On December 11, 2023, a Pennsylvania medical malpractice jury returned its verdict in the amount of $14 million for the death of a 4-year-old due to a botched intubation at the now closed Einstein Medical Center in Elkins Park. The jury reportedly held Children’s Hospital of Philadelphia (CHOP), the sole defendant at the time of trial, 67% responsible for the death.
Background Facts
Freddy Munoz took his four-year-old son, S.M., to the Einstein ED on June 7, 2015, for treatment of a fever. S.M. had been treated at the same facility for pneumonia in January of 2015. At the conclusion of the June 7 visit, S.M. was discharged with a diagnosis of a herpes lesion on his lip, was given Ibuprofen, and was directed to follow up with his pediatrician in two days.
S.M. returned to the ED the following day because he had developed congestion and was having difficulty breathing. At 4:33 p.m., S.M. was seen by Dr. Parrillo. Lab tests revealed, inter alia, that S.M.’s oxygen levels and white blood count were extremely low and his heart rate was very high. Dr. Parrillo first diagnosed S.M. with asthma, then with cancer. An x-ray revealed pneumonia.
At 5:06 p.m., Dr. Parrillo called CHOP’s emergency services department and informed CHOP of S.M.’s condition, which Dr. Parrillo described as an emergency. Dr. Parrillo was connected with CHOP’s pediatric intensive care unit (“PICU”), which agreed to admit S.M. Dr. Parrillo then engaged in a series of conversations with Matt Taylor, M.D. (“Dr. Taylor”), a pediatric intensive care fellow in CHOP’s PICU. After Dr. Parrillo described S.M.’s condition, Dr. Taylor suggested administration of saline and antibiotics. Dr. Taylor asked if Dr. Parrillo believed S.M. could “crash” and require intubation. Dr. Parrillo said he did not believe so but that he could intubate S.M. if necessary.
At approximately 5:41 p.m., CHOP advised Dr. Parrillo that a transport team was available and would arrive in approximately one hour. The CHOP team included two pre-hospital nurses, Donna Galvin and Heather Maerten, both of whom had specialized training in intubating children and running codes under a physician’s direction. The team did not include an intensivist physician, although CHOP’s transport policy did provide for an intensivist to be part of the team for some patient transports, including “patient[s] with unstable vital signs and potential for loss of vital signs on transport.” While the CHOP team was en route to Einstein, S.M. was provided oxygen through a mask.
The CHOP team arrived at Einstein at approximately 6:35 p.m. Nurse Galvin received a report from the Einstein nursing staff while Nurse Maerten went to the area in the ED where she located S.M. and his father and observed that S.M. was “blue.” Nurse Galvin called CHOP, reported that S.M. was blue, that his oxygen saturation was very low at 80%, and that she was going to “get this kid intubated.” At approximately 6:45 p.m., Dr. Parrillo administered a pre-intubation sedative and paralytic and, approximately seven minutes later, attempted-unsuccessfully-to intubate S.M. His second intubation attempt at 6:54 p.m. was similarly unsuccessful. The CHOP nurses were nearby, but neither participated in the intubation attempts. Testimony at trial revealed that Nurse Galvin had intubated many more pediatric patients than Dr. Parrillo, perhaps 30 or so to his five.
Dr. Parrillo attempted to increase S.M.’s oxygen levels with an Ambu bag and mask. By 6:56 p.m., S.M. had no detectable pulse and Einstein providers began CPR. Dr. Parrillo accepted a King’s Airway device (an alternative to intubation) from the CHOP team and inserted it at 6:59 p.m. as CPR continued.
At 7:03 p.m., S.M. regained his pulse. His oxygen level rose [to] between 90% and 96%, and CPR was discontinued. Nurse Galvin left the area and updated Dr. Taylor over the phone. During this phone call, Dr. Taylor suggested to Nurse Galvin that: any abnormalities to electrolytes be corrected; that S.M. receive bicarbonate, calcium gluconate, and another dose of epinephrine, and that a chest tube be considered. Nurse Galvin stood across the hall during this conversation, and repeated portions of the recommendations. Plaintiffs’ expert Dr. Paynter testified that Dr. Taylor’s suggestions constituted “running the code.” Upon cross examination however, Dr. Paynter elaborated that “if Nurse Galvin is there conveying Dr. Taylor’s suggestions and confirming, that’s fine.”
Subsequently, S.M. lost his pulse again and CPR was resumed, this time with Nurse Maerten taking turns with Einstein providers. At approximately 7:16 pm., after receiving Nurse Galvin’s update call, Dr. Taylor engaged in a number of conversations with CHOP’s transport service and arranged to send a second team to Einstein by ambulance, this time with an intensivist physician. (Sending a team by helicopter was not an option due to weather conditions.) The transport team would arrive in an hour. It was ultimately determined that the team would not arrive in time to assist in S.M.’s care. Therefore, a second team was not dispatched.
In the meantime, at 7:12 p.m., the first of two Einstein anesthesiologists arrived in the ED. Each unsuccessfully attempted to intubate S.M. S.M. was pronounced dead at 7:36 p.m.
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