The clinic had replaced its defibrillator with a newer model, recognizing that a facility performing surgical procedures had to be prepared for possible resuscitation of patients. When the newer model arrived, it operated differently than the previous one, and the staff needed instruction in its use.

Even if the anesthesiologist was previously unaware that such instruction was necessary, the nurse's comment that the staff would require in-service training made him aware of the need. It also should have signaled to him that serious patient injury could occur if that instruction was not immediately accomplished. For unidentified reasons, the anesthesiologist chose not to conduct the training, even after he was again reminded, much later, that the training had not been done and was still needed.

Such conduct could be the basis for allegations of substandard care, could violate statutory requirements and could be considered egregious enough to allow the family to seek punitive damages. Although many states allow punitive damages in medical malpractice lawsuits, they are awarded rarely and there may be limits on damages recoverable or may require a stricter burden of proof. However, punitive damages may or may not be covered by malpractice liability insurance. Even if the jury were to find that the conduct was not sufficiently outrageous to award punitive damages to the patient's family, the jury's possible anger toward the anesthesiologist's conduct could influence the award of compensatory damages.