3 year old boy dies during dental procedure

[GassYous]

Ive wondered that myself.
For some strange reason, ive never 'solo' in any shape or form had bad laryngospasm or cico or whatever. I dont know whether thats luck or no but ive never even come close to that situation.

When i was a resident I worked with one staff (who was very nice but in hindsight incredibly incompetent), and he had laryngospasm reasonably bad on 4 out of 4 cases in one day. He just did the wrong thing at the perfect ****storm wrong time... and boom spasm. Each time he would slightly differently **** it up. And he couldnt understand why

It was like dancing with a girl when you were kids man. You didnt know what you were doing but it was just rhythm, it didnt matter... Im sorry to say but this guy just hadnt any rhythm. And i dont know if you can teach that. You either have it or you dont. A 6th sense to pull that tube right now or else... Nope give more prop and wait til next time

You cant read about this stuff in a book. You just gotta go Luke Skywalker on it...

Just luke skywalking on the haters

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[chocomorsel]

Ah...
Ive had days of Type A's. 3 back to back was worst run. All 40-50% mortality on GERAADA. arresting arriving
Ive had weeks averaging 10 units of blood product per case. Its no big deal

But i am definitely incompetent!

You clearly lack reading comprehension skills for sure. Maybe you are incompetent, maybe you just can’t read and comprehend.

 

[chocomorsel]

Just luke skywalking on the haters

And you as well. Learn to read and comprehend. The entire thing dingus.
Let’s continue this hate-hate relationship.
I won’t stop.

 

[Tony C anesthesia]

Kansas mother hopes for answers after 3-year-old son dies after dental procedure, dentistry releases statement

A Kansas mother is sharing her family’s tragedy and looking for answers after her 3-year-old son died following a dental procedure in Wichita on Tuesday.

www.ksn.com

Just saw this on the news. Sad. According to the article the Dental office uses a solo CRNA group to administer anesthesia during their cases.

A horrible recipe for disaster: a dentist goes super cheap, hires an inexperienced CRNA, the CRNA has a big ego and no freaking adequate knowledge, gives inhalational anesthesia with no IV available, some sort of emergency (probably airway related) ensues and a child's life is gone. Such a tragedy, most probably preventable if it was thought out well in advance.

 

[coffeebythelake]

A horrible recipe for disaster: a dentist goes super cheap, hires an inexperienced CRNA, the CRNA has a big ego and no freaking adequate knowledge, gives inhalational anesthesia with no IV available, some sort of emergency (probably airway related) ensues and a child's life is gone. Such a tragedy, most probably preventable if it was thought out well in advance.

Nothing in the article says the patient was given inhalational anesthesia and without an IV.

 

[nimbus]

Nothing in the article says the patient was given inhalational anesthesia and without an IV.

Anesthesia Methods » Special Anesthesia Services

From their website it looks like TIVA or IM ketamine+TIVA.

 

[patriot6]

Ive wondered that myself.
For some strange reason, ive never 'solo' in any shape or form had bad laryngospasm or cico or whatever. I dont know whether thats luck or no but ive never even come close to that situation.

When i was a resident I worked with one staff (who was very nice but in hindsight incredibly incompetent), and he had laryngospasm reasonably bad on 4 out of 4 cases in one day. He just did the wrong thing at the perfect ****storm wrong time... and boom spasm. Each time he would slightly differently **** it up. And he couldnt understand why

It was like dancing with a girl when you were kids man. You didnt know what you were doing but it was just rhythm, it didnt matter... Im sorry to say but this guy just hadnt any rhythm. And i dont know if you can teach that. You either have it or you dont. A 6th sense to pull that tube right now or else... Nope give more prop and wait til next time

You cant read about this stuff in a book. You just gotta go Luke Skywalker on it...

I understand the sentiment, but you can, in fact, “read about this stuff in a book”.

