A Contraindicated Dye, a Spinal Injection, and a $38.3 Million Verdict

On October 24, 2003, Amanda Slavin went into surgery at Mount Sinai Medical Center in Miami Beach for what should have been a straightforward repair of a spinal fluid leak. During the operation, her neurosurgeon, Dr. Mario Nanes, called for methylene blue, a dye kept in the surgical suite's medicine cabinet. Methylene blue is common in operating rooms as a marking agent, but it carries a federal contraindication against intraspinal injection, because it can poison nerve tissue it touches directly. Two ampules were brought from the cabinet, and the drug was injected into the intrathecal space around Slavin's spinal cord.

Slavin, a nurse, developed ascending adhesive arachnoiditis. Scar tissue formed around the nerves of her spinal cord and produced severe burning pain along with progressive neurologic damage. She went through repeated surgeries, was eventually left bedridden, and had to give up her career in nursing.

Colson Hicks Eidson tried the case in Miami-Dade Circuit Court, with Julie Braman Kane and Joseph J. Kalbac, Jr. representing Slavin. The suit named Dr. Nanes, Mount Sinai, and McKesson Medication Management, the company that ran the hospital's pharmacy services and stocked the locked medicine cabinets inside its operating rooms under a services agreement. The plaintiffs showed that the FDA-required warning against putting methylene blue into the spine never reached the people in that operating room, on either the packaging at the point of use or through any training. Mount Sinai settled before trial.

In March 2009, the jury returned a compensatory award of $38,323,196, about $38.3 million. It placed most of the fault on Dr. Nanes, with smaller shares assigned to the hospital and to McKesson.

McKesson appealed. In 2011, Florida's Third District Court of Appeal reversed the judgment against the company. The jury had held McKesson liable on a single theory, that it owed a duty to train hospital staff to obtain drug information during surgery, and the appellate court ruled that no such legal duty existed. The decision left the neurosurgeon's portion of the verdict and the hospital's pre-trial settlement as the sources of Slavin's recovery.

Slavin died after years of disability. According to her trial lawyer, the verdict led the hospital's board to change how methylene blue was stored and handled in its operating rooms.