Anesthesia Malpractice Cases: A Clinical Screening Framework for Plaintiff Attorneys

Anesthesia malpractice is a specialized area of medical liability with its own documentation conventions, its own standard of care framework, and its own set of clinical scenarios that determine viability. These cases are among the most technically demanding in plaintiff practice and among the most expensive to develop incorrectly.

The Anesthesia Record

The anesthesia record is unlike any other medical document in a chart. It is a continuous, minute-by-minute flowsheet of vital signs, drug administration, and clinical events from induction through emergence. A physician reading an anesthesia record is evaluating the management of the patient across the entire perioperative period, not a series of episodic notes.

High-Merit Anesthesia Cases

**Failure to recognize and respond to malignant hyperthermia.** Malignant hyperthermia is a rare but life-threatening reaction to certain anesthetic agents with a defined treatment protocol. Cases where the clinical signs of MH were present and not recognized or not treated with dantrolene in a timely fashion are among the clearest anesthesia malpractice cases.

**Esophageal intubation not recognized.** Endotracheal tube placement verification is a standard of care requirement. Cases where the tube was placed in the esophagus and the error was not recognized in a timely manner, resulting in hypoxic injury, require careful documentation review but can be viable when the capnography record supports the argument.

**Inadequate pre-operative evaluation.** Cases where a patient had documented comorbidities that required pre-operative optimization or modified anesthetic management, and the pre-operative evaluation failed to identify or address them, can support a viable argument when the intraoperative complication relates directly to the unaddressed condition.

Where Anesthesia Cases Collapse

**The known risk that materialized.** Anesthesia carries well-documented risks including death, neurological injury, and organ damage. When a consented risk materializes in a procedure where the technique was within the standard, the case is extremely difficult.

**The multi-factorial causation problem.** Many adverse anesthesia outcomes involve multiple contributing factors including the patient's underlying health status, the surgical procedure itself, and the anesthetic management. Isolating the anesthetic component as the proximate cause of the injury requires a causation analysis that is often more challenging than the standard of care analysis.

What Clinical Screening Provides

Anesthesia cases require a reviewer who can read a continuous anesthesia flowsheet, understand the pharmacology of the agents used, and apply the standard of care framework for the specific scenario at issue. The technical complexity of these records is significant, and a clinical screen before expert retention is particularly valuable given the cost of anesthesia subspecialty experts.

Anesthesia cases are among the most expensive to develop incorrectly. Submit for clinical screening before retaining anyone.