Assessment of Common Criteria for Awake Extubation in Infants and Young Children - PubMed

Conjugate gaze, facial grimace, eye opening, purposeful movement, and tidal volume greater than 5 ml/kg were each individually associated with extubation success in pediatric surgical patients after volatile anesthetic. Further, the use of a multifactorial approach using these predictors, may...

pubmed.ncbi.nlm.nih.gov

 

[propadope]

Ive wondered that myself.
For some strange reason, ive never 'solo' in any shape or form had bad laryngospasm or cico or whatever. I dont know whether thats luck or no but ive never even come close to that situation.

When i was a resident I worked with one staff (who was very nice but in hindsight incredibly incompetent), and he had laryngospasm reasonably bad on 4 out of 4 cases in one day. He just did the wrong thing at the perfect ****storm wrong time... and boom spasm. Each time he would slightly differently **** it up. And he couldnt understand why

It was like dancing with a girl when you were kids man. You didnt know what you were doing but it was just rhythm, it didnt matter... Im sorry to say but this guy just hadnt any rhythm. And i dont know if you can teach that. You either have it or you dont. A 6th sense to pull that tube right now or else... Nope give more prop and wait til next time

You cant read about this stuff in a book. You just gotta go Luke Skywalker on it...

Do enough inhalational induction on kids and you will see them. Nothing to do with 6th sense or timing. Post extubation is rare in my experience due to well established extubation criteria. Its usually if you are in a rush and bend the rules where you get yourself into trouble there.

 

[epidural man]

Intra-arterial injection of some drugs is associated with terrible injury. I don't know which are safe and unsafe. I'm not sure anyone does.

Promethazine is well known for causing phlebitis and GIS will return a horror show of black hands from extravasation and especially accidental arterial injection. NMBDs sting a lot (way more than propofol) so I'd be extra wary of giving roc through a radial a-line.

I'd wager that those of us who trained before ultrasound became standard of care for IJ central lines could hit that with a 23 g needle on a syringe reliably and quickly. From time to time, I'll draw intraop labs that way if the arms are tucked or the peripheral veins suck. I've never directly injected drugs that way but think I'd do that before I put something into an arterial line.

Several years ago, as I was checking out with the Floor Walker (as we call them), he said - “I need you and Brian to go get some labs on this lady.” Apparently everyone in the hospital had tried.
I was prepared for the 1 hour poke fest looking up and down the arms and legs with ultrasound. Brian said, “hey watch this“ and put her in t-berg, turned her head, with a small needle made one pass in her neck and in 10 sec had 10ml of blood.
Changed my life….

 

[deleted697127]

Several years ago, as I was checking out with the Floor Walker (as we call them), he said - “I need you and Brian to go get some labs on this lady.” Apparently everyone in the hospital had tried.
I was prepared for the 1 hour poke feast looking up and down the arms and legs with ultrasound. Brian said, “hey watch this“ and put her in t-berg, turned her head, with a small needle made one pass in her neck and in 10 sec had 10ml of blood.
Changed my life….

Have you done it yourself since?

 

[Arch Guillotti]

Please keep it professional or the thread will be closed. Thanks.

 

[pro-propofol]

Please keep it professional or the thread will be closed. Thanks.

You need to do what you need to do!
Just turn off the fountains of needless aggression!

 

[deleted697127]

Please keep it professional or the thread will be closed. Thanks

Wait what? Is this to my post asking if he’s drawn labs from a neck vein himself since seeing a colleague do it? Was legitimately curious and not trying to criticize. I would consider it in an asleep patient if arms are tucked and needed unpredicted labs stat but unable to draw back on an IV. In an awake patient, i think I’d rather draw labs from radial artery rather than neck. I wouldn’t want to be the catalyst for a patient that’s a difficult stick starting to demand labs from their neck routinely.

 

[Arch Guillotti]

Is this to my post asking if he’s drawn labs from a neck vein himself since seeing a colleague do it?

No.

 

[Arch Guillotti]

You need to do what you need to do!
Just turn off the fountains of needless aggression!

And the nattering nabobs of negativity.

