Stephen M. Smith decided to undergo throat surgery to remove a spot on his esophagus — a spot that he feared could become cancerous.
As he walked into St. Francis Hospital and Medical Center in Hartford on July 3, 2008, Smith and his wife, Benay, were expecting a short hospital stay. They planned a belated Fourth of July barbecue at their East Hampton home. Smith, 55, hoped to return to work in the hardware section at Lowe's in a few weeks.
After the throat surgery, Smith had complications, though, among them a heart arrhythmia. A cardiologist recommended a second surgery to insert a pacemaker. The procedure lasted 17 minutes. As Smith lay on a hospital gurney afterward, unmonitored, he started choking on his own saliva. Nearby hospital staff was busy cleaning the operating room.
By the time a staff member noticed what was happening to Smith, his blood pressure had fallen drastically, to 30 over 19 and his brain had been without oxygen for an extensive period of time, medical records show.
Smith went into cardiac arrest, but was revived, and for 10 days he remained in a coma. When Smith finally woke he had suffered severe brain damage. The voracious reader, who graduated with an English degree from Colgate University, could barely read a newspaper. He would require 24-hour nursing for the rest of his life.
"I never really got an answer as to what happened to Stephen," Benay Smith said during a recent interview at her lawyer's office in Hartford. "I kept asking what happened to my husband and they never gave me an answer. All they kept saying was sometimes things happen during surgeries."
Months after Stephen Smith came home, and after reading stories in The Courant about hospitals failing to report potential adverse events to the state Department of Public Health, Benay Smith decided to ask the state to investigate.
The DPH opened an investigation and eventually produced a 14-page report citing St. Francis with 10 separate violations of the state health code in Smith's case. The hospital was not fined. An investigation into two nurses is still underway.
But the DPH investigation gave Benay Smith answers she hadn't gotten from the hospital, including the facts that the St. Francis never reported her husband's case to the state, that Smith was without oxygen for up to 37 minutes while nurses cleaned the lab and that the alarm on the ventilator machine had inexplicably been turned off.
"You expect that a hospital will be honest with your family," Benay Smith said. "They knew that something bad had happened to Stephen and they either were afraid to say anything or covered it up."
Now the Smith family has filed a lawsuit in Hartford Superior Court against St. Francis Hospital seeking compensation to pay for Smith's extensive medical care.
"I want them to know that they just can't walk away after destroying my husband and ruining our family," Benay Smith said. "They did this and they have a responsibility to help pay for his care."
Hospital officials issued a statement Friday but declined to answer specific questions about Stephen Smith's care.
"our hearts go out to the Smith family. We are cooperating fully in this matter, and look forward to a fair and prompt resolution,'' the statement said.
A SPOT AND A DECISION
Stephen Smith had always suffered from acid reflex, but by 2005 the problem was getting worse and a visit to a doctor showed that he had Barrett's esophagus, which effects less than 1 percent of the population.
Smith tried several non-invasive procedures to deal with the disease, but none worked. One procedure, which involved injecting black dye into his system, is done by only a few hospitals in the country, including St. Francis. During the black dye procedure for Smith, doctors at St. Francis discovered a spot on his esophagus that, while not cancerous, could become a problem later on, Benay Smith said.
Rather than live with the constant threat of cancer hanging over his head, Smith decided to get a part of his esophagus removed.
Benay Smith had reservations about the surgery, but her husband was insistent.
"Stephen was terrified that he was going to get throat cancer," she said. "I was afraid of the surgery and I told him that late one night, but he just said everything would be OK."
The surgery took more than seven hours. Smith expected to stay in the hospital for 10 days.
"No one was saying that this was some life-threatening surgery," said the Smiths' attorney, Michael Walsh. "Everyone expected a complete, 100 percent recovery from it."
But almost immediately after the initial surgery, Smith suffered health problems and was becoming delirious, calling friends from the hospital in the middle of the night and ripping the tubes out of his body and trying to walk around the hospital halls.
"He just kept getting sicker and sicker," Benay Smith said.
The biggest issue was a heart arrhythmia, which led to an evaluation by a cardiologist 15 days after the initial surgery. Doctors decided a second surgery to insert a temporary internal pacemaker was necessary.
"I remember it was a Sunday and it was almost like my first normal day. I took the dog for a walk and then left my cellphone on the kitchen counter and went to visit a neighbor," Benay Smith said.
When she got home there were several messages from the hospital — they needed her permission to do the operation.
After giving her approval, she hurried to Hartford while Smith was prepped for surgery and brought to the catheterization laboratory.
In preparation for that surgery Smith was intubated — a tube was placed in his neck — and he was placed on a portable ventilator at the request of Dr. Julian Esteban, the surgeon. The surgery in the cardiac catheterization laboratory took 17 minutes, medical records show, but at no time during the procedure did the staff monitor Smith's oxygen saturation rate.
