Florida Verdicts

Type:

Verdict-Defendant

State:

Florida

Venue:

Hillsborough County

Court:

Hillsborough County Circuit Court, 13th

Injury Type(s):

Case Type:

Medical Malpractice – Anesthesiology, Brain Injuries, Failure to Monitor, Negligent Treatment, Failure to Communicate

Case Name:

Terry Tibbs and Karen Tibbs v. Sondra Shields, Birute Sachen Paulauskas and Brandon Ambulatory Surgery Center LLC,
No. 08-CA-18467

Date:

October 15, 2013

Plaintiff(s):

Karen Tibbs (Female), 

Terry Tibbs (Male, 65 Years)

Plaintiff Attorney(s):

Christopher S. Knopik;
Knopik Deskins Law Group;
Tampa,
FL,
for
Karen Tibbs, Terry Tibbs ■ Maureen M. Deskins;
Knopik Deskins Law Group;
Tampa,
FL,
for
Karen Tibbs, Terry Tibbs

Plaintiff Expert(s):

Dana Debosky;
Ph.D.;
Neuropsychology;
Temple Terrace,
FL called by
Christopher S. Knopik, Maureen M. Deskins ■ Fred Raffa;
Ph.D.;
Economics;
Orlando,
FL called by
Christopher S. Knopik, Maureen M. Deskins ■ James Downs;
M.D.;
Anesthesiology;
Dunnellon,
FL called by
Christopher S. Knopik, Maureen M. Deskins

Defendant(s):

Sondra Shields, 

Birute Sachen Paulauskas, 

Brandon Ambulatory Surgery Center LLC

Defense Attorney(s):

Ronald H. Josepher;
Josepher & Batteese, P.A.;
Tampa,
FL,
for
Birute Sachen Paulauskas ■ Richard B. Mangan Jr.;
Rissman, Barrett, Hurt, Donahue & McLain, P.A.;
Tampa,
FL,
for
Sondra Shields ■ John W. Bocchino;
Bobo, Ciotoli, Bocchino, White, Buigas & Russell, P.A;
Orlando,
FL,
for
Brandon Ambulatory Surgery Center LLC ■ Roy Clifton Acord II;
Rissman, Barrett, Hurt, Donahue & McLain, P.A.;
Tampa,
FL,
for
Sondra Shields

Defendant Expert(s):

Allen Elster;
Neuroradiology;
Winston-Salem,
NC called by
Richard B. Mangan Jr., Roy Clifton Acord II ■ Louis Guzzi;
Anesthesiology;
Longwood,
FL called by
Richard B. Mangan Jr., Roy Clifton Acord II ■ Rodney Vanderploeg;
Neuropsychology;
Tampa,
FL called by
Richard B. Mangan Jr., Roy Clifton Acord II

