Respiratory Failure

The mother heard speaking in the above ad was present when a teenage driver recklessly careened down a quiet street striking her young son.  The teen pulled into the nearby driveway of his home not even having realized he had hit and dragged the child.  Miraculously, the child had only suffered severe scrapes and bruises.

The child was promptly taken to an emergency department of a large teaching hospital where a thorough survey confirmed the child had suffered no head injury or internal injury and the family was relieved.   During the course of the various studies that were performed an endotracheal tube was inserted through the child’s mouth and into his airway to assure control over the child’s breathing should an, as yet, undetected injury to the lung or the space surrounding the lung be present.  Because the child naturally resisted having a tube in his throat and respirator breathing for him, the child was chemically paralyzed so that he could not interfere with the respirator breathing for him.  Though by end of day the tests were all negative the tube and respirator were left in place.

The child was transferred out of the emergency department to a monitored unit with the plan being that the tube and ventilator be removed the next morning.

That night, while a physician was teaching a less experienced resident physician to perform a procedure on the child the tubing connecting the respirator to the endotracheal tube in the child was unintentionally bumped by the doctors and the endotracheal tube was displaced such that the respirator was no longer ventilating the child.  This event went unrecognized because alarms on the ventilator designed to warn immediately and loudly of the occurrence of such an event had been turned off.  The disconnect was not therefore discovered until the child was virtually in cardiac arrest.  Though the child survived following resuscitation, brain injury which resulted from the tube displacement and ensuing respiratory failure left him initially comatose.

The child’s mom and dad though present in the hospital were not in their child’s room when this catastrophe occurred.  When they saw their son the next day they weren’t alarmed that he wasn’t moving because they knew he was chemically paralyzed.  Excuses were given for why the child wasn’t removed from the ventilator that day and required continuation of the paralytic drugs for another day or so.  Then the paralytic drugs were removed and the child was successfully able to be removed from the ventilator and have his endotracheal tube removed and he breathed on his own.  He did not however wake up until much later.

Doctors provided the family with no explanation for why their child who had been admitted for bumps and bruises was now in coma.  The delayed resuscitation of their child and the physicians’ role in unintentionally displacing the endotracheal tube was not disclosed.

These unique circumstances led the parents to contact a lawyer.  I had the privilege of being the lawyer who was contacted.  My investigation revealed that the child had an unexplained need for a resuscitation because of an allegedly sudden drop of oxygen levels in his blood which coincidentally occurred at the same time that the child’s endotracheal tube suddenly became displaced for no particular reason.  Being a former respiratory therapist who had worked with respirator-dependent patients for many years, I was well aware that, in this child who had no lung disease or lung injury, there would not have been any sudden drop in his oxygen level from a displacement of an endotracheal tube because such a displacement would be immediately recognized if the alarms were properly set.

Eventually, I was able to discover and establish that the airway accident was easily avoided and that improper monitoring had led to such a delay in the recognition that a tube displacement had occurred.  The child was needlessly suffocated and anoxic brain damage had occurred.

Because of requirements of confidentiality imposed by a state agency on all medical malpractice cases, I am unable to report the means by which I was able to discover and prove the truth.  Similar confidentially requirements also prevent me from reporting the method or means by which we were able to help this child and his family meet the many economic and other challenges they faced.

This story is just one of many such stories untold.  Regrettably, because so many of these stories are untold, many victims of malpractice are unaware of what happens and where it happens and that it happens in every hospital.

When unexpected tragedies occur and doctors have inadequate or suspicious explanations, an experienced lawyer may be the only way victims can ever discover the truth.  By then taking action victims are no longer powerless.  Indeed, they help make the healthcare system better.  After all, you cannot fix something you don’t think is broken.

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If Mothers Only Knew

by Jerry Meyers on July 20, 2009

In an opinion piece published in the June issue of the American Journal of Obstetrics and Gynecology, Dr. Dwight J. Rouse from the Center of Women’s Reproductive Health at the University of Alabama at Birmingham, suggests that a thousand fewer children each year would suffer from handicapping cerebral palsy if magnesium sulfate were uniformly administered to mothers prior to delivery of children born prematurely at 32 weeks gestation or sooner.

Indeed, a debate has been ongoing about the use of magnesium sulfate to lower the risk of cerebral palsy for many years.  Between 2003 and 2008 three large studies of magnesium sulfate used to protect the infant brain were reported.  Individually and collectively the results of the studies justify the administration of magnesium sulfate to pregnant women threatening delivery prior to 32 weeks to protect their babies who survive their preterm birth from developing cerebral palsy.

In spite of the published studies and the opinion piece by Dr. Rouse and others, magnesium sulfate remains, “unproven” and its use is not the standard of practice for preventing cerebral palsy though it is regularly used by obstetricians for the treatment of other conditions.

Where are the voices of mothers and mothers to be in this debate.  For those who know the hardships faced by children with cerebral palsy and their families, the lack of action by leaders in obstetrics to bring about a change is inexplicable but not uncommon.

Many children died needlessly from neonatal respiratory distress syndrome during the 22 year period between the first individual trial which demonstrated in 1972 that steroids given to the mother prior to birth would be effective in preventing the syndrome until 1994 when the National Institutes of Health consensus guidelines were published making the administration of steroids prior to early preterm birth standard.

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