Boston Partner, Joe Flanagan, recently obtained a defendant’s verdict for a physician in a medical malpractice case in Middlesex Superior Court. The 72 year old female patient had recently received chemotherapy for Hodgkins lymphoma and had an excellent prognosis. She was admitted to the hospital for sudden onset of nausea, vomiting, and fever. Although she initially showed signs of improvement, two days later her heart and respiration rates suddenly increased and her oxygen saturations decreased. Our client hospitalist ordered that oxygen be administered by BiPAP machine (bi-level positive airway pressure) which necessitated placement of a tight-fitting mask over the patient’s nose and mouth. He gave this order notwithstanding the patient’s history vomiting throughout her stay and as recent as two hours earlier. Unfortunately, the patient again vomited while wearing the mask an hour later and aspirated a large amount of emesis which caused severely impaired breathing, drastic reduction in oxygen saturations, and, allegedly, brain damage. She died a week later of sepsis. The plaintiff alleged that there were a number of other ways to oxygenate the patient without incurring the risk of aspiration in a patient with recent nausea and vomiting.
We established that the doctor made a reasonable decision to order BiPAP because the only reasonable alternative, endotracheal intubation, carried a number of risks. Joe also established through expert testimony that the patient actually suffered from a severe undiagnosed pulmonary condition called Acute Respiratory Distress Syndrome which would have been fatal even had the subject aspiration event not occurred. Finally, Joe presented the testimony of an oncologist that the patient’s once favorable prognosis for recovery from lymphoma had turned bleak in light of the patient’s inability to fight infection. Indeed, the symptoms that resulted in her hospital admission were caused by undiagnosed sepsis which manifested itself on the evening in question.