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Anderson v. United States

United States District Court, W.D. Washington, Tacoma

June 18, 2019

JOSHUA ANDERSON, as Guardian Ad Litem of minor B.J.P.; ARMANI PORTER; and TYLER PORTER, Plaintiffs,
v.
UNITED STATES OF AMERICA, Defendant.

          FINDINGS OF FACT AND CONCLUSIONS OF LAW

          Ronald B. Leighton United States District Judge

         THIS MATTER came before the Court on plaintiffs' claims against the defendant, United States of America, arising from the negligence of defendant's employees, medical care providers at Madigan Army Medical Center. Having reviewed the evidence, heard the testimony, and considered the arguments of counsel, the Court now enters these Findings of Fact and Conclusions of Law.

         I. FINDINGS OF FACT

         A. BACKGROUND FACTS

         1. Tyler Porter (“Tyler”) was born on March 24, 1996 in Virginia.

         2. According to mortality tables, the normal male life expectancy aged 23 years is 52.73 years.

         3. Tyler will likely live another 52.73 years, the normal life of a man aged 23 years.

         4. Armani Saunders (formerly Porter) (“Armani”) was born on August 1, 1996 in Virginia.

         5. According to mortality tables, the normal female life expectancy of a woman age 22 years is 58.64 years.

         6. Armani will likely live another 58.64 years, the normal life of a female aged 22 years.

         7. Tyler and Armani were married in Virginia on December 6, 2014.

         8. B.J.P. was born on July 28, 2014 in Virginia.

         9. According to mortality tables, the normal male life expectancy aged 4 years is 71.09 years.

         10. B.J.P. will likely live another 71.09 years, the normal life of a male aged 4 years.

         11. Tyler is B.J.P.'s father.

         12. Armani is B.J.P.'s mother.

         13. Tyler, Armani, and B.J.P. lived in Virginia after B.J.P.'s birth.

         14. In January 2015, Tyler enlisted in the United States Army.

         15. Tyler received orders to be stationed at Ft. Lewis Washington and Tyler, Armani, and B.J.P. moved to Washington on July 10, 2015.

         B. B.J.P.'S SURGERY AND THE SURGICAL FIRE

         16. Madigan Army Medical Center is a federal military treatment facility at Joint Base Lewis-McCord, Washington.

         17. Defendant United States of America operates Madigan Army Medical Center.

         18. B.J.P. underwent surgery at Madigan Army Medical Center on September 2, 2015 (“the Surgery”).

         19. The purpose of the Surgery was to remove a small, benign cyst from above B.J.P.'s left eye.

         20. The care team involved in the Surgery consisted of active duty service members and Department of Army civilian employees.

         21. The care team involved in the Surgery included Phillip Cuenca, M.D., John Horton, M.D., and Benjamin Althuisius.

         22. Dr. Cuenca was the anesthesiologist for the Surgery.

         23. Dr. Horton was the pediatric surgeon who performed the Surgery.

         24. At the time of the Surgery, Benjamin Althuisius had just finished his first year of training to become a nurse anesthetist.

         25. During the Surgery, Benjamin Althuisius was under the supervision of Dr. Cuenca.

         26. Dr. Cuenca did not communicate with Dr. Horton the planned method of administering anesthesia for the Surgery.

         27. Dr. Cuenca did not inform Dr. Horton that supplemental oxygen would be supplied at a concentration in excess of 30% using an open oxygen delivery system during the Surgery.

         28. Dr. Horton did not communicate with Dr. Cuenca the planned method of excising B.J.P.'s small cyst during the Surgery.

         29. Dr. Horton did not inform Dr. Cuenca that Dr. Horton would be using an electrocautery device to excise B.J.P.'s small cyst during the Surgery.

         30. Dr. Cuenca did not believe that an electrocautery device would be used during the Surgery.

         31. Dr. Cuenca assumed that Dr. Horton would be using a scalpel to excise B.J.P.'s small cyst during the Surgery.

         32. Had Dr. Cuenca known that Dr. Horton intended to use an electrocautery device during the Surgery, Dr. Cuenca would have administered anesthesia differently.

         33. Had Dr. Cuenca known that Dr. Horton intended to use an electrocautery device during the Surgery, Dr. Cuenca would have administered concentrated oxygen at a lower level.

         34. Surgical fires require the existence of an oxidizer, an ignition source, and a fuel source.

         35. When an environment lacks a sufficient quantity of an oxidizer, fire cannot occur.

         36. When an environment lacks an ignition source, fire cannot occur.

         37. When an environment lacks a fuel source, fire cannot occur.

         38. Oxygen is an oxidizer.

         39. Oxygen-enriched environments increases the likelihood of fire.

         40. An electrocautery device is an ignition source for fire.

         41. A fuel source for fire is any combustible material, including a surgical mask and human skin.

         42. Surgical fires can have devastating consequences for patients.

         43. During the Surgery, B.J.P. was given inhaled anesthetic and concentrated oxygen through a mask, an open oxygen delivery system.

