When the Surgery Succeeds But the Anesthesia Team Fails
A $2,250,000 Anesthesia Malpractice Settlement
She Survived the Hard Part. The System Let Her Down After.
Claire was 35 years old, and she had already beaten the odds more times than most people ever have to.
Born with Larsen Syndrome, a rare connective tissue disorder that affects the bones, joints, and respiratory system, she had undergone more than 35 surgical procedures over the course of her life. She knew operating rooms. She knew recovery rooms. She knew how to be a patient when her body demanded it and how to get back to living when it was done.
What Claire loved most, though, had nothing to do with hospitals. She was the kind of person her whole family orbited around. She was the aunt who remembered every birthday, who gave more than she could afford, who had quietly sponsored children in underdeveloped countries for years, scraping together donations from a modest income and traveling to meet them. She couldn’t have children of her own, so she mothered every child who came near her.
In December 2020, Claire was admitted to a major Pittsburgh hospital for an aortic valve replacement. This is a serious surgery, but a known procedure that was performed by an experienced cardiac surgical team. The operation itself went well. It was over in under three hours. Claire was transferred to the ICU, intubated and stable, with a plan to extubate her the following morning under controlled conditions with an anesthesiologist present.
She was declared brain dead four days later.
What happened in those four days, and the systemic failures that caused it, is the subject of this case study. It is also a window into one of the most serious and underrecognized categories of medical malpractice: anesthesia negligence in airway management.
What Is Anesthesia Malpractice?
Lupetin & Unatin has handled many anesthesia malpractice cases and written on the topic extensively. Most people think of anesthesia as the part of surgery where you “go to sleep.” And for most patients, that’s more or less how it feels. But anesthesiologists are doing something far more complex and far more dangerous than simply administering medication. They are temporarily eliminating your body’s ability to protect its own airway and taking full responsibility for keeping you alive in its absence.
When that responsibility is met with carelessness, inadequate preparation, or poor decision-making, the results can be catastrophic, even deadly.
Anesthesia malpractice cases typically fall into several categories:
Failure to evaluate and plan for a difficult airway.
Some patients present known anatomical challenges to intubation (e.g. small mouth openings, limited neck mobility, structural abnormalities of the larynx or trachea). The standard of care requires anesthesiologists to identify these risks before any procedure begins, review prior anesthetic records, consult relevant specialists, and develop a detailed plan for what to do if standard intubation fails.
Failure to follow established difficult airway protocols.
The American Society of Anesthesiologists maintains a published Difficult Airway Algorithm. This is a step-by-step decision tree that guides how anesthesiologists should respond when intubation proves challenging. Deviating from that algorithm without clinical justification is a deviation from the standard of care.
Failure to use available tools and techniques.
When standard intubation fails, there are well-established backup options: laryngeal mask airways (LMAs), video-assisted laryngoscopy, awake fiberoptic intubation, and early escalation to a surgical airway. Failing to deploy these options in the correct sequence can turn a manageable situation into a fatal one.
Failure to communicate and hand off effectively.
Anesthesia care in a hospital setting involves multiple providers (e.g. attending anesthesiologists, residents, CRNAs, ICU physicians, ENT surgeons). When those providers fail to communicate a patient’s specific risks to one another, critical information falls through the cracks.
Failure to activate emergency response resources.
Many major hospitals have Difficult Airway Response Teams (DARTs). These are specialized multidisciplinary teams trained to respond to airway crises. Failure to activate these teams when indicated can mean that a patient in respiratory distress never receives the expert response she needed.
Medication errors.
Among the most preventable causes of anesthesia harm are errors involving the drugs themselves. Anesthesiologists manage a complex pharmacological arsenal during every procedure. These include paralytics, sedatives, analgesics, reversal agents, vasopressors, often under time pressure and in high-stakes environments. Errors can take many forms: administering the wrong drug entirely, dosing incorrectly based on the patient’s weight or renal function, failing to account for dangerous drug interactions, or overlooking a documented allergy in the pre-operative record. When these errors occur and cause serious injury, they are rarely unavoidable. They are the product of systems failures and individual lapses that a competent anesthesia team is trained to prevent.