On April 23, 2007, plaintiff Terry Tibbs, 65, a nurse, presented to Brandon Ambulatory Surgery Center in Brandon for a lumbar epidural steroid injection with anesthesia that he had scheduled with his pain management doctor. Anesthesiologist Sondra Shields was responsible for directing the anesthesia care at the hospital. Shields directed Birute Sachen Paulauskas, a certified registered nurse anesthetist (CRNA), to administer monitored anesthesia care to Tibbs during the lumbar procedure. After the procedure began, Paulauskas administered a dose of propofol, which is used to induce or maintain anesthesia. Tibbs coded and experienced respiratory arrest followed by cardiac arrest. He was intubated and transferred to Brandon Hospital for further care. Tibbs claimed he suffered a brain injury during the monitored anesthesia care. Tibbs sued Shields, Paulauskas and Brandon Ambulatory Surgery Center LLC for medical malpractice. Paulauskas and the center settled with the plaintiffs prior to trial under terms that were not disclosed. Plaintiffs’ counsel claimed that Shields performed an improper and inadequate pre-anesthesia evaluation and failed to develop and communicate a proper anesthesia plan of care to the CRNA. They claimed that Paulaskas was negligent in the administration of propofol by giving too much of it very fast. They further claimed that Shields failed to monitor the administration of Propofol because she was in another area conducting pre-procedure exams with other patients. They claimed that Brandon Ambulatory Surgery Center was vicariously liable for Paulauskas’ negligence. Plaintiffs’ counsel also claimed that Shields negligently supervised the CRNA during the administration of propofol and allowed the procedure to go forward without an end tidal C02 monitoring. They claimed that the CRNA administered a large dose of propofol shortly after the procedure began and lost the airway. They alleged that Tibbs’ respiratory and cardiac arrests were caused by a combination of the rapid administration of the large dose of propofol and the absence of end tidal CO2 monitoring. They further claimed that Shields had very little knowledge of the specific qualifications or experience of the CRNA and did not speak with her prior to the procedure regarding Tibbs’ classification as an ASA III patient. The American Society of Anesthesiology Classification system is used by anesthesiologists to stratify the severity of a patients’s underlying disease and potential for suffering complications from general anesthesia. Plaintiffs’ counsel claimed that ASA III classified Tibbs as a patient with a severe systemic disease requiring the need for special considerations because of his sleep apnea. Plaintiffs’ counsel also claimed that the hospital had a written policy requiring end tidal C02 monitoring, which was not followed in Tibbs’ case. The C02 monitoring measures a patient’s exhaled carbon dioxide to detect any respiratory problems. Plaintiffs’ counsel argued that Shields was ultimately responsible for the negligence of the CRNA because the CRNA could not practice unless Shields was present. The plaintiffs’ expert in anesthesia care testified that Shields did not communicate an appropriate anesthesia plan of care to the CRNA prior to allowing her to administer propofol to Tibbs. He also testified that Shields was responsible for ensuring that the hospital’s policy requiring end tidal CO2 monitoring during pain management procedures was followed. He further testified that if end tidal CO2 had been used, the respiratory compromise, which ultimately progressed to cardiac arrest, would have been detected much sooner and that Tibbs’ coding would not have occurred. He also testified that Shields was responsible for the negligent administration of propofol by the CRNA and her negligent monitoring of Tibbs’ airway. The defense’s expert in anesthesia care testified that Shields met the standard of care. He further testified that her pre-anesthesia evaluation of Tibbs was reasonable and appropriate. He testified that Shields was permitted to delegate the actual administration of propofol and airway monitoring to the CRNA, who was a separate, individually licensed and trained professional. He further testified that Shields was not responsible for any alleged negligence of the CRNA in the actual administration of propofol and airway monitoring. He also testified that the end tidal CO2 monitoring was not required by the standard of care even though the hospital required it.

Tibbs claimed that he suffered an anoxic brain injury. He claimed that he developed memory loss, post-traumatic stress disorder, and the inability to mult-task as a result of his brain injury. He claimed that he had to resign his position as a cardiac nurse because he was having difficulty remembering verbal orders from physicians and would have stress reactions when patients would code. He claimed that he was subsequently fired from four other jobs as a result of his inability to keep up. He claimed that he had never been fired from any job he held before the incident. Tibbs’ neuropsychological expert testified that Tibbs’ testing showed that he was suffering memory impairment, inability to multi-task, and PTSD as a result of the incident. Tibbs’ expert economist testified that the value of his past and future lost earnings as a nurse was $288,000. Tibbs sought to recover damages for past and future medical costs, past and future pain and suffering, and past and future lost wages. His counsel suggested that the jury award $1 million. Tibbs’ wife, Karen Tibbs, joined the action on a consortium claim. The defense’s neuroradiology expert testified that after viewing Tibbs’ pre- and post-incident MRIs. they were virtually identical. He testified that there was no radiographic evidence suggesting there was any area of brain damage that would have been related to an anoxic or hypoxic event. The defense’s neuropsychological expert testified that he performed an evaluation of Tibbs and found him to be functioning very well. He also testified that Tibbs did not demonstrate any evidence of memory impairment related to the incident. He further testified that Tibbs did not have PTSD and opined that Tibbs was still employable as a nurse.

The jury ruled that Shields was not negligent.

Judge:

James M. Barton

Demand:

$120,000

Offer:

None

Trial Length:

7
 days

Trial Deliberations:

1
 hours

This report is based on information that was provided by defense counsel for Shields and Brandon Ambulatory Surgery Center. Plaintiffs’ counsel and defense counsel for Paulauskas did not respond to the reporter’s phone calls.