Following the surgery, the lab called to have Smith transferred back to intensive-care unit, but when the nurse arrived in the lab she found a disturbing site — rather than monitoring the patient, the staff was busy cleaning the room, the DPH investigation found.
The nurse immediately noticed the portable ventilator was making a "funny noise." She observed that Smith's color was poor, almost "dusky," that fluids from his endotracheal tube were flooding into the ventilator tubing and that the precautionary alarms on the ventilator had been silenced.
The nurse quickly removed Smith from the ventilator and suctioned "copious amounts of frothy, tan colored sputum" from the endotracheal tube, according to the report. Smith's blood pressure had fallen to 30/19 and he went into cardiac arrest and needed to be resuscitated.
Benay Smith was sitting in the waiting room of the intensive-care unit upstairs when she heard the emergency call in the catheterization laboratory.
"I heard the Code Blue to the cath lab and all I could think is, 'Oh my God, Stephen is dying?' " Benay Smith said.
She asked ICU personnel what had happened and they told her her husband was the subject of the Code Blue, but they didn't know why.
Smith was revived but suffered enormous brain damage because of a lack of oxygen. He was in a coma and hospital officials told Benay to stay overnight "in case he died during the night."
He remained in a coma for 10 days. When he finally woke, it was clear he would never be the same. The then-55 year-old man who went into the hospital for throat surgery would never be able to eat solid foods again and had almost no short-term memory.
During several meetings with hospital officials, Benay Smith tried to find out why her husband went into cardiac arrest, but no one had an answer.
Benay Smith said she doesn't believe hospital officials didn't realize what had happened within hours of the incident.
"I didn't know it at the time but now it's clear that my husband's brain was without oxygen for up to 37 minutes and that he was brain dead long before the nurse ever discovered he was choking," Benay Smith said.
'It Just Breaks My Heart'
One day, while she was driving to see her husband, she heard that Gov. M. Jodi Rell's husband, Louis, had similar throat surgery at the Hospital of St. Raphael in New Haven, and that it had been successful. She asked that her husband be transferred there.
Smith spent a month at St. Raphael's and then a few more at the Hospital for Special Care in New Britain trying to retrain his body to do little things such as walk and eat.
Smith finally came home to East Hampton in January 2010, more than six months after he had walked into St. Francis.
Smith can walk but not without someone at his side. He is unable to eat solid food, he is fed once a day through a feeding tube. He can no longer work.
Smith recognizes his wife, and their now 17-year-old son. But he doesn't remember much else of his life before the surgery.
"It just breaks my heart into a million pieces," Benay Smith said. "He was my best friend. We've been married for 18 years. The hardest part was watching our son try to understand that the dad he knew was not there anymore."
Benay Smith isn't sure whether the fact that her mother is state Sen. Edith Prague was a factor in DPH moving quickly to investigate the case, and she doesn't care.
DPH investigators made two unannounced visits to St. Francis in late 2009. They discovered that the nurse on duty in the lab the day of Smith's surgery lacked "training in the operation and troubleshooting of portable ventilators."
DPH spokesman William Gerrish said that St. Francis was not required to report Smith's case under the "adverse event" law. Under the law, hospitals must inform the DPH when patients suffer certain serious unintended harm. The reports remain confidential unless DPH investigates.
A Courant investigation in November 2009 found that thousands of incidents in which hospital patients were injured or killed have been hidden from the public by hospitals and the DPH. From minor accidents to deadly errors, public access to adverse events at hospitals events has fallen 90 percent since the legislature redrafted the law in 2004. The Courant found that even when hospitals disclosed medical errors, the DPH investigated only about 25 percent of them.
The legislature rewrote the law in the last session eliminating the confidentiality clause.
In its report, DPH cited St. Francis for 10 violations of the health code and order the hospital to submit a comprehensive plan of correction.
St. Francis changed several policies within a few weeks of Smith's case. The new policy, which the DPH approved, requires a nurse to stay with any patient on a ventilator who is in the catheterization lab. The hospital later insisted to DPH that the Smith "incident" had nothing to do with the policy change.
According to the DPH report, the most serious violations from the Smith case included failing to continuously monitor oxygen saturation rates; failing to have personnel trained to properly monitor the portable ventilator; and failing to make sure that the portable ventilator systems, including the alarm, were working properly.
It is the last one, about the alarm, that still puzzles Benay Smith.
"That alarm should never have been turned off, but why was it and who did it?" she asked. "You expect that a hospital will be honest with your family. They knew that something bad had happened to Stephen and they either were afraid to say anything or covered it up. I owe it to Stephen to find out which one."