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H. H. v Sharp Healthcare

Dr. Fagel achieved a settlement of $2 million on behalf of a 59 year old male who suffered a wrongful death as a result of asphyxia, causing a lack of oxygen to his heart. Mr. Houtkin was admitted to the Sharp-Grossmont Hospital and diagnosed with acute peritonsillar abscess. The ENT surgeon and Dr. Mohedin initially discussed their concerns regarding possible airway obstruction and decided that Mr. Houtkin should be moved from the Post Anesthesia Care Unit to the Surgical Intensive Care Unit after surgery. Additionally, the pair decided that Mr. Houtkin should be monitored for at least 10-12 hours after the surgery.

The asphyxia which led to his death began while Mr. Houtkin was at in the PACU. Several signs of asphyxia went unnoticed by the medical staff who merely increased pain medication dosages to further sedate the patient. Before the surgery started, it was recognized by the staff that Mr. Houtkin may experience problems maintaining open and stable pathways. If blocked, these pathways would prevent him from breathing. The anesthesiologist and the ENT surgeon were able to place an ETT through his nose; however, they did not adequately stabilize the ETT for the necessary amount of time following surgery. Additionally, approximately 2 1/2 hours after the surgery, RT Simon moved the ETT without notifying any physician or any consideration for the bleeding that was currently occurring in the patients' hypopharynx.

Additionally, the medical staff failed to suction properly. The only time that suctioning was performed through the ETT was after RCP Grimm noted a rise in inspiratory pressure. The suctioning revealed blood and clots in the ETT. Since the surgical site in the hypopharnyx was the only source of blood within the surgical site, the sole explanation for how blood and clots could be suctioned from the ETT was that blood seeped past the tip of the ETT and blocked the airways. Nurse Brown, who oversaw the entirety of this episode, never contacted any physician. Although Dr. Mohedin was down the hall, Nurse Brown failed to report any breathing concerns. Crucially, Nurse Brown was not certified by the American Society of PeriAnestesthia Nurses, but was nevertheless assigned to care for Mr. Houtkin as she was the only nurse in the PACU unit.

Mr. Houtkin was moved to the SICU in unstable condition. Upon arrival, the patient "coughed up" a large blood clot and a Code Blue was declared. A cuffed tube was placed into the trachea, but there were still blood clots in the trachea. Additionally, Dr. Mohedin was unable to place a new ETT through the patient's mouth, because blood clots obscured vocal cord visibility. In the absence of any effective ventilation, Houtkin's cardiac activity slowly shut down.