CHARLESTON – The estate of a Kanawha County kindergarten teacher has sued CAMC, several physicians, nurse anesthetists and health care staffing companies, alleging an unrecognized internal hemorrhage after hip surgery caused her death.
Franklin Harman, administrator of the estate of his mother, Cynthia Ellen Harman, filed the medical malpractice and wrongful death lawsuit August 25 in Kanawha Circuit Court. In addition to Charleston Area Medical Center, other named defendants are orthopedic surgeon Jason Allen Castle; anesthesiologists Kevin Kimo Koji Souza, Daniel Everett Miller and Nathan Mendiola Remolona; certified registered nurse anesthetists Justin Cole Lyttle and Olivia Michelle Campbell; Comphealth; Independent Healthcare Providers Corp.; Qualivis LLC; and General Anesthesia Services Inc.
According to the complaint, 57-year-old Harman had a left hip replacement in 2020, but the surgical site became infected and the infection persisted despite additional procedures and antibiotics, according to the complaint. She was admitted to CAMC Memorial Hospital on October 17, 2024, with bacteremia and sepsis.
On October 23, 2024, after being medically stabilized, Harman underwent surgery to remove the infected hip implant, debride the area and place an antibiotic spacer, the complaint says. She already was anemic before surgery, with a hemoglobin level of 10.1 grams per deciliter, according to the filing.
The lawsuit says multiple pelvic blood vessels were injured while the acetabular component of the hip implant was removed. It also alleges Castle did not recognize the injuries or seek an intraoperative vascular-surgery consultation.
The operation ended at 4:32 p.m. The operative report estimated blood loss at 1,000 milliliters, or about 20% of Harman’s circulating blood volume, and directed that she receive one unit of packed red blood cells in the post-anesthesia care unit, according to the complaint.
But minutes before she left the operating room, her blood pressure was recorded at 45/11, with a mean arterial pressure of 23, the lawsuit says.
Despite that reading, the anesthesia transfer-of-care note described her as “Satisfactory/Stable,” and the operative report said she was taken to recovery in stable condition. The complaint calls those statements inconsistent with “the hemodynamic data recorded in the hospital’s own contemporaneous record.”
Harman was transferred to the post-anesthesia care unit, or PACU, at 4:51 p.m. Her first recorded blood pressure there was 89/46, and the complaint says her systolic blood pressure repeatedly fell below 90 during the next four hours while she remained tachycardic and required increasing respiratory support.
The complaint says Lyttle ordered two units of red blood cells at 4:22 p.m. and that the blood was administered between 5:02 p.m. and 6:39 p.m. It alleges no hematocrit level was obtained before, during or after those transfusions.
At 5:26 p.m., Souza signed a post-anesthesia evaluation using a blood pressure of 83/54, which the hospital record itself marked “critical” and “low,” the complaint says. “No further anesthesia assessment of Ms. Harman appears anywhere in the record after that note,” according to the complaint.
The estate further alleges no physician entered a progress note between 5:30 p.m. and 8:50 p.m.; no arterial line was placed; no hematocrit or coagulation studies were obtained; and no physician examined Harman, identified the cause of her hypotension or directed a systematic resuscitation during that period.
An arterial blood-gas test at 7:23 p.m. showed metabolic acidosis, elevated lactate and a hematocrit of 26.6%, which the complaint says indicated inadequate tissue perfusion and evolving hemorrhagic shock.
“No defendant acted upon these results,” the complaint states.
A critical-care consultation was obtained at 8:50 p.m. for shock and decreased consciousness, nearly four hours after Harman arrived in recovery, according to the complaint. By then, she had received two units of blood, two liters of crystalloid fluid, 75 grams of albumin and 4,000 micrograms of phenylephrine but remained profoundly hypotensive, according to the complaint.
The consultant diagnosed hemorrhagic shock, activated a massive-transfusion protocol and ordered Harman transferred to the intensive care unit, the complaint states.
A CT angiogram early the next morning showed a pelvic hematoma measuring 17 by 13 by 7.9 centimeters with active bleeding, according to the complaint. Harman later underwent emergency angiography and coil embolization of branches of the left internal iliac artery, left superior gluteal artery and left profunda artery.
The embolization stopped the bleeding, but the complaint says intervention came too late. Harman remained in hemorrhagic shock on four vasopressors. Her family later chose comfort measures, and she died at 5:38 p.m. October 24, 2024.
The estate alleges Harman was conscious for part of the period in which she was bleeding internally and experienced pain, suffering and mental anguish. The complaint says she “remained awake and aware while she bled internally, while her blood pressure fell, while her breathing labored … and while no physician came to her bedside.”
Harman had worked for many years as a kindergarten teacher with Kanawha County Schools, according to the lawsuit. She is survived by three children, her mother and siblings.
The complaint alleges Castle failed to protect pelvic vascular structures, identify vascular injuries and seek emergency vascular consultation. It alleges anesthesia providers failed to recognize and treat hemorrhagic shock, obtain timely laboratory testing, place an arterial line, initiate appropriate blood-product resuscitation and ensure responsibility for Harman’s condition was assumed by a physician.
The lawsuit contends the anesthesia providers’ conduct amounted to “a conscious and reckless disregard of known and serious risks to her life.”
CAMC and the corporate defendants are accused of vicarious liability for the conduct of their employees, agents or contractors. The estate also alleges CAMC is liable for nurses and respiratory care personnel who failed to recognize and promptly escalate Harman’s declining condition.
The estate seeks compensatory damages, punitive damages against five anesthesia providers, pre- and post-judgment interests, court costs, attorney fees and other relief.
The estate is being represented by Mark R. Staun, R. Dean Hartley and John H. Zickefoose of Hartley Law Group in Charleston. The case has been assigned to Circuit Judge Richard D. Lindsay.
Kanawha Circuit Court case number 26-C-1052