Failure to adequately monitor the patient.
The standard of care requires continuous intraoperative monitoring of a patient’s oxygen saturation, blood pressure, heart rhythm, end-tidal carbon dioxide, and depth of anesthesia. Lapses in monitoring, whether due to equipment failure that goes unaddressed, inattention, or premature disconnection, can allow a deteriorating patient to reach a crisis point before anyone intervenes. One of the most disturbing manifestations of monitoring failure is anesthesia awareness: a condition in which a patient regains partial or full consciousness during surgery while still paralyzed and unable to communicate. Awareness under anesthesia occurs more often than most people realize, and its psychological consequences can be profound and lasting.
Pre-operative assessment failures.
Before any procedure, the anesthesia team is responsible for identifying risk factors that should change how anesthesia is delivered. A patient with obstructive sleep apnea requires different management than one without it. A patient with significant cardiac disease, poorly controlled hypertension, or a history of malignant hyperthermia (a rare but life-threatening reaction to certain anesthetic gases) demands a modified plan. When the pre-operative assessment is cursory, incomplete, or not acted upon, the patient is exposed to risks that a thorough evaluation would have identified and managed.
Aspiration of stomach contents.
Patients undergoing general anesthesia are typically required to fast beforehand because the drugs used to induce anesthesia suppress the protective reflexes that prevent stomach contents from entering the lungs. When those protocols are not properly followed, or when a patient at elevated aspiration risk is not given adequate airway protection, the results can include aspiration pneumonia, acute respiratory distress, and death. Certain patient populations, including those who are pregnant, obese, or have gastroparesis or bowel obstruction, require heightened vigilance that is not always applied.
Post-operative and recovery room negligence.
The anesthesia team’s responsibility does not end when the surgeon closes. Patients emerging from general anesthesia remain vulnerable — to respiratory depression, airway obstruction, hemodynamic instability, and delayed reactions to medications. Premature discharge from the post-anesthesia care unit, inadequate monitoring during recovery, and failure to recognize and respond to deterioration in the recovery room have all led to preventable deaths and serious injuries in patients who survived surgery only to suffer harm in its aftermath.
Regional and neuraxial anesthesia errors.
Not all anesthesia involves general sedation. Epidurals, spinal blocks, and peripheral nerve blocks are widely used and, in skilled hands, are safe. But errors in their administration, injecting at the wrong level, failing to recognize and treat a high spinal block, causing an epidural hematoma through improper technique or failure to account for a patient’s anticoagulation status, or damaging a nerve through direct trauma or prolonged compression, can result in paralysis, permanent neurological injury, and chronic pain that outlasts the procedure by years or decades.
Pediatric anesthesia errors.
Children are not simply small adults, and pediatric anesthesia demands specific expertise. Weight-based drug dosing must be calculated precisely. Errors that might be tolerated in an adult can be fatal in a small child. The anatomical differences in a child’s airway require different equipment and different technique. Temperature regulation, fluid management, and the pharmacokinetics of anesthetic agents all differ meaningfully across age groups. When a provider without adequate pediatric training administers anesthesia to a child, or when a pediatric case is approached with adult assumptions, the margin for error is far smaller than anyone expects.
What Happened to Claire
To understand how Claire died, you have to understand what Larsen Syndrome does to a person’s airway.
The same connective tissue fragility that had required Claire to undergo dozens of orthopedic surgeries throughout her life also affected her larynx and trachea. Her tracheal walls were narrower and more collapsible than a typical patient’s. She was at elevated risk of laryngomalacia, which is a condition where the soft tissue above the vocal cords collapses inward during breathing. And critically, her airway tissue was unusually susceptible to edema: when traumatized, even mildly, it swelled far more aggressively and far more rapidly than a typical patient’s would.
