Kalitan v. Alexander (Fort Lauderdale, Florida)
Susan Kalitan suffered a perforated esophagus during intubation for anesthesia prior to surgery for carpal tunnel syndrome. The perforation was not detected, and subsequently caused severe harm.

In his closing argument for Dr. Alexander, Robert Cousins (Quintairos Preito) pointed out that the mere occurrence of bad things that should not happen does not mean that there was negligence, and in this case the risk of negative outcomes was disclosed to the patient.

Cousins read to the jury from a patient disclosure form: “‘There is a minimal possibility of bleeding or perforation’…and so, ladies and gentlemen, this is a known and recognized complication…Should it happen? No. But does that mean there’s negligence? Absolutely not.” In this case, said Cousins, there was nothing in the post-anesthesia procedure, under the circumstances, at the time, that should have alerted Dr. Alexander to a potential problem. Therefore, his failing to recognize the perforated esophagus did not breach the standard of care.

Representing Barry University, which trained student nurse Eleidy Miedes, who allegedly caused the injury to Ms. Kalitan’s esophagus, Jeffrey Creasman (Quintairos Prieto) told the jury “There’s not a shred of evidence in this case ladies and gentlemen that Ellie Miedes did any endotrachael intubation [which was the procedure that allegedly caused the injury]. None. Not a single witness has said that….that entirely exonerates my client.” Even if Ms. Miedes did any part of the procedure that injured Ms. Kalitan, Mr. Creasman continued, Miedes would be held to the standard of care of a student nurse directly supervised by a physician, and she would not have been expected to anticipate a difficult airway.

Representing Broward General Medical Center, Tom Heath (Heath Carcioppolo) told the jury that Broward’s nurses were top-notch critical care nurses who behaved properly throughout Ms. Kalitan’s stay. The nurses discharged Ms. Kalitan because she was medically stable and not in pain.

In his closing rebuttal, Crane Johnstone (Schlesinger) told the jury, “What you’ve seen is the attorneys for a month now and in closing remarks defend the indefensible. And, that’s what defense attorneys do. They speak for the defendants, and they will even, in a case like this, do what they have done, which is defend the indefensible.“

Reminding the jury of a nurse’s testimony, Mr. Johnstone said, “It was inexcusable and it was below the standard of care for three nurses to have heard from Susan about the pain that she had after a minor wrist procedure and not serve as an advocate and speak for her to make sure that the doctor came, or the nurses higher up in the hierarchy — the charge nurse, the supervising nurse — to get someone to see this woman before she went home…The pain she was experiencing was so severe she could barely stand up, and then got more pain medication, and it put her to sleep.“

“They never get a physician in to see her, despite the rules and the regulations of the hospital, that say that the etiology — the cause of this pain — should be determined if at all possible. And nobody did that…They never checked on her that afternoon to make sure that when the pain medication wore off she was ok, and that she didn’t require further help from her doctor. When they finally called her the next day, they called the wrong number. That’s the evidence in the case. That’s the care she got.“

Moreover, said Mr. Johnstone, nurse Miedes was on academic probation at Barry University and had subpar clinical marks at the time she cared for Ms. Kalitan, including her marks in Physiology and Difficult Airway Assessment.

The jury found negligence on the part of all defendants, assigning 50% to Dr. Alexander, 35% to Broward Medical Center, 5% to the student nurse, and 10% to the student nurse’s supervisor, who was acting on behalf of Barry University.

The jury found that Ms. Kalitan suffered a catastrophic severe closed head injury and awarded damages as follows: Past medical expensese: $142,704; future medical expenses: $472,287; past lost earnings: $55,220; future lost earnings: $47,800; past general damages including pain & suffering: $2M. Future general damages: $2M. The total damage award was $4,718,011.

CVN webcast the Kalitan medical malpractice trial live.

Kalitan v. Alexander (Fort Lauderdale, Florida)

Dental assistant Susan Kalitan developed an injury common to those in her profession: carpal tunnel syndrome. However, unlike others who undergo surgery to eradicate the pain and discomfort associated with this condition, Ms. Kalitan ended up in a drug-induced coma and sustained a spinal cord injury in the course of what should have been a minor wrist surgery. How did Ms. Kalitan get here?

Ms. Kalitan’s attorney, Crane Johnstone (Schelesinger Firm), said that the anesthesiologist made a mistake during the procedure, and punched a hole in Ms. Kalitan’s esophagus.  The records showed that Ms. Kalitan complained of severe chest and back pain after the surgery. But instead of determining the cause of the pain, the hospital gave Ms. Kalitan pain medication and discharged her.

As a result of the hole in Ms. Kalitan’s esophagus, any food ingested risked entering not her stomach but her chest — and much of the food she consumed after being discharged did in fact end up in her chest. This led to sepsis, which brought her quickly back to the emergency room, where she underwent multiple major surgeries, eventually ended up in a drug-induced coma.

As a result of this carpal tunnel syndrome surgery gone horribly wrong, Ms. Kalitan brought this suit against the anesthesiologist, Dr. Rob Alexander, and several other defendants associated with the hospital.

Mr. Johnstone emphasized in his opening statement the damage sustained by the plaintiff over the course of the incident and since. He stated, “She was left with a feeding tube for months … She’s got major scarring all over her body. She could not eat or drink for months. To this day food hangs up in her throat. When she was lying in that hospital bed, she never got any physical therapy for the surgery on her wrist … she has been left with very serious and permanent pain in her neck and shoulders and hands.” He added that in addition to these physical injuries, as a result of the incident NAME suffered from depression and PTSD, had chronic fatigue, and could not afford to pay her debts. 

“This perforation, the evidence will show, should never have happened,” said Mr. Johnstone. “She wasn’t morbidly obese with a short neck, which makes intubation difficult. She didn’t have trauma where the airway was obstructed and there was a lot of blood you couldn’t see. There was no excuse for what happened here,” and Ms. Kalitan was never told that an anesthesiology student in her first semester of training would be practicing on her.

Defense attorney Robert Cousins (Quintairos, Preito, Wood, & Boyer)  demonstrated for the jury using tools and plastic throat models the steps involved in a rapid endotracheal intubation, concluding that it was successfully completed, and it was “extremely unlikely” that the soft, pliable tip of the endotracheal tube caused any injury or harm to the esophagus. The medical records showed that Dr. Alexander passed the tube successfully into the endotracheal area on the first attempt. If there had been an esophageal intubation it would have been noted on the records, which it was not.

An oro-gastric tube was placed through the mouth and esophagus and into Ms. Kalitan’s stomach, probably by a student, but also had a soft, flexible tube. A temperature probe was also inserted into the esophagus. The temperature probe had a more rigid tip, but was also soft and flexible. None of the devices when removed showed any signs of blood or trauma, so there was no reason for any of the caregivers to have believed that an injury had occurred.

“He was there … he supervised the case appropriately, and then he moved on to another procedure,” Mr. Cousins said. Further, even while Dr. Alexander was not present, the anesthesiologists and the certified registered nurse anesthetists followed proper hospital protocol.

Mr. Cousins told the jury that an injury during such “blind” procedures in which it was not possible to see past the vocal chords was unfortunate, but not negligent. Dr. Alexander acted reasonably, said Mr. Cousins, because Ms. Kalitan seemed fine after the procedure, and Dr. Alexander had no reason to believe that anything bad had happened.

CVN is covering Susan Kalitan v. Rob Alexander trial live.