Opinion ID: 1659361
Heading Depth: 2
Heading Rank: 1

Heading: Harm Threatened by the Defendants' Conduct

Text: This factor weighs in favor of an award of substantial punitive damages. It was well established at trialindeed, concededthat the administration of Pavulon to a patient during intubation renders the patient incapable, not only of respiration, but also of speech. A patient thus paralyzed is conscious of her surroundings, but must depend entirelyand silentlyupon her attendants for her oxygen supply. Dr. Schulte conceded that in such a case the failure of attendants timely to ascertain the location in the body of the endotracheal tube would, if it had entered the stomach, result in a rapid deterioration of the patient's condition, progressing from cardiac arrest, through irreversible brain damage, to death. He also testified that placement confirmation is properly accomplished by listening to the intubated patient's lungs and stomach with a stethoscope, but conceded that he did not listen in this manner, or direct any of the five medical personnel assisting him to do so, before Mrs. Smith lost her blood pressure and suffered a cardiac arrest. Failing timely to discover the improper placement of an endotracheal tube in a paralyzed patient imports to a physician the probability of the gravest of consequences. In such cases death, or at least severe brain damage, is virtually certain. Moreover, the trauma suffered by a patient who, conscious of her surroundings, knows that she is dying of suffocation, but, because of the paralyzing drug, is unable to communicate her distress, will be extreme. Substantial damages are necessary to punish and deter substandard behavior attended by such severe consequences of which a physician is necessarily aware. These considerations support the amount of the verdict returned in this case. They must, however, be weighed against the following countervailing factors.