Nabila Jaimes finally convinced herself that something was wrong with her daughter by giving her the Rubik's Cube. Until that moment, despite all the hours that had passed, I wanted to trust the doctors: if Emily spoke a little strangely and seemed lethargic, it was because the effects of the anesthesia sometimes took a while to wear off. But the girl had asked for the toy so insistently and loved it so much that the promise that one would be given to her helped get her into the hospital for knee surgery. “That's why I saw that she wasn't feeling well when her father put the bucket in her hand and she didn't even react. His eyes were lost, his mouth was open. “I was gone, switched off,” recalls this woman, who was born 31 years ago in Barquisimeto (Venezuela) and has lived in Spain for more than two decades.
The girl, then 10 years old, had suffered an adverse reaction to propofol, an anesthetic used during a meniscectomy at the Vall d'Hebron Hospital (Barcelona). Although the use of the drug in minors with a nut allergy, as was the case with them, was not recommended in the technical data sheet in 2017 – the year in which the girl was operated on – the family believes that what happened on that first occasion, “could.” It must have been a misfortune or an accident.” What she cannot understand is that just three days later, when the little girl underwent a brain MRI to clarify the incident, she was given the same medication again. “The doctors didn’t tell each other what happened, otherwise I can’t explain it,” muses Nabila.
After the second sedation, Emily suffered a “sudden clinical deterioration with severe impaired consciousness,” the first signs of a long list of irreversible consequences detailed in the medical reports. She spent three days in the intensive care unit and when she was finally able to return home, she was in a wheelchair, unable to eat, clean herself or meet her most basic needs. In November 2017, eight months after entering the operating room, “a level of disability of 84% due to multiple mental and physical disabilities” was noted.
Anamy, 11, plays with her sister Emily, 16, in a room in their house. Massimiliano Minocri
A ruling by the Administrative Court 16 of Barcelona now recognizes the family's right to compensation of 2.72 million euros (plus interest) for the damage caused to the girl. The judge criticizes the actions of the medical team and describes the second use of propofol three days after a “serious side effect” of the drug occurred during the first operation as “reckless”.
The Catalan Institute of Health (ICS), the Generalitat corporation that manages the Vall d'Hebron hospital, and the Zurich insurance company, which had already dismissed the family's original lawsuit alleging medical malpractice, have now appealed against the ruling. The health center and the Catalan government refuse to evaluate the verdict, saying the legal process is “still open”.
Rubén Darío Delgado, of Atlas Abogados – the law firm that the Association of Victims of Sanitary Negligence (AVINESA) made available to the family – believes that in the case “all the elements are present that allow direct financial responsibility of the administration “This is anything but good medical practice and has caused very serious harm to the girl.”
Emily has suffered from knee problems since she was six years old. He had a tendency to turn his toes inward when walking and one leg was slightly longer than the other, but the rehabilitation and gait training were very helpful. “She loved rhythmic gymnastics, she couldn’t stop doing all sorts of exercises,” says her mother. However, a tear in the lateral meniscus of her left knee caused severe pain that eventually sent her to the operating room for what would normally be a simple procedure. Even if it took some convincing. “They took school to the snow and made an appointment for him to have surgery on those very days. He didn't want to miss it, but we insisted that the surgery would stop the pain. And we promised him the Rubik's Cube. Then I thought about it a lot because it wasn't an urgent procedure…” Nabila remembers, her voice broken.
Much of the ruling's 34 pages deals with the use of propofol in minors and its possible side effects. The lawsuit highlights that the drug's technical information sheet – which doctors must adhere to unless better alternatives are not available to the patient – stipulated in 2017 that it should not be used in “individuals who are against nuts and Soy allergy” should be used and that “safety.” The use of propofol for sedation of children and adolescents under 16 years of age has not been proven.”
After anesthesia was started for the knee surgery, the girl suffered “an episode of hypotension that lasted about 10 minutes, with the onset of metabolic acidosis,” a process in which excess acids accumulate in the tissues. If not treated in a timely manner, tissue damage can lead to shock and death of the patient. Doctors managed to reverse the process by administering bicarbonate and continued with the knee operation. However, one of the symptoms of metabolic acidosis is the confusion and lethargy that Emily suffered after the procedure.
This first use of propofol led to disagreements between the various people who intervened in the legal process. A report by the Catalan Institute of Medical Assessments (ICAM) concludes that “the practice did not comply with the information provided by the Spanish Medicines Agency”, while several experts presented by the ICS and the insurer assure that the drug is used on minors, including at such allergies, “It’s safe”. In support of this position, they claim that its use in clinical practice is “very widespread,” that “subsequent studies conclude that there is no contraindication,” and that the technical specifications of the drug “take a long time to be updated”. In 2022, the contraindication of age was no longer included, while regarding allergies it states: “Propofol should not be used in patients with hypersensitivity to peanuts or soy.”
The judge rejects this defense. He insists, in the same line as the ICAM and the lawsuit, that the facts must be assessed against the data sheet in force in 2017, and emphasizes that the girl suffered precisely from one of the side effects, metabolic acidosis, described in The technical documentation itself is a warning. . “Here we have a first violation of the lex artis, but not the only one,” emphasizes the judge in the verdict.
On March 29, 2017, the day after the procedure, Emily was discharged and sent home. She was “confused,” the verdict says. “When she arrived home, the girl was 'complaining and irritable, with difficulty speaking'. “Early that morning, the minor woke up due to the pain, feeling unresponsive and sometimes staring,” the ruling continues.
The girl was transferred again in the morning to the Vall d'Hebron hospital, where further examinations were carried out on her and at some point she urinated on herself. These and other signs of cognitive deterioration – difficulty speaking, episodes of progressive irritability… – led to readmission and an MRI. In the end, it turned out that Emily had already suffered some damage to her brain, injuries that would later multiply.
“Reckless,” said the judge
The fact that the health center gave the girl propofol again to carry out this test is sharply censored in medical reports and in the judgment. A medical history entry prepared by professionals from Vall d'Hebron states: “Just three days previously, I had a serious adverse reaction (hypotension + metabolic acidosis + persistent confusional state) after receiving propofol during a knee arthroscopy. It is not explained how despite the history of allergies […] and with a serious adverse event occurring just three days earlier, the imprudence of administering propofol to the minor was committed again.”
After hearing all parties and analyzing the case documentation, the judge concluded that if “it was unwise to give propofol to an allergic girl during the first operation,” doing it a second time “has a very serious side effect “It occurred “like metabolic acidosis” was “reckless.”
In the living room of the family apartment in Barcelona's Bon Pastor district, Nabila smiles as she watches her youngest daughter Anamy play with Emily. “The little girl helped us a lot with all of this,” he says with a mixture of gratitude and admiration. “Remember that she was only five years old when everything happened and was almost motherless for a long time. I had to go to and from the hospital with Emily all day, so she had to be strong and brave even though she was so small. We have all had to adapt and continue to do so every day, but the two girls even more so,” he concludes.
Believe in mistakes. An initial version of this message incorrectly stated that starting in 2022, propofol would no longer be contraindicated for patients with peanut and soy allergy.
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