Risk Management

Fire in the Operating Room

By Ryan Bucsi, OMIC Senior Litigation Analyst

Digest, Summer 2006

ALLEGATION Facial burns from a fire in the operating room.

DISPOSITION Plaintiff verdict and subsequent post- trial settlement of $430,000.

Case Summary

An OMIC insured scheduled a repair for a patient with extreme ptosis on the right side under local anesthesia. The patient’s nose and chin were fully draped, and the anesthesiologist was administering oxygen via a mask. The ophthalmologist performed the initial incision and then proceeded to use cautery to achieve hemostasis, sparking a fire. The OMIC insured placed pressure on both eyes, removed the surgical drapes, and splashed water on the patient’s face while the nurses and anesthesiologist put out the fire. The surgical wound was sutured by the OMIC insured without performing the ptosis repair. The patient was transferred to the burn unit with first and second degree burns over her lips, the medial aspect of the cheeks, chin, paranasal region, right ear, right lateral neck, and posterior neck. The patient did not lose consciousness during the fire and remained in stable condition. The discharge note stated a diagnosis of 1% total body surface area partial- thickness burns to multiple areas of the face, adjustment disorder with mixed emotional response, and acute post-traumatic stress disorder.

Analysis

Once the fire was recognized, all members of the surgical team did all they could to care for the patient. Unfortunately, the patient not only suffered physical injuries requiring plastic surgery, she was unable to work as a result of post-traumatic stress disorder, severe depression, anxiety, and trauma. The loss of income and necessary psychiatric care greatly increased the economic damages she claimed in her lawsuit and made her allegation that the fire should have been prevented all the more compelling. When plaintiff and defense experts reviewed the care, they both criticized the poor communication between the ophthalmologist and anesthesiologist. The OMIC insured testified that he had a standing order with the facility for no oxygen during ptosis repairs; despite extensive searching, no such document could be found. The ophthalmologist acknowledged that he did not remind the anesthesiologist beforehand not to administer oxygen during the procedure or notify him that he was about to use the cautery. Instead, he assumed that the anesthesiologist would automatically turn off the oxygen and switch the patient to air. The plaintiff’s anesthesiology expert testified that the surgeon must either warn of impending cautery use or the anesthesiologist must ask whether any is planned. Other factors con- tributed to the risk of a surgical fire. Hospital staff testified that the surgeon used a pencil cautery, which does not allow for voltage control. Another expert pointed out that regard- less of the type of cautery, by fully draping the patient’s head, the surgeon allowed oxygen to accumulate below the drapes and ignite once the cautery was used.

Given the lack of support and substantial economic damages, OMIC and the surgeon’s attorney urged the insured to make a settlement offer in response to the plaintiff’s global demand of both defendants of $299,999. Despite this advice, the ophthalmologist was unwilling to offer more than $29,000, which would keep him below his state’s threshold for reporting an indemnity payment. Accordingly, the case was taken to trial, where the jury found in favor of the plaintiff against both defendants, with the ophthalmologist 80% and the anesthesologist 20% responsible for the outcome. Although the jury awarded a total of $474,994, state law allowed the plaintiff to recover both interest and the cost of the lawsuit, including expert fees. These added costs significantly raised the award, making the OMIC insured alone responsible for $439,325. OMIC was able to settle the case after the trial for $430,000.

Risk Management Principles

As this case demonstrates, surgical fires are difficult to defend. While OMIC has not had many such cases, we have had to settle all five of them, with payments ranging from $10,000 to $430,000. Just because a complication of surgery is extremely rare does not mean that proper precautions should not be taken to decrease the risk. Please see the Risk Management Hotline article in this issue for information on how to prevent surgical fires.