The death of a patient who had a blood pressure spike in a New Jersey surgery center and hours later fell and struck his head at home was not the fault of the anesthesiologist who discharged him from the ASC, a state appeals court has ruled.

Rene Templier of Linden, N.J., died in July 2006 after he fell down and hit his head in his kitchen. Just hours before, Stefan Trnovksi, MD, had discharged Mr. Templier from the Ambulatory Surgical Center of Union County, in Union, N.J., according to a state appeals court opinion issued on March 30.

Mr. Templier, 58, had end-stage renal disease, diabetes and hypertension. He went to the surgery center to have a fistula inserted in his right arm for permanent dialysis. When he arrived, his blood pressure was 188/97, and during the 75-minute procedure his systolic pressure ranged from 170 mmHg to 220 mmHg. His diastolic pressure was above 100 mmHg for most of the procedure. In the recovery area, his pressure rose to 230/99 until Dr. Trnovksi managed, with medication, to get it down to the level it was when Mr. Templier arrived at the facility. Mr. Templier told a nurse that he "felt good," according to court documents.

Dr. Trnovski then discharged the patient and recommended that he go to his primary care physician for further monitoring. But rather than go to his doctor, Mr. Templier went home with his family instead. At home, Mr. Templier said he had to go to the bathroom but he walked into the kitchen, where he urinated on himself and then fell, hitting his head. Shortly afterwards, paramedics recorded blood pressure of 270/122 and took him to the hospital. There, a CT scan revealed that he had a subdural hematoma. A hospital physician declared Mr. Templier brain dead. He died the following day, according to court documents.

Mr. Templier's family sued Dr. Trnovski, the surgeon and the surgery center for malpractice, but the surgeon and surgery center were dismissed from the case by the trial judge. Mr. Templier's family and attorney alleged that Dr. Trnovski was negligent in discharging the patient. In pre-trial testimony, an expert witness for the plaintiffs said that Dr. Trnovksi deviated from the standard of care and that he should have either kept Mr. Templier longer at the surgery center or sent him directly to a hospital for monitoring. Sending him to a hospital emergency department would have been preferable because Mr. Templier could be continuously monitored and would have been closer to a specialist if needed, the expert testified, according to court documents.

Before the start of the trial, the judge dismissed the family's case because the plaintiffs couldn't establish enough of a direct link between Dr. Trnovksi's care and Mr. Templier's death.

In response to an appeal by the family, a pair of appeals judges affirmed the lower court's dismissal of the case. "The trial court did not err," wrote the judges. "There was nothing about Templier's high blood pressure at the time of his fall in and of itself that was suggestive of a causal link between Trnovski's failure to monitor that condition and Templier's injuries."

Dr. Trnovksi's attorney, as well as the attorney for the Templier family, did not return a request for comment for this article.

Kent Steinriede