Anesthesia Errors and Wrongful Death in Pennsylvania

But anesthesia errors still occur. And when they do, the consequences are frequently catastrophic — brain injury from oxygen deprivation, cardiac arrest, allergic reactions from medications that were contraindicated, or death on the operating table. These outcomes are not always the result of unforeseeable complications. In many cases, they are the result of a failure to follow the standard of care — a failure that a qualified anesthesia provider, exercising appropriate care and skill, should have prevented.

The Standard of Care in Anesthesia Practice

Anesthesiology is a specialty governed by detailed, evidence-based standards developed by the American Society of Anesthesiologists (ASA) and enforced by hospital credentialing requirements, accreditation standards, and Pennsylvania law. Key elements of the standard of care include:

• Pre-operative evaluation: Every anesthesia provider is required to review the patient’s complete medical history, medications, allergies, prior anesthesia history, and relevant physical findings before administering anesthesia. Failure to conduct this evaluation — or failure to act on findings identified in it — is a departure from the standard of care.
• Informed consent: Patients are entitled to information about the anesthesia plan, material risks, and alternatives before they consent to the procedure. Failure to obtain proper informed consent is independently actionable.
• Appropriate agent selection and dosing: The selection of anesthetic agents, reversal agents, and other medications must be tailored to the individual patient’s weight, age, comorbidities, and current medications. Dosing errors — administering too much or too little — can cause cardiac arrest, respiratory depression, or awareness under anesthesia.
• Continuous monitoring: ASA standards require continuous monitoring of oxygenation, ventilation, circulation, and temperature during every anesthetic. Failure to monitor, or failure to respond to monitoring alarms, is a direct departure from the standard of care.
• Airway management: Inability to manage the patient’s airway — intubation failure, unrecognized esophageal intubation, or failure to have appropriate airway rescue equipment available — is a leading cause of preventable anesthesia-related death.
• Post-anesthesia care: The recovery period is as important as the operative period. Premature discharge from the PACU, failure to monitor for respiratory depression in patients who received opioids, and inadequate management of post-operative pain or nausea can all lead to serious harm.

The CRNA Supervision Requirement

In Pennsylvania and across the country, certified registered nurse anesthetists (CRNAs) frequently administer anesthesia in both hospital and ambulatory surgical settings. CRNAs are highly trained advanced practice nurses who play an essential role in anesthesia care.

The question of appropriate supervision is a recurring issue in anesthesia malpractice cases. A landmark study examining more than 117,000 surgical cases in Pennsylvania found that mortality rates were measurably higher when an anesthesiologist was not involved in the case. The research suggested that anesthesiologist involvement — whether as the primary anesthesia provider or as a supervising physician — is associated with better outcomes.

Pennsylvania hospitals have their own policies governing CRNA supervision requirements. When those policies are not followed — when a CRNA encounters a complication that requires physician oversight and none is available, or when the supervising anesthesiologist is simultaneously supervising too many rooms to provide meaningful oversight — and a patient is harmed, the failure of supervision may be central to the malpractice claim.

Common Anesthesia Error Patterns We Investigate

The anesthesia malpractice cases we handle at Lupetin & Unatin typically involve one or more of the following failure patterns:

• Failure to identify and respond to a known allergy or contraindication in the pre-operative evaluation
• Medication errors — wrong drug, wrong dose, drug administered to the wrong patient
• Unrecognized esophageal intubation — tube placed in the esophagus rather than the trachea, leading to oxygen deprivation
• Failure to respond to oxygen desaturation alarms during surgery
• Anesthesia awareness — patient is conscious and able to perceive pain during surgery due to inadequate depth of anesthesia
• Delayed recognition of malignant hyperthermia — a rare but life-threatening reaction to certain anesthetic agents that requires immediate treatment with dantrolene
• Post-operative respiratory depression in patients who received opioids, benzodiazepines, or neuromuscular blocking agents without adequate reversal or monitoring
• Inadequate pre-operative evaluation of a patient with significant cardiac, pulmonary, or metabolic disease

Anesthesia-Related Death: What Families Should Know

When a patient dies on the operating table or in the post-anesthesia care unit, the cause of death is not always immediately clear. Hospitals have an interest in attributing unexpected deaths to the underlying surgical condition or to unavoidable complications rather than to anesthesia error. Families are often told that the patient’s medical condition made the outcome inevitable.

That explanation may sometimes be true. But it is not always true, and families deserve an independent evaluation before accepting it.

In Pennsylvania, the death certificate lists the cause of death, but it does not resolve the question of whether negligence contributed. A full review of the anesthesia record, the operative notes, the monitoring data, and the post-mortem findings by an independent anesthesiology expert is the only way to assess whether the standard of care was met.

Pennsylvania’s wrongful death and survival action statutes allow the estate and surviving family members to recover damages when a patient dies as a result of medical negligence. These damages can include medical expenses, funeral costs, lost earnings, and the profound loss suffered by the patient’s family.

What to Do After a Suspected Anesthesia Error

• Request a complete copy of the anesthesia record, pre-operative assessment, operative notes, and PACU records immediately. These records document the anesthesia provider’s decisions in real time.
• Request copies of all monitoring data if available — pulse oximetry logs, end-tidal CO2 readings, and blood pressure records that were generated during the case.
• If the patient died, request the autopsy report and all laboratory and pathology findings.
• Do not sign any documents or releases from the hospital without first consulting an attorney.
• Contact an attorney promptly. Pennsylvania’s statute of limitations for medical malpractice is generally two years from the date of injury or death.

About Lupetin & Unatin, LLC

Lupetin & Unatin is a boutique medical malpractice and catastrophic injury firm based in Pittsburgh, Pennsylvania. We represent patients and families harmed by anesthesia errors, surgical complications, and hospital negligence throughout Pennsylvania. Our attorneys are Fellows of the American College of Trial Lawyers and have been recognized by Super Lawyers and Best Lawyers in America. All cases are handled on a full contingency fee basis — no fee unless we win.