This case involves a patient in Illinois who suffered complications following neck surgery. A few days before the incident in question, she received an injury to her cervical spine and as a result underwent surgery. The first night following her cervical spine surgery, she was placed in a high dependency unit. There, doctors conducted a neurological exam on the patient. It was noted that the patient had been suffering from severe obstructive sleep apnea and, as a result, the defendant left verbal orders for a continuous positive airway pressure device to be used. Despite these instructions, the patient slept without the machine that night and suffered a stroke. It was also noted that, despite the patient’s presence in a high dependency unit, there was no cardiac monitoring, no oximetry or CO2 monitoring, nursing evaluations, or neurological checks.
Question(s) For Expert Witness
- 1. Do you have experience treating patients with sleep apnea?
- 2. What are the proper steps and protocols post opp for a patient on PCA?
Expert Witness Response E-010079
I am the medical director for stroke and, at a second facility, the medical director of stroke and sleep. I am board certified in vascular neurology and double boarded in sleep by the ABSM and ABIM. I frequently treat patients with sleep apnea. I am highly knowledgeable about the proper steps post opp for a patient on positive airway pressure. A dose is set and based on the surgery and pain control required, and the patient is allowed a certain amount of medication through the pump. I have experience monitoring patient control analgesia setups. If the patient develops central or obstructive apneas or desaturations on oxygen, a BiPAP is placed especially in a patient with known severe sleep apnea.
Expert Witness Response E-008469
I have over 10 years of experience working with sleep apnea, as well as with physicians and surgeons in a range of specialty areas – not only in bariatric and orthopedic surgery, but spine surgery as well. Currently, I am the Medical Director for the a major university’s Sleep Disorders Center. I frequently treat patients with Sleep Apnea. Patients with obstructive sleep apnea that is left untreated, especially when it is severe, have a higher rate of complications following surgery than ones that are treated. Anesthesia physicians, along with the sleep physician, need to be sure patient uses continuous positive airway pressure machines before, during, and after surgery.