Why Respiratory Therapists Get Sued: The Ventilator, the Disconnection, and the Lost Airway

By John Mahoney · June 2026 · 8 min read

Respiratory therapists are sued far less often than physicians, but when they are, the cases are some of the most catastrophic in medicine. The reason is the patient population: a respiratory therapist's worst outcomes happen at the bedside of a ventilated or critically ill patient where minutes without oxygen mean permanent hypoxic brain injury or death. Most RT claims never surface, but the ones that do tend to involve a ventilator setting, a disconnected circuit, a silenced alarm, or a lost airway — mechanisms that produce severe, lifelong damages. An attorney who treats a respiratory therapy intake like an ordinary nursing or allied-health file will misjudge both the liability theory and the damages. This guide explains where respiratory therapy liability actually lives, the cannot-miss failures behind it, and what separates a strong case from a weak one — for plaintiff and defense med-mal attorneys.

Disclaimer: This article is for informational purposes only and does not constitute legal advice. The patterns described below draw on commonly reported closed-claims themes, allied-health liability literature, and adverse-event datasets that span different eras and definitions; treat them as directional, verify against the controlling jurisdiction, and value any individual case on its own record.

The Frequency-and-Severity Reality

By frequency, respiratory therapy is a low-claim discipline. Respiratory therapists carry their own professional liability exposure but appear in malpractice filings far less often than the physicians and hospitals named alongside them, and claims naming the RT individually are uncommon relative to the volume of ventilator-days and procedures they handle. Much of the real exposure is absorbed by the employing hospital under vicarious liability, so the therapist's conduct is frequently litigated through the institution rather than against the individual license.

Severity, however, is the opposite of the frequency picture. Because respiratory therapists work at the airway and the ventilator, their adverse events are concentrated in the highest-severity outcomes medicine produces: anoxic and hypoxic brain injury, permanent neurological devastation, and death. A few minutes of unrecognized hypoxia from a disconnected circuit or an unresponsive alarm can convert a recoverable patient into a vegetative one, and those cases carry life-care and lost-earning damages that dwarf the modest payouts seen in lower-acuity allied-health claims. The screening lesson is that respiratory therapy is a low-frequency, catastrophic-severity profile — rare to encounter, but devastating when the mechanism is a true oxygenation failure. Route every RT intake to the question of whether oxygen delivery was interrupted and, if so, for how long and why it was not caught.

The Dominant Allegation Types

Respiratory therapy claims cluster into a ventilator-and-airway group, a monitoring-and-escalation group, and a procedural-and-medication thread that runs alongside both:

• Ventilator management errors — the highest-severity category: wrong or unsafe ventilator settings, an undetected circuit disconnection or fault, and silenced, mis-set, or unresponsive alarms that allow hypoxia to go unrecognized.
• Airway loss and extubation — unplanned or accidental extubation, failure to secure or re-secure the endotracheal tube, and failure to manage a difficult-airway or re-intubation event.
• Failure to recognize and escalate respiratory deterioration — not acting on falling saturations, rising work of breathing, or worsening blood gases, and failing to notify the physician or call for help in time.
• Oxygen-therapy and non-invasive support failures — errors in oxygen, high-flow, CPAP/BiPAP, and NIV management, including mask, flow, and FiO2 errors and unmonitored support.
• Procedural and medication/aerosol errors — complications from assisting intubation, arterial-blood-gas draws, bronchoscopy assistance, and suctioning, plus aerosolized-medication and nebulizer delivery errors.

The structural point: by count, the procedural and oxygen-therapy claims are more common, but by dollars, the ventilator, alarm, and airway-loss claims dominate because they are the ones that produce hypoxic injury. Any intake should be triaged first on whether oxygenation was interrupted, because the merit analysis, the experts, and the damages are entirely different on that side of the line.

The Cannot-Miss Conditions and Failures

The conditions and failures that drive respiratory therapy litigation are:

• Undetected ventilator disconnection or circuit fault. The signature catastrophic claim. A disconnected or leaking circuit, a kinked or displaced tube, or a ventilator malfunction that went unrecognized because the alarm was silenced, set wrong, or not responded to — producing minutes of hypoxia and permanent brain injury.
• Unsafe or wrong ventilator settings — inappropriate mode, tidal volume, FiO2, PEEP, or rate, and failure to adjust to blood-gas or clinical changes, including ventilator-induced lung injury.
• Unplanned or accidental extubation — an unsecured or inadequately secured tube that comes out, with delayed or failed re-intubation and an unprotected airway during the gap.
• Difficult-airway and intubation-assist events — failure during assisted intubation, esophageal or unrecognized misplacement, and inadequate response to a can't-intubate/can't-oxygenate situation.
• Failure to recognize and escalate deterioration — falling SpO2, hypercapnia, and rising work of breathing that were charted or alarming but not escalated, plus ABG, bronchoscopy-assist, and aerosol-medication complications that were not promptly recognized.