This was not unknown information. It was documented in the medical literature on Larsen Syndrome, easily accessible to any anesthesiologist who searched for it. It had also manifested directly during Claire’s thyroid surgery two years earlier, when the anesthesia team documented early, significant airway edema during intubation and had to transfer to a senior attending to complete the procedure. That prior record was in Claire’s chart.
Day 1: Claire’s aortic valve replacement proceeds successfully. She is transferred to the ICU, intubated, hemodynamically stable. The plan is a controlled extubation the next morning with anesthesia present.
Day 2: Claire is extubated without a cuff leak test. This is a simple bedside check that would have revealed whether her airway was already beginning to swell. No steroids are administered prophylactically. No ENT consultation is obtained. Within hours, her oxygen saturation begins to fall. The team escalates her respiratory support through the afternoon and overnight, including nasal cannula, then high-flow oxygen, then BiPAP, without apparently recognizing that her airway was closing.
Day 3, morning: Claire is on BiPAP, retaining carbon dioxide, growing confused. The ICU team decides she needs to be re-intubated. They call anesthesia.
The anesthesiologist who responds, aware that Claire had a previously documented difficult airway, makes a series of decisions that the expert retained in this case would later describe as a direct departure from established standards of care.
Rather than pursuing an awake fiberoptic intubation, which would have preserved Claire’s ability to breathe on her own if attempts failed, the anesthesiologist induces general anesthesia and administers a paralytic agent. This eliminated Claire’s respiratory drive entirely. The dose of the paralytic is more than double the appropriate weight-based amount, meaning Claire cannot breathe on her own for an extended period no matter what happens next.
Multiple intubation attempts fail. Each attempt traumatizes Claire’s already fragile airway further, causing additional edema and worsening the obstruction. A laryngeal mask airway is never attempted. This is a potentially life-saving bridge device explicitly recommended by difficult airway guidelines in exactly this situation.
Other providers, not expert in difficult airway management, are permitted to attempt intubation. They fail. Each attempt makes the next attempt harder.
A STAT page goes out for any available surgeon. Claire is rushed to the OR. By the time she arrives, she is severely hypoxic. An emergency tracheostomy is eventually performed, but not before Claire has suffered approximately 50 minutes of profound oxygen deprivation.
She never regains consciousness. On December 8, 2020, she is declared brain dead.
How Lupetin & Unatin Built the Case
Claire’s family came to Lupetin & Unatin in the aftermath of an outcome that the hospital had characterized, in its communications with the family, as a tragic but unavoidable complication of a complex medical situation.
It wasn’t.
Our firm’s investigation began with a complete review of Claire’s medical records, including her admission records, her operative notes, her nursing documentation, her arterial blood gas values charted minute by minute through the crisis on December 6th, and her prior anesthetic records from years of prior procedures. What emerged from that review was not a picture of an unavoidable complication. It was a picture of a cascade of identifiable, preventable failures.
The records showed that the December 6th anesthesiologist had documented reviewing Claire’s prior history but had failed to specifically account for the respiratory implications of Larsen Syndrome. Her pre-anesthesia note contained no mention of laryngomalacia, no mention of the Larsen Syndrome-specific risk of post-intubation airway edema, and no plan for what would happen if standard intubation failed.
The records showed that no cuff leak test was performed before extubation. They showed that steroids were never administered. This is a standard preventive measure for patients at risk of post-extubation edema. They showed that ENT was never consulted until Claire was already in cardiac arrest.
The records showed that a laryngeal mask airway was never used, even as Claire’s oxygen saturation dropped into the 70s.
And the deposition testimony of the providers involved revealed something equally significant: the anesthesiologist’s own stated research into Larsen Syndrome on the morning of Day 3 had not surfaced any specific findings about airway management risks. This is a statement that itself reflected a failure of due diligence, given how well-documented those risks are in the anesthesia literature.
