I am at a loss. A very good friend of mine underwent surgery at a Chicago, Illinois, hospital and never woke up. He is now severely brain injured. How could this happen? He was only thirty and in great health. The hospital says it was just a tragic accident but I am wondering whether it could be medical malpractice.

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I am deeply sorry about what happened, and yes, it could be medical malpractice. Surgeries are not risk-free. They can result in unintended injuries even under the best care; however, there are some kinds of injuries that raise an immediate red flag to lawyers like me who focus on medical negligence cases. For example, surgical or operating room fires are called never-events in that they should never occur. When my firm gets a call about someone getting burned during surgery we know right away that it was the result of hospital negligence. Although not quite in the category of fire, brain injuries during surgery are a similar type of “red-flag” injury. In other words, they are the type of injury that should almost never occur, especially in young, healthy patients like your friend. To understand how brain injuries occur during surgery it is helpful to review some medical basics.

First, it is important to understand that the immediate cause of nearly all surgical brain injuries is insufficient oxygen supply. In other words, something (the initiating cause) leads to the brain getting deprived of oxygen and, unless reversed, will cause death of the brain tissue.

Second, the brain gets deprived of oxygen in three main ways (the intermediate cause): insufficient blood flow to the brain (oxygen is carried in the blood), insufficient oxygen in the blood or damage to the brain cells that process oxygen. The first two are the most common intermediate causes of brain injury during surgery.

Third, there can be several different initiating causes of oxygen deprivation during surgery. One of the most common initiating causes is impaired breathing. During surgery a patient is given powerful drugs to “knock them out,” i.e., to prevent them from feeling pain. These same drugs, however, paralyze the patient’s breathing. Consequently, a doctor, called an anesthesiologist, must use machines to breath for the patient during surgery. If the anesthesiologist is negligent in doing this — puts the breathing tube in the wrong place (negligent intubation), for example — oxygen will not get into the patient’s blood. It doesn’t take long for this to lead to oxygen deprivation of the brain.

Another way the brain can get deprived of oxygen is if the patient bleeds excessively during surgery or if his or her blood pressure gets too low (hypotension) for too long. In either case, not enough blood gets to the brain and once again the brain is deprived of oxygen. And, of course, the brain will get deprived of oxygen if the patient’s heart stops (cardiac arrest) during surgery. (This, apparently, is what happened to Joan Rivers).

Again, there are many possible causes of oxygen deprivation and brain injury during surgery. Almost all of them are preventable with reasonable care. If your friend’s family were to contact our law firm, Cirignani, Heller & Harman, we’d review the medical records carefully to determine how the oxygen deprivation happened. My partner, Stan Heller, is a lawyer who is also a doctor, and he’ll do this review and talk about what he’s found free of charge, and without anyone having to hire us or make any other commitments. When a tragedy like this happens the most important thing to do is to find out why. We can help:

Answered 09/17/2014

Disclaimer: This answer was provided by an attorney selected to Super Lawyers, and is intended to be an educated opinion only. This answer should not be relied upon as legal advice, nor construed as a form of attorney-client relationship.

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