For the catastrophic side, the single most actionable screening question is the alarm-and-monitoring question: did the ventilator or pulse-oximeter alarm, and how did the therapist respond? A hypoxic-injury claim very often turns on whether an alarm was active, audible, and answered — or silenced, mis-set, or ignored — rather than on the underlying disease. For the airway side, the decisive question is whether the tube was secured and monitored and how fast a lost airway was recovered.

The Contributing Factors That Drive Payouts

Across respiratory therapy claims, the recurring contributing factors are:

• Alarm response and monitoring — the decisive factor: silenced, paused, or mis-set ventilator and oximeter alarms, and delayed or absent response to an alarm or falling saturation. This is where most catastrophic hypoxic-injury claims are won or lost.
• Clinical judgment and escalation — failure to recognize deteriorating gas exchange and failure to notify the physician or call for help, which drives the high-severity "failure to rescue" claims.
• Technical skill and procedure — unsafe ventilator settings, unsecured tubes, and complications during intubation assist, ABG, bronchoscopy assist, or suctioning.
• Communication and handoff — incomplete handoffs about ventilator status, alarm limits, and airway risk between shifts and between the RT, nursing, and the physician team.
• Documentation — incomplete records of ventilator checks, alarm settings, oxygen-therapy parameters, and the timeline of recognition and response that weaken the defense.

Two of these are the respiratory-therapy-specific levers. The first is the alarm-response record: in a ventilator-disconnection or hypoxia case, the line between a defensible file and a paid claim is almost always whether the chart and device logs show the alarm was active and answered. The second is the recognition-and-escalation timeline: when oxygenation was failing, the expected-payment weighting turns on how long the deterioration went unrecognized and whether the therapist escalated. Documentation rarely creates liability here, but the monitoring and alarm record consistently decides whether a claim is paid — and modern ventilators and monitors generate device logs that fix the timeline with precision the chart alone cannot.

Strong Case vs. Weak Case in Respiratory Therapy Malpractice

The same factors grade the file, and the framing is useful to both sides.

What makes a respiratory therapy case strong (plaintiff) / dangerous (defense)

• A ventilator disconnection or circuit fault that produced documented hypoxia while the alarm was silenced, paused, or set outside safe limits, with a delayed or absent response — a clean alarm-failure mechanism.
• An unplanned extubation from an inadequately secured tube followed by a delayed or failed re-intubation, with an unprotected airway and falling saturations during the gap.
• A clear period of unrecognized deterioration — falling SpO2 or rising CO2 that was charted or alarming but never escalated — supporting a strong "failure to rescue" causation theory tied to anoxic brain injury.
• Device logs or telemetry that fix the hypoxic interval and contradict the charted timeline of recognition and response.

What makes a respiratory therapy case weak (plaintiff) / defensible (defense)

• A documented ventilator check with appropriate settings, active and correctly set alarms, and a recorded, timely response to the alarm or desaturation — the monitoring loop intact.
• A deterioration that was promptly recognized and escalated to the physician with documented notification, framing any harm as disease progression rather than a monitoring failure.
• A patient whose record shows the outcome was driven by the underlying critical illness, refractory hypoxemia, or an unavoidable difficult airway despite competent, by-protocol management.
• A secured tube, correct settings, and a difficult-airway response performed to protocol with a documented timeline and device logs that confirm rapid recognition and action.

Respiratory therapy rewards a fast triage to the oxygenation question. On the catastrophic side, the case lives or dies on the alarm-and-monitoring record and the failure-to-rescue causation chain linking the hypoxic interval to the anoxic injury. On the procedural and oxygen-therapy side, it turns on technique, settings, and prompt recognition. Whichever side you are on, grading the file means pulling the ventilator and monitor device logs, building the minute-by-minute timeline, and pressure-testing the critical-care or respiratory-therapy expert who will carry it.

Bottom Line

Respiratory therapists get sued rarely, and many of the claims that come are absorbed by the hospital under vicarious liability. But the specialty hides a sharp severity spike: when a ventilator setting, a disconnected circuit, a silenced alarm, or a lost airway interrupts oxygenation, the result is hypoxic brain injury or death and some of the largest damages in medicine. The cannot-miss facts are the undetected disconnection, the silenced or mis-set alarm, the unsecured tube that came out, and the deterioration that was charted but never escalated. Whether you are screening these cases for the plaintiff or defending them, triage first to whether oxygen delivery was interrupted, then grade the file on the alarm-response record, the recognition-and-escalation timeline, and the device logs — not on the catastrophic outcome alone.

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