The plaintiff, acting as the administrator of the deceased’s estate, alleged that the Defendant, Dr. Aouida, an anesthesiologist at Miramichi Regional Hospital, was negligent in administering spinal anesthesia to the deceased during an urgent urological surgery. The deceased, Ms. Crawford, an obese patient with several comorbidities and sepsis, went into respiratory arrest during the procedure. Despite resuscitation, Ms. Crawford’s respiratory arrest resulted in brain damage and ultimately her death.
The plaintiff alleged that Dr. Aouida’s actions were negligent in the following ways:
On April 23rd, 2025, the Court of King’s Bench of New Brunswick ruled in favour of the plaintiff, finding that Dr. Aouida breached the standard of care expected of an anesthesiologist and that this breach caused Ms. Crawford’s death.
Ms. Crawford, a 36-year-old woman, arrived at the Emergency Room at the Miramichi Regional Hospital on May 13th, 2016, describing pain in her right flank. A CT scan on May 14th, 2016, revealed an obstructive stone at the uretero-vesical junction along with signs of pyelonephritis and early indications of a potential abscess. Dr. Steel, the plaintiff’s expert witness, testified that Ms. Crawford’s condition deteriorated in the first 12 hours of her hospital admission, displaying symptoms consistent with the development of sepsis. The patient was promptly referred to a urologist, Dr. Vonkeman, for urgent assessment. After evaluation, Dr. Vonkeman determined that immediate surgery was necessary to remove the obstructive stone and to place a double J stent.
During her pre-operative assessment, Dr. Aouida, the defendant, reviewed Ms. Crawford’s hospital records, gathered information about her medical history, and performed a physical examination, which included an assessment of her airways. In evaluating Ms. Crawford, Dr. Aouida concurred with Dr. Vonkeman’s assessment that surgery must be carried out urgently. However, he expressed concerns about the challenges of intubation with general anesthesia and the increased likelihood of anesthetic complications due to her morbid obesity. Consequently, Dr. Aouida concluded that spinal anesthesia was the most appropriate anesthetic option.
Although Dr. Aouida prepared for possible complications by setting up a difficult intubation cart and vasopressors in anticipation of a potential drop in blood pressure, Ms. Crawford went into respiratory arrest shortly after testing the spinal anesthesia and positioning her in the modified lithotomy position for surgery. After an unsuccessful attempt to ventilate her, a code blue was called, and the Cardiorespiratory Intensive Care protocol was initiated. Ms. Crawford was successfully resuscitated shortly thereafter. The surgery was then completed, and she was transferred to the ICU.
While in the ICU, Ms. Crawford experienced ongoing issues with ventilation requiring several days of sedation. She subsequently developed kidney failure, fungal infections, and pressure ulcers, leaving her in critical condition. Ms. Crawford passed away on June 24th, 2016.
The two issues in dispute in this case were whether Dr. Aouida breached the standard of care expected of an anesthesiologist and whether that breach directly caused Ms. Crawford’s death.
Dr. Claudio DiQuinzio was qualified as an expert in anesthesiology, with specific knowledge in the administration of anesthesia to patients with obesity and sepsis. He testified on the standard of care of anesthesiology practice, particularly regarding the use and risks of spinal anesthesia in patients with these comorbidities.
Dr. DiQuinzio drew upon his clinical experience and educational background, including his role as an examiner for the Royal College of Physicians and Surgeons of Canada, where he evaluated anesthesia candidates on their clinical judgment and knowledge. He referenced authoritative anesthesiology textbooks and clinical standards commonly used to prepare residents for their Royal College examinations.
Dr Andrew Steel was a qualified expert in both anesthesiology and critical care. He testified to the appropriateness of spinal anesthesia in a patient like Ms. Crawford.
Dr. Luc Arel was qualified as an expert in the field of anesthesia, authorized to provide an opinion on the question of the standard of care
Dr. Arel worked for 38 years as an anesthesiologist in the operating room at the Centre intégré de santé et de services sociaux du nord de Lanaudière (“CISSSNL”) in Joliette, Quebec. He held the role of head of the anesthesiology department for 10 years, and served on the board of directors of the Association des Anesthésiologistes du Québec.
Dr. Yoanna Skrobik was qualified as an expert in internal medicine and critical care authorized to provide an opinion on the causality and quality of the anesthetic choices offered by Dr. Aouida.
After carefully weighing the evidence and testimonies from medical experts, the court determined that Dr. Aouida breached the standard of care required of an anesthesiologist in like circumstances and that breach directly caused Ms. Crawford’s respiratory arrest and subsequent death.
The court found that Dr. Aouida failed to meaningfully consider the use of general anesthesia and largely disregarded the potential benefits of its use. Nonetheless, once spinal anesthesia was chosen, he failed to properly manage the foreseeable consequences of its use by not providing adequate monitoring and cardiovascular support. Lastly, the court ruled that Dr. Aouida had inadequately informed Ms. Crawford of the benefits of general anesthesia, rendering her unable to make an informed decision about the best course of action.
Consequently, the court determined that Dr. Aouida’s actions deviated from what was expected of a reasonable anesthesiologist in similar circumstances. This deviation was found to be a direct cause of Ms. Crawford’s respiratory arrest and death.
Decision Date: April 23, 2025
Jurisdiction: Court of King’s Bench New Brunswick
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