The family of a 29-year-old Texas woman who died after aspirating a dislodged nasal pack has settled its malpractice lawsuit against an anesthesiologist whose actions allegedly caused the fatality for $350,000.

According to Tarrant County District Court records, the patient, Joella Johnson, had a history of obesity, gastroesophageal reflux and chronic hoarseness. In May 2007, she was admitted to Harris Methodist Northwest Hospital in Azle, Texas, for multiple procedures, including septoplasty, turbinectomy, bilateral maxillary antrostomies and ethmoidectomies, and left concha bullosa removal.

The attending surgeon concluded the procedures by packing the patient's nose with surgical sponges secured by sutures. Anesthesiologist William Clifford Sanders, DO, performed a deep extubation and the patient was transferred to recovery.

On the way there, however, she inhaled one of the nasal packs an inch back into her left nostril. While Dr. Sanders pulled the dressing back into place, the sutures securing them were apparently severed, after which the patient aspirated the right nostril's packing.

Urgent remedial measures proved unsuccessful. Dr. Sanders initially tried to mask ventilate and intubate her, to no avail. The patient's vital signs plummeted. Dr. Sanders then tried a cricothyroidotomy, and the surgeon attempted a bronchoscopy followed by an emergency tracheotomy. Ultimately, the nasal packing was removed by forceps from the patient's throat.

She was transferred to the hospital's intensive care unit, where she suffered metabolic acidosis, pulmonary edema, unstable blood pressure and cardiac arrhythmia before dying that afternoon.

The family sued Dr. Sanders for gross negligence. Among their charges were that Dr. Sanders had performed an ill-advised deep extubation in spite of the patient's obesity, difficult airway and aspiration risks; dislodged the nasal pack and suture during extubation; failed to exercise prudent care and remove all the dressing after aspiration became a threat; and failed to notify the attending surgeon before manipulating it himself. These missteps, the family claimed, delayed proper treatment and hastened the patient's death.

Ms. Johnson's family eventually settled its case, an agreement which the court approved on July 13. Greg Jackson, the Fort Worth attorney who represented the family, declined further comment. An attorney for Dr. Sanders did not immediately return calls seeking comment.

Robert J. Murphy