In surgery, when something goes wrong, minutes become hours.
Minutes are the focus of a lawsuit filed by the family of a 29-year-old Seymour nurse who died in February 2015 after undergoing minor elective sinus surgery at the North Haven Surgery Center. The suit alleges that the center waited as long as 29 minutes to call an ambulance after Katherine O’Donnell’s blood pressure and pulse fell to critical levels on the operating table – and that doctors continued to proceed with surgery, even as their efforts to resuscitate her failed.
The case raises questions about how well equipped freestanding surgical centers are to handle emergencies, and what sanctions they face for alleged lapses in care. The lawsuit alleges that the center and Fairfield Anesthesia Associates, LLC, which handled anesthesia in the case, failed to properly respond by stopping the surgery immediately and calling a “Code Blue” emergency when O’Donnell’s blood pressure and oxygen levels plummeted.
Records show the state Department of Public Health investigated the incident in March 2015 and found that “the standard of care was met” for anesthesia and surgical services. The agency cited the center for two minor violations related to documentation, but did not raise concerns about the time that elapsed before an ambulance was called. No other state action is pending, a DPH spokesman said.
O’Donnell, known as Katie to her family and friends, was a dog lover and avid New York Yankees’ fan who worked as a licensed practical nurse at a visiting nurse agency in Stratford. She was in good health when she went in to the North Haven Surgery Center on Feb. 25 for elective sinus surgery, records show.
But within minutes of being put under general anesthesia shortly before 11 a.m., O’Donnell’s blood pressure began falling, according to court documents based on the surgery center’s medical records. By 11:11 a.m., her blood pressure was “unobtainable” and the pulse oximeter was “not reading,” documents show. According to anesthesia notes and the Code Blue emergency sheet, surgery was allowed to continue, even as cardiopulmonary resuscitation efforts were underway.
While the anesthesia notes say that CPR was started and an ambulance was called at 11:18 a.m., American Medical Response (AMR) records show no call was made until 11:40 a.m., reflecting “an approximate 29-minute delay in calling EMS despite a cardiac arrest situation,” according to a medical expert’s review included in the lawsuit.
O’Donnell arrived at Yale-New Haven Hospital at 12:22 p.m. Despite efforts to revive her, she was pronounced dead an hour later.
The lawsuit alleges that the surgery center and Dr. Barry D. Stein, an anesthesiologist employed by Fairfield Anesthesia Associates, LLC, failed to properly respond to the medical emergency, failed to keep proper records of the procedure, and failed to accompany O’Donnell to the hospital, among other lapses. O’Donnell’s father, John O’Donnell, is seeking unspecified damages in the case, which is pending in New Haven Superior Court. He referred comment to the family’s attorney, Josh Koskoff of Bridgeport.
Attorney Sally O. Hagerty of Stamford, representing Stein and Fairfield Anesthesia Associates, declined to comment on the case. An attorney for the North Haven Surgery Center did not return messages seeking comment.
Koskoff said O’Donnell’s family is seeking answers about what went wrong – not just for themselves, but for others who may turn to outpatient surgery centers as an alternative to hospitals. He cited another wrongful death case filed last year by the family of 53-year-old Michael A. Palmer of Stratford, who died after medical staff at an outpatient center in Trumbull allegedly gave him the wrong medication. Fairfield Anesthesia Associates is also a defendant in that case.
“We’re really in a dawn age with these surgery centers, and they really need to get their act together,” Koskoff said. “They’re fine when nothing goes wrong, but they don’t have those added layers of protection that hospitals do” in case of complications.
“It’s really important to Katie’s family not only that her case be brought to justice, but that it might help to prevent something like this from happening to any other family,” Koskoff said.
The Ambulatory Surgery Center Association says that the growing national network of outpatient centers is tightly regulated to ensure patient safety and quality.
Medical records in O’Donnell’s case offer conflicting accounts of how long Stein and the surgeon in the case, Dr. Craig S. Hecht, continued operating on O’Donnell after her blood pressure and oxygen levels began to fall. Hecht is mentioned in the lawsuit but is not named as a defendant.
The DPH report indicates that O’Donnell was given epinephrine, a heart stimulant, at 11:10 a.m., soon after surgery began. A Code Blue emergency was not initiated until 26 minutes later, at 11:36 a.m., when her pulse rate was recorded at just 42 beats per minute, the DPH report says.
An expert’s review of medical records, included in the lawsuit, cites conflicting accounts of what happened in the interim. The “anesthesia note” on the case says that all anesthetic medications were discontinued at 11:15 a.m., that surgery was stopped, and that CPR was started. Meanwhile, the Code Blue Emergency Chart says surgery was halted at 11:22, but then resumed at 11:30.
The surgeon’s operative report appears to support that surgery continued after O’Donnell’s vital signs failed. The report “documents completion of extensive surgery . . . far more extensive than could have been completed in the four minutes preceding Ms. O’Donnell’s circulatory collapse,” the expert’s review says.
In its report, the DPH cites several other discrepancies in the case. The agency notes that Stein, the anesthesiologist, originally had documented that he gave O’Donnell 300 mcg of epinephrine, but later “changed the amount to 500 mcg by writing over the initial entry.”
The DPH report also cites misleading documentation on the time O’Donnell was transferred to Yale-New Haven. The patient transfer form “incorrectly identified” that O’Donnell was transferred at 11:45 a.m., 10 to 15 minutes before EMTs actually took over her care.
A spokesman for the DPH, Christopher Stan, said there are no other actions pending against practitioners involved in the case. Stan confirmed that, in general, the DPH has authority to cite facilities for not following proper procedures in alerting emergency personnel. All outpatient surgical facilities are required to have guidelines for emergencies, as well as emergency equipment and drugs for resuscitation.
Stein is a managing partner of Fairfield Anesthesia Associates and is listed as medical director of the North Haven Surgery Center. He did not return messages.
The North Haven Surgery Center is part of a national for-profit chain of surgical centers owned by United Surgical Partners International and Tenet Healthcare, according to court filings. Dr. Mark Thimineur, director of the Comprehensive Pain & Headache Treatment Centers in Derby, is a principal of the North Haven center and was involved in its founding as the North Haven Pain Medicine Center, state records show.
Thimineur’s Derby pain center has been the subject of state and federal scrutiny in the past year. A nurse who was employed there, Heather Alfonso, was charged last summer with accepting kickbacks from a drug company in exchange for her prescribing of a powerful cancer drug. Thimineur was reprimanded and fined $7,500 in June by the Medical Examining Board for writing prescriptions without properly assessing patients.