$9.25 Million Medical Malpractice Settlement

Delayed Code Blue During C-Section Leads to Catastrophic Brain Injury

Sexner Injury Lawyers LLC represented the interests of a young mother and her family in a medical malpractice case that ultimately resulted in a $9.25 million settlement.

The woman entered the hospital for a C-section. During the procedure, a medical emergency developed that deprived her brain of adequate oxygen. Our medical malpractice claim alleged that the anesthesiologist and nursing staff failed to activate a Code Blue in a timely manner after her condition became critical.

The central allegation was not simply that an unexpected complication occurred during childbirth. Rather, the claim focused on the response to that emergency. It was alleged that the medical team waited too long to call the Code Blue and summon the emergency personnel and resources necessary for immediate resuscitation. By the time the emergency response was activated, the opportunity to prevent or substantially reduce the neurological damage had allegedly been lost.

The mother suffered a severe and irreversible hypoxic brain injury. She remained in a vegetative state and later died. The case was resolved through a $9.25 million medical malpractice settlement.

Cases involving an emergency during surgery may involve overlapping responsibilities among anesthesiologists, nurses, physicians, hospitals and other healthcare providers. Our Chicago medical malpractice lawyers investigate whether a patient's deterioration was recognized promptly and whether the medical team responded as the circumstances required.

What Is a Code Blue?

In hospitals, a “Code Blue” generally refers to an emergency response used when a patient experiences cardiac arrest, respiratory arrest or another immediately life-threatening medical crisis requiring rapid resuscitation. The precise criteria and procedures can vary according to the hospital's policies and the patient's circumstances.

Activating a Code Blue is intended to rapidly bring an appropriately trained resuscitation team and necessary emergency equipment to the patient's bedside or operating room. Depending upon the patient's condition, the response may include cardiopulmonary resuscitation, airway management and ventilation, cardiac monitoring, defibrillation when appropriate, medications and other advanced life-support measures.

The American Heart Association's guidelines concerning systems of care emphasize recognition of cardiac arrest, prompt activation of the emergency response system, high-quality CPR and coordinated advanced resuscitation. The AHA also recognizes the importance of preparedness for high-risk situations, including obstetric emergencies.

Why the Timing of a Code Blue Can Be Critical

A medical emergency involving loss of breathing, circulation or adequate oxygenation can become catastrophic very quickly. The heart and brain require a continuous supply of oxygenated blood. When that supply is interrupted, every delay in restoring adequate circulation and oxygenation can potentially affect the patient's outcome.

That is why emergency response systems are designed to operate rapidly. Recognition of the emergency is only the first step. The appropriate personnel must then be alerted, equipment brought to the patient, resuscitative measures begun and the underlying cause of the emergency addressed.

The American Heart Association has specifically emphasized the importance of rapid response in hospital Code Blue situations. Its resuscitation guidance treats recognition and emergency activation as an early link in the chain of survival, followed by high-quality CPR and other advanced interventions when indicated.

Whether a Code Blue should have been called at a particular moment is a medical question that depends on the patient's condition, vital signs, hospital protocols and other circumstances. In a malpractice case, medical experts may review the records to determine when the emergency became apparent, when the Code Blue was actually activated and whether an earlier response probably would have changed the outcome.

The Role of the Anesthesiologist During a C-Section

Anesthesia care is particularly important during a C-section because the anesthesiologist is responsible for monitoring the mother's condition while anesthesia is administered and the procedure is underway.

The medical team may monitor blood pressure, heart rate, oxygen saturation, breathing and other indicators of the patient's condition. A sudden and significant change can require immediate evaluation and treatment.

Anesthesia malpractice does not necessarily mean that the wrong medication was administered. A case may instead involve failure to recognize deterioration, inadequate monitoring, failure to manage the airway, delayed treatment or failure to summon additional assistance when a patient's condition becomes critical.

Our page concerning anesthesia errors in Chicago discusses other ways that negligent anesthesia care may cause severe injuries during surgery and other medical procedures.

Nursing Responsibilities During a Medical Emergency

Nurses are also an essential part of the hospital response to a rapidly deteriorating patient. Depending upon their role and the circumstances, nursing personnel may be responsible for monitoring vital signs, recognizing significant changes, communicating those changes to physicians, following emergency protocols and initiating or assisting with an emergency response.

Medical malpractice investigations involving a delayed Code Blue often require careful review of nursing notes, anesthesia records, vital-sign records, medication records, electronic monitoring data, Code Blue documentation and other portions of the hospital chart.

The timeline can be especially important. Attorneys and medical experts may compare when abnormal findings first appeared with when staff recognized them, when a physician was notified, when emergency measures began and when the Code Blue was formally activated.

What Is a Hypoxic Brain Injury?

A hypoxic brain injury occurs when the brain does not receive enough oxygen. As explained by MedlinePlus in its discussion of cerebral hypoxia, the brain requires a constant supply of oxygen and nutrients in order to function.

The severity of brain damage can depend upon factors including how severely oxygen delivery was reduced, how long the deprivation continued and how quickly adequate oxygenation and circulation were restored.

Severe oxygen deprivation can cause permanent neurological impairment, loss of cognitive function, inability to communicate, loss of voluntary movement, disorders of consciousness and, in the most serious cases, death.

Our discussion of serious brain injuries includes additional information about hypoxic brain damage caused by medical negligence and other events that deprive the brain of oxygen.

When Can a Delayed Emergency Response Become Medical Malpractice?

Not every medical emergency or poor outcome is evidence of malpractice. Serious complications can occur even when doctors and nurses provide appropriate care.

A medical malpractice claim instead examines whether the healthcare providers complied with the applicable standard of care and whether a failure to do so caused or contributed to the patient's injury.

In a delayed Code Blue case, important questions may include:

When did the patient's condition first become critical?
Were changes in oxygen level, heart rate, blood pressure or breathing recognized promptly?
Did the anesthesiologist and nursing staff communicate appropriately?
Did hospital personnel follow applicable emergency-response protocols?
When should the Code Blue or other emergency response have been activated?
When was it actually activated?
What treatment was provided before and after activation?
Would earlier intervention probably have prevented or reduced the brain injury?

Answering these questions commonly requires review by qualified medical experts who can reconstruct the sequence of events and evaluate whether the care provided met accepted medical standards.

Permanent Brain Injury Followed by Death

Catastrophic hypoxic brain injury can affect virtually every aspect of a patient's life. A person who survives the initial emergency may require intensive care, mechanical ventilation, feeding assistance, skilled nursing care and extensive long-term medical treatment.

When the injury leaves a patient in a vegetative state or another severe disorder of consciousness, the consequences extend to the entire family. Loved ones may face profound emotional loss while also confronting difficult medical decisions and the costs associated with continuing care.

If the patient ultimately dies as a result of the injury, the case may also involve rights under Illinois law relating to wrongful death in addition to claims arising from the injuries and losses sustained before death.

Investigating a Delayed Code Blue Medical Malpractice Case

Cases of this nature can involve thousands of pages of medical information and a detailed minute-by-minute reconstruction of what occurred.

Evidence may include anesthesia records, electronic vital-sign data, nursing notes, physician orders, operative records, fetal and maternal monitoring information, medication administration records, laboratory results, Code Blue records and hospital policies governing emergency activation.

The medical records may also need to be reviewed by specialists in anesthesiology, nursing, critical care, obstetrics, neurology or other fields. One of the principal issues may be causation: whether appropriate action taken earlier probably would have avoided the catastrophic injury or materially improved the patient's outcome.