 

[pgg]

Several years ago, as I was checking out with the Floor Walker (as we call them), he said - “I need you and Brian to go get some labs on this lady.” Apparently everyone in the hospital had tried.
I was prepared for the 1 hour poke feast looking up and down the arms and legs with ultrasound. Brian said, “hey watch this“ and put her in t-berg, turned her head, with a small needle made one pass in her neck and in 10 sec had 10ml of blood.
Changed my life….

I have to confess I enjoy the looks on others' faces when I pull blood out of a neck.

 

[Agast]

Anesthesia Methods » Special Anesthesia Services

From their website it looks like TIVA or IM ketamine+TIVA.

Haven’t done peds in forever. Wouldn’t ketamine make the kid slobbery for a dental procedure?

 

[propadope]

Haven’t done peds in forever. Wouldn’t ketamine make the kid slobbery for a dental procedure?

Nothing glyco can’t fix

 

[patriot6]

This conversation was well timed. I actually had a bad spasm after extubating a 4 yo today. Got rushed and thought I could pull it. Quick desat to 60%. Had to give some sux. I’m still green, but I’m learning. Always appreciate the gray-haired advice around here. Take away from today is that I will never again allow anyone to rush me when doing peds.

 

[deleted126335]

This conversation was well timed. I actually had a bad spasm after extubating a 4 yo today. Got rushed and thought I could pull it. Quick desat to 60%. Had to give some sux. I’m still green, but I’m learning. Always appreciate the gray-haired advice around here. Take away from today is that I will never again allow anyone to rush me when doing peds.

People consider giving sux for laryngospasm a measure of failure. I have never regretted giving it. I have regretted not giving it sooner including IM.

 

[nimbus]

People consider giving sux for laryngospasm a measure of failure. I have never regretted giving it. I have regretted not giving it sooner including IM.

Agree. A few years ago I had an adult develop NPPE which could have been prevented with a timely dose of sux. Live and learn.

 

[IlDestriero]

One pedi center we cover is asking us to refrain from drawing up the sux, unless needed in an emergency

Thoughts?

Tell them to buy the pre made 5cc syringes of sux and you’ll consider it. That’s what we use.
When I’m trying to mask ventilate, jaw lift, Larson, etc. I don’t have free hands to start drawing up drugs.
Cheap bastards.
Remind them a brain damaged kid could be an 8 figure check. And that email they sent will make a nice blow up poster for your defense when they are looking for blame and how to divide liability.

 

[IlDestriero]

Several years ago, as I was checking out with the Floor Walker (as we call them), he said - “I need you and Brian to go get some labs on this lady.” Apparently everyone in the hospital had tried.
I was prepared for the 1 hour poke feast looking up and down the arms and legs with ultrasound. Brian said, “hey watch this“ and put her in t-berg, turned her head, with a small needle made one pass in her neck and in 10 sec had 10ml of blood.
Changed my life….

This was every time I was asked to get labs on call. Step one, explain we aren’t the IV service. Step two, have them bring the patient to the pre op AND WAIT THERE. Step 3, ninja the EJ. Syringe drop. Out.

 

[epidural man]

Please keep it professional or the thread will be closed. Thanks.

If only I could maintain an hour long poke fest at home.

 

[epidural man]

Have you done it yourself since?

A few times. Most people that the "whole hospital" has tried, have very prominent hand veins. It usually isn't needed.

I've used the femoral vein as well.

 

[GassYous]

Tell them to buy the pre made 5cc syringes of sux and you’ll consider it. That’s what we use.
When I’m trying to mask ventilate, jaw lift, Larson, etc. I don’t have free hands to start drawing up drugs.
Cheap bastards.
Remind them a brain damaged kid could be an 8 figure check. And that email they sent will make a nice blow up poster for your defense when they are looking for blame and how to divide liability.

Same. I've never understood drawing up neo or ephedrine beforehand because you can easily draw it up and administer in less than 30 seconds. But atropine and sux need to be there for every peds case. I also find it wasteful to be drawing up new meds every day. You could probably use the same syringe for a week.