To translate these findings into trial-ready proof of negligence, the firm secured the opinion of one of the nation’s foremost experts in anesthesiology and neurocritical care: a triple board-certified Professor of Anesthesiology, Critical Care Medicine, and Neurology at a major academic medical institution, with decades of experience in difficult airway management and ICU care. That expert reviewed all of Claire’s records and all of the deposition testimony, and concluded within a reasonable degree of medical certainty that Claire’s death was a direct and preventable consequence of the failures described above. With appropriate management of her known airway risks, she would not have suffered the catastrophic brain injury that killed her.
The defendants were represented by experienced defense counsel. They disputed negligence. They disputed causation. They put forward their own expert opinions.
The case was litigated through full discovery. We took the depositions of every treating provider, conducted extensive expert preparation, and developed demonstrative materials designed to explain the medicine to a jury in human terms. The firm took the case to the eve of trial before the defendants agreed to a settlement of $2,250,000.
What Families Should Know About Anesthesia Complications
Not every bad outcome after anesthesia is malpractice. The truth is that most of the potential anesthesia malpractice cases we review must be declined for one reason or another. Anesthesia carries inherent risks, and some complications occur even when everything is done correctly.
But some do not.
If you or someone in your family has suffered a serious injury, including brain damage, cardiac arrest, prolonged hypoxia, death, following a procedure involving anesthesia, the following questions are worth investigating:
Was there a documented difficult airway history?
If a patient had prior documented intubation difficulties, what steps were taken to account for that history?
Was the appropriate pre-procedure workup completed?
Did the anesthesia team review prior records? Consult relevant specialists? Develop a backup plan?
Were established guidelines followed?
When intubation proved difficult, did the team follow the ASA Difficult Airway Algorithm or did they deviate from it in ways that put the patient at greater risk?
Were available tools used?
Was a laryngeal mask airway considered? Was an awake intubation technique offered? Was a Difficult Airway Response Team available and activated?
Was there adequate communication?
Were the patient’s specific risks communicated from one provider to the next? Were hand-offs documented?
Was a cuff leak test performed before extubation?
In patients at elevated risk for post-extubation airway problems, was this simple, standard safety check completed?
These are the kinds of questions that Lupetin & Unatin asks at the beginning of every potential anesthesia malpractice case. Sometimes the answers reveal that the care was appropriate. Often, they don’t.
Pennsylvania Anesthesia Malpractice: What You Need to Know
In Pennsylvania, a medical malpractice claim requires proof that a healthcare provider deviated from the accepted standard of care, and that the deviation caused the patient’s injury. In anesthesia cases, the standard of care is defined in part by national guidelines, like the ASA Difficult Airway Algorithm, and in part by the expert testimony of qualified anesthesiologists who practice in the relevant specialty.
Pennsylvania also requires that before a malpractice complaint is filed, the plaintiff must obtain a certificate of merit. This is a sworn statement from an appropriate licensed professional attesting that the care at issue fell outside acceptable professional standards. This threshold requirement exists to screen out meritless claims, and it means that serious cases require serious expert support from the beginning.
The statute of limitations for medical malpractice in Pennsylvania is generally two years from the date of the injury, with limited exceptions. If you believe a family member’s death or injury may have involved anesthesia negligence, time matters.
If This Story Resonates With You, We Want to Hear From You
Claire’s family never stopped believing that what happened to her wasn’t inevitable. They were right.
At Lupetin & Unatin, we have spent decades investigating cases where families were told there was nothing more that could have been done and proving otherwise. We handle a small number of cases at a time precisely so that we can give each one the attention it deserves: the thorough record review, the right medical experts, the courtroom preparation that persuades defendants to do the right thing.
If someone you love has suffered a serious injury or death following anesthesia, surgery, or another medical procedure, and you have questions about whether what happened was preventable, we invite you to contact our firm. There is no cost and no obligation for an initial consultation. We handle all cases on a contingency fee basis, which means you pay nothing unless we recover compensation for you.
Lupetin & Unatin can help. Call or message us to see if you have a viable anesthesia malpractice case.
The outcome described in this case study involved unique facts and circumstances. Prior results do not guarantee a similar outcome in any future case. The names and certain identifying details of the individuals involved have been changed to protect their privacy in connection with a confidential settlement.