Last month, a Pennsylvanian jury was asked to decide a medical malpractice lawsuit in which an eleven month old boy allegedly suffered brain damage following surgery for sleep apnea. The suit alleged the surgeon failed to properly assess the boy after surgery and order that his oxygen levels be monitored in recovery. The jury agreed and returned a $1.1 million dollar verdict in his favor and against the surgeon.
Although everyone has brief pauses in breathing during sleep, sleep apnea is a potentially serious sleep disorder where breathing periodically stops for prolonged periods of time. Although more commonly diagnosed in adults, sleep apnea can occur in children as well. There are three types of sleep apnea that can impact children. The most common form of sleep apnea in children is "obstructive apnea" in which apnea is caused by an airway obstruction like enlarged tonsils and/or adenoids. The symptoms of obstructive apnea may include snoring followed by gasping, labored breathing while sleeping, restless sleep and sleeping in unusual positions, and daytime sleepiness or behavioral problems. It is estimated that 1% to 3% of pre-school aged children have obstructive apnea. The treatment for this condition can involve keeping the throat open to assist airflow, surgically removing the tonsils and adenoids, or continuous positive airway pressure (or CPAP) where the patient wears a special mask during sleep. "Central apnea" occurs when the area of the brain that controls breathing does not function properly such as in severely premature infants. "Mixed apnea" is a combination of obstructive and central apnea which can occur when the child is asleep or awake.
When surgery is indicated for obstructive apnea, complications are rare. However, as the Pennsylvania case shows, even rare complications can occur and the consequences can be devastating. According to the medical malpractice lawsuit, the surgeon determined the 11 month old had obstructive apnea and recommended surgery. The lawsuit did not criticize the decision to perform surgery but, rather, how the post-operative care was managed. Specifically, the lawsuit alleged the surgeon failed to recognize the boy's preexisting condition placed him at increased risk of respiratory complications immediately after surgery. Based on this increased risk, the boy's medical malpractice lawyer alleged the standard of care required the surgeon to order that the little boy's oxygen levels be monitored after surgery. This was not done. As a result, the little boy was not monitored and lost both a heartbeat and pulse until someone finally realized he was not breathing.
After finding the surgeon negligent in failing to order the boy be properly monitored after surgery, the jury was asked to determine whether this medical negligence caused the child to suffer brain damage. This is called "causation" or "proximate cause." Indeed, in many medical malpractice cases, the hardest element to prove is often whether the medical mistake proximately caused the injury. In this case, the jury determined causation was proven by finding the child would not have suffered brain damage had the child been properly monitored. Ultimately, the jury awarded $1.1 million.
The Patriot-News, Harrisburg-area Child Awarded $1.1 Million In Medical Malpractice Lawsuit, June 20, 2012.
Kidshealth.org, Sleep Apnea, Viewed July 22, 2012
Mayo Clinic, Sleep Apnea, Viewed July 22, 2012.