The patient in this case, a toddler, presented to the defendant dentist for extraction of several teeth. The patient was given general anesthesia by the co-defendant anesthesiologist. Even though both of the child’s parents were in attendance for the procedure, neither the anesthesiologist nor the dentist obtained informed consent prior to commencing the procedure. They also both failed to document the patient’s baseline health data, including whether the patient had any specific risk factors that may warrant additional consultation before sedation.
 
As the patient was being anesthetized, he started wheezing. The dentist continued with the procedure and four teeth were extracted. However, as the patient was coming out of anesthesia, his breathing became extremely compromised. He was given five liters of supplemental oxygen, but his oxygen saturation steadily dropped, his respiratory rate increased, and his heart rate rose to 138. The anesthesiologist began to bag-mask the patient, but that only forced air into his stomach rather than his lungs. The dentist suggested intubating the patient, but the anesthesiologist refused. EMTs were then called. When the EMTs arrived several minutes later, they immediately suggested the patient needed to be intubated, but the anesthesiologist again refused. While EMTs were placing the patient in the ambulance, they again suggested intubation, and the anesthesiologist refused a third time.
 
When the patient arrived at the hospital he was immediately intubated and prepared to be air-lifted to a hospital better suited for the care he would need. At the second hospital, the child’s condition worsened. He exhibited signs of post cardiopulmonary arrest and anoxic-ischemic brain injury. Four days after the tooth extraction procedure, the patient was pronounced brain dead. Autopsy records showed asphyxia due to anesthetic sedation as the cause of death.
 
Allegations against the anesthesiologist and dentist included failure to obtain informed consent for the extraction procedure with anesthesia, failure to promptly call for emergency services, and failure to intubate. Attempts to dismiss the dentist from this case were ultimately unsuccessful due to the failure to obtain and document informed consent prior to the procedure and other documentation deficiencies.
 
The parties reached a settlement for greater than $1 million.


^{With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.
 
References
Coté, C. J., & Wilson, S. (2019). Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatric dentistry, 41(4), 26E-52E. https://pediatrics.aappublications.org/content/143/6/e20191000.
Laska, L. (2021). Failure to intubate after extraction of four teeth leads to breathing problems – death - $1 million settlement. Medical Malpractice Verdicts, Settlements & Experts, 37(7), 3.
 
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