         44. Benjamin Althuisius was in charge of holding the mask on B.J.P.'s face and ensuring that B.J.P.'s airway remained open during the Surgery.

         45. During the Surgery, combustible materials were located at or in the vicinity of where Dr. Horton attempted to use the electrocautery device.

         46. No fire risk assessment or any other assessment of surgical fire risk was performed by the treatment providers before proceeding with the Surgery.

         47. Less than five minutes into the Surgery, Dr. Horton activated the electrocautery device.

         48. Benjamin Althuisius did not inform Dr. Horton that Dr. Horton was about to activate the electrocautery device in proximity to the open oxygen source and in an oxygen enriched environment.

         49. Benjamin Althuisius did not inform Dr. Cuenca that Dr. Horton was about to activate the electrocautery device in proximity to the open oxygen source and in an oxygen enriched environment.

         50. After Dr. Horton activated the electrocautery device, Benjamin Althuisius felt a fireball come over his right hand.

         51. When Benjamin Althuisius felt the fireball come over his right hand, Benjamin Althuisius' right hand was located on B.J.P.'s face.

         52. After feeling the fireball come over his right hand, Benjamin Althuisius threw the surgical drapes and mask into the air and away from his hand and B.J.P.'s body.

         53. When the treatment providers realized a fire had occurred, the treatment providers aborted B.J.P.'s cyst excision.

         54. The treatment providers doused saline on B.J.P.'s face.

         55. The surgical mask, which had fallen to the floor in flames, was extinguished with water.

         56. The surgical team and Dr. Horton did not allow excess oxygen to dissipate prior to Dr. Horton activating the electrocautery device during the Surgery.

         57. Dr. Cuenca was actively administering oxygen through an open delivery system in an amount much greater than 30 percent at the time Dr. Horton activated the electrocautery device.

         58. Dr. Cuenca estimates the level he was administering oxygen through an open delivery system at the time of the surgical fire to be 90%.

         59. The September 2, 2015 surgical fire occurred in an oxygen enriched environment.

         60. The September 2, 2015 surgical fire would not have ignited if the environment had not been oxygen enriched.

         61. The September 2, 2015 surgical fire was caused by the use of an electrocautery device in an oxygen enriched environment in the presence of combustible fuel sources.

         62. The September 2, 2015 surgical fire was preventable.

         63. B.J.P. was asleep under anesthesia when the September 2, 2015 surgical fire erupted.

         64. Defendant admits that it failed to exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at the time in the profession or class to which he or she belongs, in the state of Washington, acting in the same or similar circumstances and that this failure was the sole proximate cause of the September 2, 2015 surgical fire and the damages proven to result from the September 2, 2015 surgical fire.

         C. DAMAGES

         B.J.P.'S DAMAGES

         1. B.J.P.'S ACUTE RECOVERY AND ACUTE RECOVERY RELATED DAMAGES AND HARMS

         65. Initial evaluation of B.J.P. immediately following the September 2, 2015 surgical fire noted obvious burns to B.J.P.'s face with the right side worse than the left. The size of the burned area was estimated up to 10% of B.J.P.'s total body surface area.

         66. Harborview Medical Center Burn Center was contacted and immediate transport of B.J.P. to Harborview Medical center for further management and treatment of the injuries was recommended.

         67. B.J.P. was moved to the Madigan Army Medical Center Pediatric Intensive Care Unit and awaited emergent airlift to Harborview Medical Center.

         68. B.J.P. was transported by emergent airlift to Harborview Medical Center Burn Unit on September 2, 2015.

         69. On September 2, 2015, B.J.P. was admitted to Harborview Medical Center Pediatric Intensive Care Unit (PICU) pending stabilization and/or appropriate management of anesthesia, pain control, respiratory management, wound care, and fluid management.

         70. While in the PICU, B.J.P. was critically ill.

         71. While in the PICU, B.J.P. appeared restless and agitated.

         72. While in the PICU, B.J.P. remained intubated before eventually self-extubating.

         73. While in the PICU, B.J.P. was diagnosed with acute respiratory failure.

         74. While in the PICU, B.J.P. received medications, including narcotic pain medications and sedation medications.

         75. While in the PICU, B.J.P. received wound care.

         76. While in the PICU, B.J.P. experienced complications directly related to his burn injuries, including bradycardia, tachycardia, hypertension, inadequate sedation, rapid oxygen desaturation, acute respiratory failure, and significant edema.

         77. As a direct result of the injuries sustained in the surgical fire, B.J.P. was unable to open his eyes for approximately three days following the fire.

         78. On September 5, 2015, B.J.P. was transferred from the PICU to acute care where he received continued monitoring and wound care.

         79. On September 9, 2015, B.J.P. was placed under general anesthesia and ...


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