Teen dies days after surgery for sleep apnea

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In fall 2012, the plaintiff’s decedent, then 16, was treated for mental health issues and prescribed Lithium and Olanzapine.

Her primary care provider then referred her to the defendant, an otolaryngologist, for evaluation of what was thought to be a tonsil problem. On examination, the defendant noted that the decedent had for a few months experienced chronic snoring, mouth breathing and tiredness, which he deemed “signs and symptoms concerning for possible obstructive sleep apnea.”

The defendant recommended tonsillectomy and adenoidectomy for adenotonsillar hypertrophy with upper airway obstruction. The defendant did not order a polysomnogram (sleep study) to confirm his presumed diagnosis of sleep apnea.

The decedent was advised to continue taking her psychiatric medications pre- and post-operatively.

On Dec. 20, 2012, the defendant performed a tonsillectomy and adenoidectomy without complication. The decedent was discharged home with a prescription for liquid Roxicet.

Two days after the surgery, she was found unconscious with dried vomit around her mouth. She went into respiratory arrest and then cardiac arrest, and suffered a severe and ultimately fatal anoxic brain injury.

The plaintiff’s expert, a local otolaryngologist, opined that the defendant breached the standard of care by proceeding to surgery without first ordering a sleep study. Without such a study, the expert said, the defendant could not determine whether the decedent in fact had sleep apnea and whether surgery was indicated.

According to the expert, because sleep apnea places adolescent patients at risk for life-threatening respiratory depression from post-operative narcotics, it was a breach of the standard of care to proceed to surgery without a sleep study to determine the severity of the sleep apnea. Without that determination, the defendant could not assess the risks associated with narcotic use, the expert said.

The defendant argued that given his finding of adenotonsillar hypertrophy with airway obstruction, no sleep study was required and that such studies are very rarely done prior to tonsillectomies.

Action: Medical malpractice

Injuries alleged: Death

Case name: Withheld

Court/case no.: Withheld

Jury and/or judge: N/A (settled)

Amount: $950,000

Date: June 15, 2018

Attorneys: Kevin Donius and Ralph F. Sbrogna, of Sbrogna, Brunelle & Donius, Worcester (for the plaintiff)