A certified life care nurse planner testified that medical bills for a plaintiff in a Madison County medical malpractice case could be as high as $8.4 million if the woman lives another 30 years.

On Thursday, Jan Klosterman of St. Louis testified in a trial against Anderson Hospital and anesthesiologist Timothy Kurt, M.D. that Christina McCray, who is in a persistent vegetative state, will need 24-hour nursing care for the rest of her life.

Ernest McCray filed the suit in 2001, on behalf of Christina McCray, a disabled adult.

Christina was a patient of Kurt who is the head of the anesthesia department at Anderson Hospital in Maryville.

According to the eighth amended complaint, Kurt was providing anesthesia for Christina as she underwent a right hand carpal tunnel surgery on July 6, 2001.

Represented by Drew Baebler of St. Louis, McCray claims Christina was over-sedated by the anesthesia team, including Kurt, causing her to become bradycardic, hypotensive and hypoxic which caused severe and permanent brain damage.

McCray claims Kurt failed to apply the knowledge and skill ordinarily used by a reasonably well qualified physician or director of anesthesia services.

Klosterman testified that Christina McCray needs 24-hour care to manage her airway and to control seizures. She also testified that Christina McCray is in a state of unconsciousness, does not respond to stimuli, is on oxygen and needs a feeding tube for nutrition.

She testified that medical costs would range between $220,000 and $283,029 per year.

Klosterman said she first did an assessment of Christina McCray in 2002, and reviewed medical records and performed an on-site assessment at Willow Creek Nursing Home.

She testified that Christina McCray has the same needs in 2008 as she had in 2002, when she was first assigned to the case. Her needs include seeing doctors specializing in eight different areas of medicine, such as neurology, podiatry and infectious disease.

Klosterman also testified that Christina McCray is sometimes hospitalized due to respiratory and urinary infections.

Klosterman told the jury that she was a graduate of the Jewish Hospital School of Nursing, that she has worked as a registered nurse in Missouri since 1979, and that her clinical experience includes critical care, home health care, case management and private physician practice.

Klosterman has worked in the medical-legal consulting industry since 1998, completing training in life care planning through the American Association of Nurse Life Care Planners (AANLCP). She maintains current certification as a Nurse Life Care Planner (CNLCP) and as a Medicare Set-Aside Consultant (MSCC), while continuing her education in medical-legal issues.

During the trial, Christina McCray's lawyer will try to prove that Kurt negligently and carelessly:

  • Failed to adequately supervise Nurse McClenahan;

  • Failed to administer anesthesia consistent with the recommendations of the American Society of Anesthesiologists (ASA);

  • Failed to develop regulations for the safe administration of anesthesia;

  • Failed to monitor and evaluate the anesthesia service;

  • Failed to properly assess pre-op risks;

  • Violated the Nursing and Advanced Practice Nursing Act by failing to discuss with the nurse anesthetist the anesthesia plan and by failing to remain physically present and be available on the premises during the delivery of the anesthesia; and

  • Failed to inform co-defendant Dr. Collins that Christina McCray had been transferred to a different operating room so that Dr. Collins could supervise the anesthesia given.

    Baebler will also try to prove that Kurt failed to issue directives to the anesthesia department and to Anderson Hospital and that Kurt failed to issue directives that Atropine, Epinephrine and Ephedrine must be mixed up prior to the surgery's commencement.

    He will try to prove that Kurt failed to inform Christina McCray that a CRNA would administer the anesthesia, failed to issue a proper and detailed order for anesthesia plan and that he failed to ensure that the anesthesia machine alarms were activated prior to surgery.

    Baebler will also argue that Christina McCray has lost the ability to earn income and fringe benefits for her family.

    Kurt is represented Jeffrey Glass, while co-defendant Collins is represented by Tim Richards. They both deny they deviated from the standards of care.

    Madison County Circuit Judge Barbara Crowder is presiding over the case that is expected to last until the end of the month.

    About 10 members of Christina's family were present for testimony on Thursday.

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