The number of times I go into a partners room and see they have 10 different syringes and run 2 L/ min smh...I do almost every ett case with two syringes and lmas with one.

 

[jwk]

People consider giving sux for laryngospasm a measure of failure. I have never regretted giving it. I have regretted not giving it sooner including IM.

Seems like newer folks are taught that sux is poison and are afraid to use it.

 

[jwk]

Same. I've never understood drawing up neo or ephedrine beforehand because you can easily draw it up and administer in less than 30 seconds. But atropine and sux need to be there for every peds case. I also find it wasteful to be drawing up new meds every day. You could probably use the same syringe for a week.

The number of times I go into a partners room and see they have 10 different syringes and run 2 L/ min smh...I do almost every ett case with two syringes and lmas with one.

LOL - that's really old school. Back in the 80's, we'd use big 5gm bottles of pentothal over multiple days. Just use 4 of morphine? Save the other 6 for tomorrow. Label? What label?

 

[pgg]

Seems like newer folks are taught that sux is poison and are afraid to use it.

It IS poison - the myalgias suck.

But sometimes poison is needed.

What I don't understand are the people who electively use it when roc would be just fine.

 

[GassYous]

LOL - that's really old school. Back in the 80's, we'd use big 5gm bottles of pentothal over multiple days. Just use 4 of morphine? Save the other 6 for tomorrow. Label? What label?

I trained with guys who started when there was no pulse ox and residency was 2 years

It IS poison - the myalgias suck.

But sometimes poison is needed.

What I don't understand are the people who electively use it when roc would be just fine.

Just pre them with 5-10 of roc beforehand.

 

[pgg]

Just pre them with 5-10 of roc beforehand.

Disagree.

If the point of using succ is that it works fast, the defasciculating dose slows its onset.

If the point is to prevent myalgias, just don't use succ. In any case, a defasciculating dose may help, but certainly isn't reliable. It's not the squirrelly muscle contracting that cause the postop pain. Some people get them despite the roc, despite NSAIDs, despite whatever prayerful case-report-based mitigation strategy is employed.

My argument is that there is no reason to use succ absent an actual articulatable indication - RSI, laryngospasm, or if you want ideal conditions as fast as possible (eg that patient you know is going to desaturate like a boat anchor).

The people who routinely use succ when roc is OK, either don't care about the myalgias, or they incorrectly believe they can reliably prevent them.

 

[GassYous]

Disagree.

If the point of using succ is that it works fast, the defasciculating dose slows its onset.

If the point is to prevent myalgias, just don't use succ. In any case, a defasciculating dose may help, but certainly isn't reliable. It's not the squirrelly muscle contracting that cause the postop pain. Some people get them despite the roc, despite NSAIDs, despite whatever prayerful case-report-based mitigation strategy is employed.

My argument is that there is no reason to use succ absent an actual articulatable indication - RSI, laryngospasm, or if you want ideal conditions as fast as possible (eg that patient you know is going to desaturate like a boat anchor).

The people who routinely use succ when roc is OK, either don't care about the myalgias, or they incorrectly believe they can reliably prevent them.

I use it for nerve monitoring cases. But I have seen the literature and I do agree with you. I almost never use it.

 

[deleted126335]

It IS poison - the myalgias suck.

But sometimes poison is needed.

What I don't understand are the people who electively use it when roc would be just fine.

No reversal agent needed.
Neostigmine is a barf drug. Suggamadex is not cheap.

That said, I still choose roc over sux more than most of my colleagues mostly for the myalgia issue.

 

[T-burglar]

Succinylcholine is ALMOST obsolete in the era of sugammadex.

also late reply regarding the intra arterial injection discussion. You guys realize that the circulation is all connected right ? There’s nothing truly special about arteries compared with the veins. The only consideration is that an IA injection will amplify the problems associated with dangerous dilution practices. If undiluted rocuronium doesn’t sclerose a vein, then it won’t sclerose an artery either. It’s the same tissue as a vein it just has more smooth muscle…

I do see a lot of people fail to consider the osmotic or irritant toxicity of the drugs they are giving so maybe a blanket ban on arterial injection is just a human factors solution to this problem. I do see a lot of my partners giving undiluted calcium chloride or 8.4 sodium bicarbonate through peripheral veins. I’ve also seen a nurse thrombose an AC vein with undiluted promethazine.

