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Suit: Improper injection led to medical crisis, brain damage
DeKalb County, State Court
brain-traumatic brain injury; other-drug overdose; other-loss of consortium; cardiac-heart
Medical Malpractice - Nurse, Hospital, Anesthesiology, Surgical Error, Ear, Nose & Throat, Negligent Injection, Failure to Communicate
Carol Monteagudo and Graham Clemence v. Robert James Burton, Jr., M.D., Ambulatory Anesthesia Alliance of Georgia, LLC, Kingsley N. Chin, M.D., Piedmont Ear Nose Throat & Related Allergy, PC, Dennis Surgical Center, LLC, Carol West, R.N., Amy Tate and ABC Corporation, No. 14A50905-2
August 3, 2016
Graham Clemence (Male, 59 Years),
Carol Monteagudo (Female, 51 Years)
Michael G. Regas II; Houck | Regas | Reynolds; Atlanta, GA, for Graham Clemence, Carol Monteagudo ■ M. Paul Reynolds; Houck | Regas | Reynolds; Atlanta, GA, for Graham Clemence, Carol Monteagudo
Carol West, R.N.,
Kingsley N. Chin, M.D.,
Dennis Surgical Center, LLC,
Robert James Burton, Jr. M.D.,
Ambulatory Anesthesia Alliance of Georgia, LLC,
Piedmont Ear, Nose, Throat & Related Allergy, PC
Daniel J. Huff; Huff, Powell & Bailey LLC; Atlanta, GA, for Robert James Burton, Jr. M.D., Ambulatory Anesthesia Alliance of Georgia, LLC ■ None reported; for ABC Corporation ■ Matthew F. Barr; Hawkins Parnell Thackston & Young LLP; Atlanta, GA, for Carol West, R.N., Dennis Surgical Center, LLC ■ L. Evan Cline; Huff, Powell & Bailey LLC; Atlanta, GA, for Robert James Burton, Jr. M.D., Ambulatory Anesthesia Alliance of Georgia, LLC ■ Paul E. Weathington; Weathington Smith, PC; Atlanta, GA, for Kingsley N. Chin, M.D., Piedmont Ear, Nose, Throat & Related Allergy, PC ■ Tracy M. Baker; Weathington Smith, PC; Atlanta, GA, for Kingsley N. Chin, M.D., Piedmont Ear, Nose, Throat & Related Allergy, PC ■ Gregory S. Ellington; Hall Booth Smith, PC; Columbus, GA, for Amy Tate, Carol West, R.N., Dennis Surgical Center, LLC ■ Sherrie M. Brady; Hawkins Parnell Thackston & Young LLP; Atlanta, GA, for Carol West, R.N., Dennis Surgical Center, LLC
Preferred Physicians Medical Risk Retention Group, Inc. for Burton/Ambulatory Anesthia Alliance; Lexington Insurance Co. for West/Dennis Surgical Center, Tate; Chattahoochee Risk Retention Group Captive Insurance Co. for Chin/Piedmont Ear, Nose, Throat
On April 12, 2012, plaintiff Carol Monteagudo, 51, a homemaker, presented to Dennis Surgical Center, LLC for septoplasty with bilateral inferior turbinate reduction for the treatment of chronic nasal congestion. The procedure had been recommended by Monteagudo's treating otolaryngologist, Kingsley N. Chin, M.D. The surgical team consisted of Chin, anesthesiologist Robert James Burton, Jr., M.D., circulating nurse Carol West, and scrub technician Amy Tate. West and Tate were employees of Dennis Surgical Center. In preparation for the procedure, West prepared three injections, allegedly on orders from Chin. One of those injections was a topical Epinephrine/saline solution used for hemostasis, instead of the normal one-percent Lidocaine (with a 1:100,000 concentration of Epinephrine). The evidence was unclear as to whether the syringes were relayed through Tate or placed directly onto the sterile MAYO stand. Regardless, Chin administered the topical Epinephrine/saline solution, which led to a precipitous and dangerous rise in Monteagudo's blood pressure and heart rate during the procedure. Burton administered Labetalol and increased delivery of anesthetic gases to control the patient's blood pressure. The drugs caused the patient's blood pressure to drop and she became hypotensive, which necessitated administration of Ephedrine to raise her blood pressure. Neither Burton nor West communicated these events to Chin, who was unaware of any blood pressure problems. Monteagudo awoke from anesthesia screaming. She was not responsive to verbal commands and her eyes deviated up and to the left. She was unable to make eye contact or identify her husband's name. She was transferred to emergency for treatment of her symptoms and was later diagnosed with cardiac stunning and resulting acute congestive heart failure. She was subsequently determined to have a mild hypoxic brain injury characterized by short-term memory loss. Monteagudo filed suit against Chin, Burton, West, Tate, Dennis Surgery Center and the doctors' practices, alleging medical malpractice. Chin settled for a confidential amount prior to trial. However, Chin remained in the case as an apportionment defendant. Monteagudo alleged that the medical team failed to communicate with one another, which led to the administration of an improper solution. West reportedly testified that she mixed the solution as requested by Chin, even though it was not the concentration normally used. She documented the mixture on the operative notes, which, per Monteagudo, were not read by Chin until several weeks after the procedure. Chin denied giving the order and testified that he ordered the usual one-percent Lidocaine with Epinephrine. According to Monteagudo, the syringes prepared by West were used by Chin without confirmation as to what they contained. Monteagudo argued that Chin breached the standard of care by ordering use of the Epinephrine solution or in failing to appropriately communicate and confirm the oral medication orders given to West. Monteagudo further alleged that Burton should have known what drugs were being administered to the patient during the procedure; West should have been aware of the dangers associated with injected Epinephrine; West should have confirmed the use of the Epinephrine order; and West should have alerted the doctors to the solution they were using. Additionally, Monteagudo alleged that Tate should have confirmed the unlabeled medication when it was placed in the sterile field. Monteagudo argued that the combined failure of the team to communicate with one another resulted in Monteagudo's injuries. Prior to settling, Chin had contended that he did not order the overdose mixture and that West did not prepare/provide the proper injection. Burton argued that injections given by the surgeon were not his responsibility and that he appropriately responded to the crisis, but did not cause it. West argued that she mixed the injection as ordered by Chin and was not responsible for his order. Tate denied any responsibility for the patient's injuries.
Monteagudo suffered cardiac stunning with resulting acute congestive heart failure and mild cognitive brain injury following septoplasty. Monteagudo sought $79,000 in medicals, as well as damages for pain and suffering. Her spouse, Graham Clemence, sought damages for loss of consortium. The defense argued that Monteagudo exaggerated her residuals and that her memory loss was due to natural factors.
The jury determined that the plaintiff's damages totaled $500,000, with 70-percent liability attributed to West, Tate and Dennis Surgical Center and 30-percent liability attributed to Chin. The verdict was reduced to $350,000 to reflect the apportionment of liability against West, Tate and Dennis Surgical Center since Chin had been previously dismissed. Burton was found not negligent and received a defense verdict.
Carol Monteagudo: $500,000 Personal Injury: damages
There was no appeal. The judgment was paid and this case is closed.
This report is based on information that was provided by plaintiffs' counsel.