse and respiratory therapist escorted the patient with the respiratory therapist manually bagging the patient (so he can breathe).

In the radiology department, once the patient was reconnected to the mechanical ventilator, numerous breathing issues were immediately apparent. The patient became agitated and restless, began to breathe rapidly, there was asynchrony with the ventilator, tidal volumes decreased, he was coughing, and his oxygen saturation level dropped to a dangerously low level of 87% (below 90% is hypoxic, i.e. insufficient oxygen). As a result, the respiratory therapist removed the patient from the ventilator and manually bagged the patient (again to breathe).

After the patient was given additional sedation medication, he was again reconnected to the ventilator. Unbeknownst to the nurse, the respiratory therapist decided to leave without telling anyone. Again, there were breathing problems: the oxygen saturation level again dropped to 87%, the tidal volumes decreased, and the nurse had to abort the procedure and remove the patient from the ventilator because of respiratory distress; yet, no respiratory therapist was present. Notably, the nurse testified that she was “surprised” that the respiratory therapist left, that the respiratory therapist never leaves in situations like this, and that the respiratory therapist shares the responsibility of monitoring the patient’s airway.

Shortly thereafter, the nurse noticed that the breathing tube was dislodged. Since the respiratory therapist that left had yet to return, the radiology tech took over doing the respiratory therapist’s job from the nurse (bagging the patient) so that the nurse could finally start doing her job. Eventually, the patient turned blue, began sweating, had a critically low oxygen saturation rate of 78%, and underwent a hypoxic arrest (from lack of oxygen). According to the records, it was not until after this period, after the patient “continued to decompensate”, that a code was finally called.

When the anesthesia team finally arrived and checked the airway, the breathing tube was found in the patient’s esophagus. All the while, the patient’s heart beat kept getting lower; from 57 beats to 46 beats, etc. His blood pressure went from 66/44 to not being recorded for 15 minutes. The patient eventually lost his pulse and went into cardiac arrest. Following the arrest and resuscitation efforts, due to the high likelihood of the patient suffering a hypoxic (lack of oxygen) brain injury, the patient was placed in hypothermic cooling. Thereafter, the patient suffered seizures, had an abnormal EEG, had abnormal eye movements, body twitching, and abnormal motor movements, etc.

In fact, during this admission following this event, the hospital’s own neuropsychologist evaluated the patient and diagnosed him with “Status post hypoxic head injury.” The neuropsychologist also concluded that the patient “demonstrated deficits in sustained attention, concentration and memory … his general level of intellectual functioning is well below average …” At the hospital, the patient was again evaluated for cognitive intervention which found his low attention continued to negatively affect auditory processing and that he required frequent redirection and repetition to ensure comprehension of simple questions.

Roughly twenty-three days after this incident, the patient was transferred from this hospital to Healthsouth Harmarville Rehabilitation Hospital for rehabilitation which included speech therapy, occupational therapy, physical therapy, and cognitive training. At Healthsouth, it was noted that the patient had encephalopathy, cognitive delays, left lower facial weakness, and dysarthria (a motor speech disorder resulting from neurological injury). He remained at Healthsouth for nearly one month until his discharge. His discharge diagnosis at Healthsouth included “impaired cognition” and “status post hypoxic arrest with encephalopathy.”

Practically speaking, the defense of this case consisted of the hospital’s insurance lawyer trying to personally smear Mr. Geiger in any way possible, i.e. trying to make admissible as much irrelevant “dirt” as they could find on him to try and convince the jury that this patient was not worthy of a recovery even if the hospital negligently caused him to suffer a brain injury. An example of this was arguing that the patient’s prior sporadic history of marijuana use was relevant to show the jury that Mr. Geiger, a former Marine and laborer by trade, was a bad person and would have not amounted to much in life.

Notably, after suit was filed against the hospital, the hospital’s neuropsychologist was deposed. In his deposition, he testified that his report was incorrect and that the patient really did not suffer a brain injury. He also, coincidentally, testified that the patient’s prior marijuana use was likely the cause of any cognitive deficits that the patient did have.

Prior to trial, the case settled for a substantial amount.