Anesthesia Group Must Pay Up After Patient Bleeds Out in Recovery

A hernia repair patient suffered from internal bleeding in PACU for more than 2 hours before undergoing emergency surgery.

An anesthesiologist is liable for the death of a woman who bled out in PACU after undergoing a hernia repair, an Illinois appellate court recently ruled, leaving the doctor’s anesthesia group on the hook for a multi-million dollar verdict granted during a previous trial.

The appellate court affirmed a lower court’s decision that Anesthesia Associates in DeKalb, Ill. — the group anesthesiologist Mark Nessim, MD, JD, belongs to — is responsible for the 2010 death of Gloria J. Ormond. Ms. Ormond, 57, died after undergoing hernia repair surgery and suffering from internal bleeding in PACU that clinicians failed to recognize in time.

Ms. Ormond was admitted to the Kishwaukee Community Hospital for laparoscopic hiatal hernia repair in October 2010, according to the lawsuit. The surgery went as planned, court records state, and Ms. Ormond was then admitted to PACU. In PACU, Dr. Nessim was in charge of her care while a PACU nurse monitored her.

Almost immediately after entering the PACU, the nurse noticed that Ms. Ormond’s blood pressure was dropping. She called Dr. Nessim, who was with another patient at that time. He told the nurse to give Ms. Ormond IV fluids and 10 mg of ephedrine.

But Ms. Ormond’s blood pressure continued to drop. The nurse called Dr. Nessim again a few minutes later, records state, and he ordered another 50 mg of ephedrine. In court documents, Dr. Nessim said he believed Ms. Ormond’s blood pressure was low because she was taking high blood pressure medication pre-operatively, which can lower a patient’s post-op blood pressure when combined with anesthesia.

Despite the 2 ephedrine doses, Ms. Ormond’s blood pressure continued to drop. After the nurse called him a third time, Dr. Nessim came down to PACU and administered a dose of vasopressin and then a dose of Neo-Synephrine, court documents state. Both medications failed to raise Ms. Ormond’s blood pressure.

Seeing that her condition was worsening, Dr. Nessim told the nurse to call the on-call surgeon, who ordered a complete blood count, a comprehensive metabolic panel and chest x-rays. However, after this initial call, Dr. Nessim told the nurse to call the surgeon again and have him come down to PACU immediately.

In between this last phone call and the surgeon arriving, Ms. Ormond lost consciousness, court records say. The surgeon arrived and took Ms. Ormond into emergency surgery, where he found that a pulsatile arterial bleed had filled her abdomen with blood. Although he was able to stop the arterial bleed, she lost so much blood that she then experienced disseminated intravascular coagulation and was spontaneously bleeding from multiple locations, records state. She was placed on life support and died the next day.

Ms. Ormond’s daughter filed a lawsuit on behalf of her mother’s estate, claiming that the hospital’s clinicians and anesthesia providers were negligent in their care. A jury ruled in favor of Ms. Ormond and awarded her estate $4.3 million. After the ruling, the Kishwaukee Community Hospital settled with the estate for $2.4 million. However, Anesthesia Associates appealed the verdict, saying its providers followed the standard of care and calling the award “excessive.”

An appellate court, though, affirmed the lower court’s ruling last week, which means the group is now responsible for the multi-million dollar verdict, though it was not immediately apparent how much of the original $4.3 million award the group must pay. Representatives for Dr. Nessim, Anesthesia Associates and the Kishwaukee Community Hospital did not return requests for comment.