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News: The patient, a 55-year-old woman, underwent surgery to have polyps removed from her vocal cords. The procedure took place at a hospital and was supposed to take only about 10 minutes, with the patient able to return home the same day. However, during the procedure, the surgeon’s laser came into contact with the tube placed inside the patient’s airway. This tube caught fire and began to burn inside the patient’s throat, which caused serious injuries including leaving the patient unable to speak. The patient was moved to a different hospital, where she underwent extensive care and numerous surgeries over more than three months. The patient brought suit against the initial hospital, the hospital’s healthcare system, surgeon, and anesthesiologist, and argued that multiple oversights and errors caused the fire. The defendants denied any responsibility. The hospital settled for $12 million, and the jury returned a verdict for an additional $18 million.
Background: In this matter, the patient was a 55-year-old woman who underwent laser surgery at a hospital to have polyps removed from her vocal cords. During the procedure, the surgeon’s laser came into contact with the breathing tube used to supply the patient with pure oxygen while she was under anesthesia. The laser acted as an ignition source, and combined with the pure oxygen source from the tube, a fire began in the patient’s throat. This fire caused the tube itself to burn, which resulted in severe damage to the patient’s throat. The patient was quickly flown to a different hospital. She stayed in intensive care and went through multiple surgeries in an attempt to repair the damage. The patient stayed at this second hospital for more than three months on a ventilator recovering from her injuries. The seriousness of the injuries will require long-term care, as the patient still needs assistance breathing.
The patient brought suit against several parties involved in the accident: the initial hospital, the hospital’s healthcare system, the surgeon, the anesthesiologist, and the manufacturer of the air tube that caught fire. The patient alleged that all the parties were negligent and at fault for causing the fire and that failures on multiple levels created the catastrophic event. Initially, the surgeon erred when first firing the laser and missed his intended target. The anesthesiologist also was allegedly at fault for using pure oxygen rather than regular air, because pure oxygen is more flammable. The physicians blamed the hospital for providing only single-cuff tubes rather than the typical double-cuff tubes used for these procedures. Furthermore, the physicians and patient alleged that the manufacturer was at fault for failing to provide warning of similar fires and that the single-cuff tube design was faulty. After a seven-week trial, the jury deliberated for a day and a half. It ultimately found that the anesthesiologist was 52.5% at fault, the surgeon 42.5% at fault, and the hospital 5% at fault; it did not find the manufacturer to be negligent. The hospital settled, prior to the verdict, for $12 million, and the jury awarded an additional $18 million in damages.
What this means to you: Patient safety must be a top priority at hospitals. There are innumerable ways in which a patient might be threatened or harmed based on events common or uncommon. This case shows a possible catastrophic event that might occur and cause serious harm to a patient, given the right, although unlikely, circumstances. Hospitals and providers should have precautions in place in case of emergencies such as the one here. One thing that the individuals did properly in this case was taking extraordinary efforts to help the patient once the damage was done. Quick action is necessary to prevent injuries from becoming worse, which is a possibility in an emergency situation.
Precautions and emergency plans will help hospitals and providers to prepare their employees for situations that might not be expected. Having general strategies in place will help protect patients from injury and the hospital from subsequent liability. Many hospitals have emergency preparedness plans for situations involving mass casualties, natural disasters, chemical emergencies, etc., but hospitals should provide guidelines to their employees regarding smaller-scale emergencies as well, such as those for a single patient. Physicians and nurses need to be prepared for the worst and know what to do if that occurs. Information on who to contact in an emergency is critical, and this information should be widespread throughout a hospital. If an individual does not know what to do, then that individual should, at a minimum, know who he or she should contact in an emergency.
Multiple parties might contribute to a single event’s cause, and some or even all might be at fault for any injuries incurred. Causation plays an important role in medical malpractice cases, as the negligent action must be specifically linked to the injury suffered for the actor to be found liable of negligence. If a hospital acts improperly, but the action does not actually, in fact, cause the harm, then it cannot be found guilty of negligence. For a situation that involves multiple parties, any individual party might be partially at fault. A single party’s action does not have to be the "but-for" cause of the injury, however, for it to be liable. A situation might occur where two parties act improperly, but the injury is only caused by the compounded action of both parties: The injury would not have been caused by the first party’s improper action or the second party’s improper action, but the two combined cause the result. In this case, both parties can be found liable, as their actions caused the injury, despite the fact that another actor also was required to cause the harm. Hospitals thus might be liable in cases of negligence even if their action alone would not have caused the injury. If it contributed to the injury, along with another individual’s improper action, to cause the harm, liability may be found.
Hospitals should encourage physicians, nurses, and staff to immediately speak up if there is any concern about a patient’s safety or quality of care. There need to be processes to report mistakes, no matter how small, to encourage supervision and oversight. The patient’s care is the top priority, so this must care be given preference over an individual being concerned with a superior treating them disfavorably for reporting mistakes.
Hospitals encouraging this type of reporting might consider protecting such internal whistleblowers from reprimands by their superiors. Mistakes happen, even at the best hospitals, so this type of reporting is essential everywhere. Internal oversight is an important feature for hospitals, and it offers strong protection when viewed in a subsequent litigation. If a mistake occurs, hospitals can protect themselves by having proper procedures in place for reporting these mistakes and correcting them promptly. A hospital that ignores problems, instead of acknowledging mistakes and taking affirmative efforts to prevent future mistakes, might be more likely to be found negligent.
Working with especially dangerous instruments requires extra caution and training, which hospitals should provide to those working with such devices. Note that surgical fires are a constant threat when electrical equipment is used close to a source of high concentrations of O2. The humidity of the OR itself must be high enough to ensure an environment that will not promote arcing or sparking. The lowest concentration of O2 should be used when the electrical equipment will be in very close contact with the oxygen.
As technology becomes increasingly advanced and prevalent in the medical field, so too must education and training. Laser surgery is far from novel, but poses different, potentially more serious, harms than the traditional scalpel counterpart. Robotic surgery is an even more advanced field, and the liability stemming from these raises even more concerns for hospitals, particularly as these robots, such as the da Vinci Surgical System, use proprietary software that may not be modified by surgeons.
Regardless of the specific type of instrument used, hospitals must ensure that their surgeons are properly trained for the intended instrument, to prevent liability. If a hospital allows an untrained physician to use sophisticated medical equipment, this situation might bring rise to a claim of negligence against the hospital for failure to properly oversee its professionals.