Opinion ID: 1707689
Heading Depth: 2
Heading Rank: 1

Heading: Pre-Complaint

Text: On April 4, 1981, seventeen-year-old Patricia Palmer was seriously injured in an automobile accident; she was subsequently admitted to the intensive care unit of Biloxi Regional Medical Center [5] and placed under the primary care of neurosurgeon, Dr. Richard Buckley. Consultants employed by Buckley included Martin, who is a general surgeon, and Wooten, who is an oral surgeon. Wooten was employed solely and specifically to treat a fractured mandible (lower jaw). On April 6, 1981  after Patricia's neurological condition stabilized  Buckley advised Wooten that the time was ripe to place Patricia under general anesthesia and perform the nonelective surgery to repair her fractured jaw. Postponement beyond April 8, according to Buckley, would not be in Patricia's best interest. Wooten performed the surgery without complication on April 7 and 8, 1981. Patricia died of cardiopulmonary arrest [6] on April 11. Buckley noted on the discharge summary that the cause of the arrest was [u]ndetermined, pending results of autopsy. An autopsy was performed by Dr. Eldon McClain, a pathologist at BRMC. McClain summarized the autopsy diagnoses: [Patricia] was admitted shortly following an automobile accident at which time she was noted to have bruises, abrasions and cranial fracture. She had initially shown loss of consciousness but neurologic function appeared to be intact. She underwent operative repair of the mandibular fracture on the fourth hospital day. On the seventh hospital day there was an unexpected cardiac arrest. Resuscitative attempts resulted in reestablishment of cardiac function. However, neurologic function was that of a total coma. The patient was maintained on a respirator for about sixteen hours following arrest during which time no neurologic function was discernible. After this time, support measures were discontinued and the patient was pronounced dead. The autopsy demonstrated the multiple injuries suffered in the automobile accident. These included the bilateral basilar skull fracture, abrasions and bruises of the left arm, thigh and head. There were multiple internal contusion injuries. These included multiple small areas of submeningeal injury with congestion and hemorrhage in the right frontal lobe, subpleural contusion injuries of the left lung base and small areas of injury beneath the capsules of the spleen and left lobe of the liver. No clear cause of the cardiac arrest was determined. Cerebral swelling and edema occurred primarily due to the anoxic damage suffered during the arrest, but was perhaps in part related to the original injury. Left pleural effusion with some blood staining was in part due to the original injury but this along with pulmonary congestion and edema were also terminal changes. The remaining findings at autopsy are considered incidental and are listed [elsewhere in the report]. (emphasis added). Notably, the death certificate  signed by an individual other than McClain  states that Patricia died of cardiopulmonary arrest due to a stress ulcer. [7] The detailed autopsy report, however, concluded that [n]o actual ulcerations [were] found in the gastrointestinal tract.