An Anesthesia Team Skipped Rapid Sequence Induction, and a Young Mother Aspirated and Died
After trial: Reduced. The trial court cut the jury's $20 million verdict to $4 million under Alabama's excessiveness review, and the Alabama Supreme Court affirmed the reduced judgment on September 28, 2012.
Won by Cunningham Bounds, LLC.
In January 2006, Paulett Pettaway Hall, a 32-year-old wife and mother of two, went to Springhill Memorial Hospital in Mobile for exploratory surgery. Her records showed risk factors for pulmonary aspiration, but the anesthesia team used a routine induction instead of a rapid sequence induction, and she aspirated bile into her lungs and died of aspiration pneumonitis on January 16, 2006. A Mobile County jury returned a $20 million wrongful death verdict in December 2009, which the trial court remitted to $4 million and her estate accepted. The Alabama Supreme Court affirmed the $4 million judgment on September 28, 2012.
What happened
In January 2006, Paulett Pettaway Hall arrived at Springhill Memorial Hospital in Mobile, Alabama, for exploratory surgery to find the source of abdominal pain. She was 32, a wife and the mother of two children. Her medical records documented risk factors for pulmonary aspiration, including a prior gastric bypass, and she had come in with nausea and vomiting as well as the pain.
Anesthesiologist Dr. Randall Boudreaux and certified registered nurse anesthetist Don Ortego of Coastal Anesthesia, P.C. put her under using a routine induction. Neither man examined her for aspiration risk or reviewed her medical records first. Given those risk factors, the standard of care called for a rapid sequence induction instead, a technique meant to protect the airway during the moments a patient is most likely to breathe in stomach contents. During the routine induction, Hall aspirated bile into her lungs. Her oxygen saturation dropped, and she developed aspiration pneumonitis. She died on January 16, 2006.
Hall's family sued Boudreaux, Ortego, and Coastal Anesthesia for wrongful death in Mobile Circuit Court. Alabama's wrongful death statute allows only punitive damages, since its purpose is to punish and deter rather than to compensate a survivor's loss. In December 2009, a Mobile County jury found the anesthesia team negligent and returned a verdict of $20 million against the defendants.
The trial court reviewed the verdict against the constitutional excessiveness factors from BMW of North America v. Gore and Alabama's own Hammond and Green Oil line of cases, and remitted the award to $4 million. Hall's estate accepted the reduced figure, and the trial court entered judgment on that amount.
Boudreaux, Ortego, and Coastal Anesthesia appealed. They argued the trial judge should have granted a new trial over alleged juror misconduct, that the punitive award still violated due process and equal protection, and that $4 million remained excessive even after the cut. The Alabama Supreme Court rejected each argument. In a September 28, 2012 opinion, the court held the trial judge had properly applied the Gore and Green Oil guideposts and affirmed the $4 million judgment in full.
Joseph M. Brown, Jr., David S. Cain, Jr., David G. Wirtes, Jr., and George M. Dent III of Cunningham Bounds, LLC represented Hall's estate at trial and on appeal, along with R. Bernard Harwood, Jr. of Rosen Harwood in Tuscaloosa. The opinion remains cited in Alabama practice for how a trial court is expected to apply the Gore and Green Oil factors when a jury's punitive verdict draws a due process challenge.
Sources
This account is drawn from contemporaneous public reporting and the court record.
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