Anesthesiologist blamed in death of mother, fetus

(Editor's note: In this month's issue, we profile a legal case that could have ramifications for your women's health program. The case revolves around a health care facility's credentialing process and resulted in a $10 million settlement.)

By Pearl Schaikewitz, JD

Legal Consultant, Atlanta

The family of a mother and her unborn baby, both of whom died when an allegedly drug-impaired anesthesiologist pierced the vena cava while trying to administer an epidural anesthetic, has settled a lawsuit for $10.5 million.

The 20-year-old woman presented to the hospital in labor in July 1995. The anesthesiologist's first attempt to administer an epidural anesthetic failed. Expert testimony established that during the second attempt, the anesthesiologist failed to inject the anesthesia into the epidural space in the spinal canal. The epidural catheter missed the spinal column entirely and pierced the vena cava, delivering the anesthetic agent ultimately to the heart and brain. Both the mother and her baby died.

The woman's family claimed that while trying to resuscitate the mother, no one attempted to deliver the baby, and none of the physicians present was qualified to perform a cesarean. The family also alleged that the anesthesiologist had a history of "possible impairment," which the hospital's anesthesia service knew about for nearly five months before this incident happened.

The anesthesiologist had listed two of his partners and the director of the anesthesia service - all of whom knew about his alleged drug abuse - as references on his application for temporary staff privileges. Those references were not contacted until three days after the episode. The hospital had granted the anesthesiologist staff privileges initially for 90 days and then renewed them for an additional 90 days. Those actions violated the hospital's bylaws.

Apparently, the anesthesiologist had admitted his drug problem in a letter to a former girlfriend. In addition to the monetary settlement, changes were mandated in the hospital's policies and procedures, including requiring hospital-based phy sicians to submit to random drug testing and improving training for obstetrical nurses. The hospital's owner decided to close the facility.

The fact that this health care facility had a credentialing process that permitted an anesthesiologist to enter the clinical area without having any of his references checked is extremely worrisome, says Beverly Gordon, RN, ASHRM, director of risk management for Memorial Hospital in Chattanooga, TN.

This would not have occurred at her institution, Gordon says. "No anesthesiologist could become a member of our staff unless we first obtained verified references. Moreover, our bylaws require the applicant to submit a statement that he or she has no physical or mental impairments that will interfere with his or her ability to exercise any of the privileges requested. There must be no pending challenges to the applicant's licensure or registration, as well as no loss of medical staff privileges at another hospital, among other things."

For temporary privileges, get references

Gordon explains that not even temporary staff privileges could be granted at her facility without securing verified references, and such privileges could be granted at her facility only for specific patients or specific procedures. Also, her hospital's bylaws provide that the provisional staff application must be completed and approved by the credentials committee within 90 days, or the privileges will be terminated automatically.

Examining her hospital's bylaws and considering its rigorous credentialing process leads Gordon to wonder what kinds of policies and procedures the facility in this case had and how and why it apparently skirted them.

"If the anesthesiologist was being hired as an employee, what were the employee guidelines in the hospital - such as drug screens - that were bypassed in their apparent haste to get this anesthesiologist on staff? Was the national practitioner databank checked to determine whether there had been any prior abuses?" she asks.

She also wonders whether there had been any other incidents in peer review. "A drug-abusing anesthesiologist tends to exhibit bizarre behavior, and this kind of incident normally is not the first. Did this anesthesiologist commit prior breaches of duty that were observed but not reported? Did this hospital discourage reporting of that kind? In my institution, if a physician was abusing drugs, people would have reported him."

Finally, she asks why an obstetrician was not on call to perform a cesarean. "Surely someone should have been available to save the baby," she says.

Reference

Glickman v. South Park Medical Center, Dunn, and B. G. Anesthesia, PLLC., 99th Judicial District (TX) District Court.