Legal Pearls: Hospital Unprepared to Handle Emergency Reaction

This month we look at a case that should never have happened. While one could say this about most medical malpractice or negligence cases, this one takes it a step further–a hospital and doctors unprepared to handle a medical emergency, resulting in a patient’s devastating cardiac arrest and brain damage.

Clinical Scenario

A 41-year-old man went to his local hospital for an MRI on the advice of his doctor. He had been experiencing lower back pain, and his physician ordered an MRI with gadolinium to improve contrast.

On the date of the MRI, a radiology technologist was tending to the patient in the radiology room when she realized that he was having trouble breathing—an allergic reaction to the gadolinium. There was no alarm or call button in the area where the patient was. The tech had to leave the patient and run to the room’s control center to activate the alarm. When it appeared nothing was happening, and she feared the alarm had not gone off, she ran into the hall and yelled for help.

The supervising radiologist heard the tech’s cries for help and sprinted in. When he saw the patient’s condition, he immediately ran out again and rushed to the emergency department (ED), which was about 60 feet down the hall. In the ED, the physician found the emergency room medical director standing on a chair, looking perplexed, trying to figure out where the alarm sound was coming from. The ED medical director had no training on the alarm and did not recognize the sound made by the alert from the MRI room control center.

“Come with me!” the radiologist called to the ED director, and both physicians went back to the MRI room, where the patient’s heart had stopped beating. The ED medical director called for the patient to be moved down the hall to the emergency department. In the ED, the staff were able to get the patient’s heart started again, but the cardiac arrest and lack of oxygen had resulted in brain damage. The patient was left unable to care for himself and reliant on care from his parents and hired help.

His parents sought counsel of a plaintiff’s attorney and sued the hospital and the supervising radiologist. The ED physician was also named in the lawsuit, but was later dropped.

The Trial

The case went to a jury trial. The plaintiff’s attorney told the jury that the patient would require round-the-clock supervision for the rest of his life. He would never be able to work again. His future medical expenses would be significant.

The radiology tech was called to testify. In answer to questions, she told the jury that the MRI room did not contain an emergency drug box with epinephrine. She recollected asking about the need for an emergency box when she was hired but was told that it was not needed since the emergency department was so close in proximity. She also told the jury that she would not have been allowed to administer the epinephrine, even if it were there.

The plaintiff’s attorney argued that there should have been an emergency box in the MRI room, and that once the adverse reaction happened, there should have been swift action. “The tech should not have had to leave the patient alone and run out into the hallway for help,” argued the attorney. “The supervising radiologist should similarly not have left the patient and run out of the room, down the hall for help. He should have been helped immediately.”      

The plaintiff introduced a physician who testified about how he had used epinephrine to successfully treat one of his patients who had experienced an allergic reaction. “They wasted precious time in this case,” testified the physician.  

A defense expert testified about the rarity of gadolinium adverse events, noting that the most common are nausea and vomiting. The defense argued that the hospital’s layout was actually beneficial because the emergency department was so close to the MRI room–only 63 feet away. In response to accusations that the supervising radiologist should have administered epinephrine immediately, rather than summoning the medical director, the defense countered that neither physician would have administered epinephrine without additional assessment.

The nail in the coffin of the defense’s case was when the plaintiff’s attorney showed the jury a copy of the hospital’s own standards of practice, indicating that an emergency drug box should be in every room where intravenous fluids are administered.

“Were the hospital and doctors as careful as they should have been?” asked the plaintiff’s attorney. The jury answered that question with a resounding “no” when it returned a verdict holding the hospital and the radiologist liable. The jury awarded a total of $10.83 million to the patient, with a large portion of the award (over $6 million) for future medical expenses and care. The jury apportioned 75% of the damages to the hospital and 25% to the radiologist.

The Takeaway

There’s a Mel Brooks song with the title “Hope for the Best (Expect the Worst)” which is very apt here. In this case a better version might be “hope for the best, prepare for the worst.” Yes, gadolinium adverse reactions of this sort are rare, but not unheard of. From the start, it was clear that the hospital was not prepared: the hospital had ignored its own policy requiring emergency drug boxes wherever intravenous fluids are administered. It had relied on the idea that the physical proximity of the MRI room to the ED would be sufficient. The alarm system was poorly thought out and had never been explained to the head of the ED, necessitating someone leaving the patient alone in order to call for help. It was a failure on many levels.

Bottom Line—Prepare for the worst. Ensure you have what you need in case of an emergency, even a rare one. Make sure your place of employment is following its own guidelines. Understand how the alarm system works, and what is the fastest way to call for help in an emergency. Then, and only then, can you hope for the best.  

Ann W. Latner, JD, is a freelance writer and attorney based in New York. She was formerly the director of periodicals at the American Pharmacists Association and editor of Pharmacy Times.