Opinion ID: 1175269
Heading Depth: 1
Heading Rank: 2

Heading: Evaluation and care prior to Sparks' cardiac arrest on January 30, 1983

Text: Following the surgery, and while still in the ICU, Sparks was intubated and breathed with the help of a respirator. During the morning of January 29, the respirator setting was changed from intermittent mandatory ventilation (IMV), which requires the machine to breathe a set number of breaths but also lets the patient breathe on his own, to a setting known as continuous positive airway pressure (CPAP), which requires the patient to breathe on his own exhaling against a pressure present in the airway at all times with the respirator's airway remaining in place. After Sparks breathed with the respirator on CPAP mode for a time, Dr. Orme ordered Sparks extubated (removed) at 12:10 p.m. on January 30, 1983. Prior to the January 30th extubation Sparks was tried off the respirator and put on a T-tube. Studies were performed, including arterial blood gasses (ABG) tests, and Enloe was responsible to return Sparks to the respirator if he did not tolerate his trial off the respirator. The results of the studies were delivered to Dr. Orme and he found them to be acceptable. The findings, however, indicated respiratory fatigue and, therefore, should have created concern given the circumstances of this case. According to Dr. Cullen's affidavit, given Sparks' size and general medical condition, the fact of respiratory fatigue should have been recognized as a problem since he had been removed from respiratory support. Additionally, the measurements should have been serially observed, but were not until 4:00 p.m. that day. After Sparks was extubated, Enloe provided respiratory therapy pursuant to Dr. Orme's orders, requiring intermittent positive pressure breathing (IPPB) or incentive spirometry every three hours. Since Sparks' efforts during the 1:30 p.m. incentive spirometry were inadequate, Enloe decided to also give him a nonordered IPPB treatment. Enloe went off shift at 2:30 p.m. She was replaced by Diane Darnell, who offered no evidence for the record. Gary Newhall was the ICU nurse who came on shift at approximately 3:00 p.m. Newhall stated that he noticed that sometime between 3:00 and 3:30 p.m. Dr. Orme was in the ICU observing Sparks. Newhall further stated that he spoke briefly with Dr. Orme concerning Sparks. Dr. Orme informed Newhall that Dr. Tim Sullivan, an anesthesiologist, was on call in the event that Sparks would need to be reintubated and that there was a flexible bronchoscope at the bedside. At 4:00 p.m. Sparks complained of being hot and was found to have a temperature of 102.6 degrees and a respiration rate of 36 breaths per minute (BPM). Repeat ABG tests still showed unacceptable results. Dr. Orme was advised of the ABG and chose not to reintubate Sparks. Instead he ordered a repeat ABG in one hour, a chest film at 6:00 p.m., and a modified IPPB treatment. Dr. Orme explained his decision not to re-intubate: Because I felt that he was having mucus and thought that they could give him an IPPB treatment with a bronchodilator and Mucomyst, and that it would be reasonable to do that and see if it didn't improve. And he was stable at the time. At 4:30 p.m. Sparks received the IPPB. Ten minutes later Sparks' skin was cool, clammy and pale colored and he complained of shortness of breath. Sparks arrested at approximately 4:57 p.m. and a Code Blue was called. As a result of the cardiac arrest, Sparks sustained severe and permanent brain damage. Despite Sparks' acknowledged abnormal ABG, and rapidly deteriorating respiratory condition, Newhall did not contact Dr. Tim Sullivan, the anesthesiologist who had been designated by Dr. Orme as being on call in the event that Sparks would need to be re-intubated. Newhall did not undertake any measures to ventilate or re-intubate Sparks even though there was a flexible bronchoscope at Sparks' bedside. Rather, Newhall simply stood by and watched Sparks go into cardiac arrest without any active medical intervention. In his affidavit, Dr. Cullen opined that [o]n January 30, 1983, St. Luke's nursing and respiratory therapy personnel assigned to care for Thomas Sparks either knew that Dr. Orme's respiratory orders for Thomas Sparks were inadequate and/or failed to recognize Thomas Sparks' desperate respiratory distress. According to the policies and procedures of St. Luke's concerning the Respiratory Therapy Department and Department of Nursing in effect in January 1983, representatives from both these departments had the responsibility of checking Sparks' tolerance to being removed from the respirator. In his affidavit, Dr. Cullen concludes that: [B]y not adequately monitoring Thomas Sparks postoperatively and recognizing his respiratory distress and/or procuring a qualified staff physician to attend to Thomas Sparks when the respiratory orders were known to be inadequate on January 30, 1983, St. Luke's Operating Room, Intensive Care Unit, and Respiratory Therapy Department negligently failed to meet the applicable standards of health care practice in the Boise, Idaho medical community in January 1983. Enloe's deposition, Newhall's affidavit and Cullen's affidavit together constitute sufficient material in the record to give rise to serious questions regarding the evaluation and care given Sparks prior to his cardiac arrest on January 30, 1983. Thus, the record before the district court upon ruling on St. Luke's motion for summary judgment should have indicated the presence of a genuine issue of material fact. That issue is whether St. Luke's personnel adequately monitored and reported Sparks' medical condition postoperatively and recognized Sparks' respiratory distress and/or procured a designated anesthesiologist to attend to Sparks, when respiratory orders were known (or in the exercise of reasonable care conceivably should have been known) to be inadequate due to the rapidly failing condition which ultimately resulted in Sparks' cardiac arrest. Therefore, we should hold that the district court's ruling as to the second claim of negligent care was also in error. JOHNSON, J., concurs.