On or about January 18, 2018, a patient described as “P.S.” was admitted to Jackson Memorial Hospital for treatment of triple vessel coronary artery disease. That same day, P.S.’s doctors performed a coronary artery bypass graft (CABG) “without complications.” As the patient was being transferred from the operating room table to a bed, his ventilation machine was inadvertently disconnected from its power source…medscape.com, Anesthesiologist Is Punished for Standard of Care Lapses, Wayne J. Guglielmo, MA, May 2022
As the anesthesiologist on duty that day, Sciarra was responsible for proper postsurgical ventilation. Thus, the complaint faulted him not only for failing to prevent the initial interruption in breathing assistance but also for its “prolonged” cessation.
The result for the patient was catastrophic: He developed severe bradycardia, “followed by a full ventricular fibrillation cardiac arrest.”
PS was taken to the intensive care unit on life support. He was pronounced dead on January 23, 2019. Court documents indicate that he lived for slightly more than a year after the CABG surgery.
Among other things, the board noted that not all of the events laid out in the administrative complaint were within Sciarra’s control and that the patient’s death was caused at least in part by a “system error.”
The board agreed that the following penalties were appropriate:
– The issuing of a letter of concern
– The requirement that Sciarra complete three CME hours in risk management
– A fine of $5,920.45, payable within 30 days of the final order