Six years have passed since a routine knee arthroscopy patient had a fatal reaction to her spinal anesthetic, yet questions persist about what if anything her anesthesiologist and nurses could have done that day to prevent it.

Khadijatu Savage went to JFK Medical Center in Edison, N.J., for outpatient right knee arthroscopy on Nov. 14, 2006. Court records show Ms. Savage's heart rate slowed, her blood pressure dropped and she went into cardiac arrest soon after anesthesiologist Balwant Saini, MD, administered spinal anesthesia. He was able to restore heart rhythm and cardiac output, but not until her brain went without oxygen for nearly a minute. Ms. Savage, 49 years old at the time of surgery, remained in a vegetative state until her death almost 3 years later.

A state appellate court has overturned a lower court's ruling that blamed the anesthesiologist and nurses involved in the case for Ms. Savage's death, bringing to light new questions about what could have been done to save Ms. Savage's life.

Hospital investigators had trouble coming to a definitive conclusion of what happened, partly because the case's anesthesia record and code sheet were apparently lost. Medical experts predictably offered opposing opinions in court, however.

Physicians speaking on behalf of Ms. Savage's family say her sudden drop in blood pressure and pulse were preventable reactions to the spinal anesthesia she received, and the duration of her cardiac arrest before resuscitation caused her coma and ultimate death.

Among other accusations, they also claim Dr. Saini didn't appreciate the risks associated with Ms. Savage's obesity and decreased intra-vascular volume, and failed to safeguard her airway before she sustained loss of protective airway reflexes.

Dr. Saini's expert witnesses countered that cardiac arrest is a known complication of spinal anesthesia, occurring in 0.1% of cases, Dr. Saini did not deviate from the standard of care and complications occur even when no mistakes are made.

Although Dr. Saini's experts "may not have been able to explain the mechanisms that caused Ms. Savage's cardiac arrest, the risk of such an event was not a reasonably foreseeable risk of the procedure," states the court's decision. The decision also notes the expert witnesses cited in the lower court's ruling did not link the nurses involved in the case or the medical center to any liability, so verdicts against them would be based on speculation.

A medical center spokesman declined to comment, citing ongoing litigation.

Attorneys for Ms. Savage's family and Dr. Saini did not return calls seeking comment.

Daniel Cook