 

[Aheadbyacentury]

Succinylcholine is ALMOST obsolete in the era of sugammadex.

also late reply regarding the intra arterial injection discussion. You guys realize that the circulation is all connected right ? There’s nothing truly special about arteries compared with the veins. The only consideration is that an IA injection will amplify the problems associated with dangerous dilution practices. If undiluted rocuronium doesn’t sclerose a vein, then it won’t sclerose an artery either. It’s the same tissue as a vein it just has more smooth muscle…

I do see a lot of people fail to consider the osmotic or irritant toxicity of the drugs they are giving so maybe a blanket ban on arterial injection is just a human factors solution to this problem. I do see a lot of my partners giving undiluted calcium chloride or 8.4 sodium bicarbonate through peripheral veins. I’ve also seen a nurse thrombose an AC vein with undiluted promethazine.

Promethazine IV is not suggested.. People have lost appendages on account of this drug. DEep IM is the way to go.. Or just use zofran

 

[vector2]

Succinylcholine is ALMOST obsolete in the era of sugammadex.

also late reply regarding the intra arterial injection discussion. You guys realize that the circulation is all connected right ? There’s nothing truly special about arteries compared with the veins. The only consideration is that an IA injection will amplify the problems associated with dangerous dilution practices. If undiluted rocuronium doesn’t sclerose a vein, then it won’t sclerose an artery either. It’s the same tissue as a vein it just has more smooth muscle…

I do see a lot of people fail to consider the osmotic or irritant toxicity of the drugs they are giving so maybe a blanket ban on arterial injection is just a human factors solution to this problem. I do see a lot of my partners giving undiluted calcium chloride or 8.4 sodium bicarbonate through peripheral veins. I’ve also seen a nurse thrombose an AC vein with undiluted promethazine.

My worry with the IA injection regarding X, Y, or Z medication is that the medication is immediately traversing down a *narrower* path. If you inject in the radial it immediately is going artery --> arteriole-> capillary bed --> tissue...with an unpredictable amount of effect and amount of drug continuing on to the venous side.

When I flush 10cc of cold saline through a PIV the pt is fine. When I flush the radial art line in an awake pt some tell me their hand is burning....

 

[pgg]

also late reply regarding the intra arterial injection discussion. You guys realize that the circulation is all connected right ? There’s nothing truly special about arteries compared with the veins. The only consideration is that an IA injection will amplify the problems associated with dangerous dilution practices. If undiluted rocuronium doesn’t sclerose a vein, then it won’t sclerose an artery either. It’s the same tissue as a vein it just has more smooth muscle…

Well, yes and no.

It's all one circulation, but arterial administration of a drug is very different than venous administration. It's not the thickness of the vessel wall that's the issue.

A drug in a vein gets massively diluted in the vena cava before it hits capillaries with walls a single cell thick in the lung. A drug in an artery hits capillaries in end organs at the full concentration, and for drugs that are hyperosmolar or just prone to angering tissues, that can be very bad news.

I'm not saying it can't ever be done. Actually just yesterday I was doing a case in IR, embolizing some liver mets, and the radiologist was having trouble getting a wire into a vasospasmed vessel. I passed off some clevidipine onto his field and he injected some directly into a branch of the hepatic artery. Of course, his intent was to kill that part of the liver anyway ... so I wasn't worried about what that drug would do in high concentrations.

 

[GassYous]

Well, yes and no.

It's all one circulation, but arterial administration of a drug is very different than venous administration. It's not the thickness of the vessel wall that's the issue.

A drug in a vein gets massively diluted in the vena cava before it hits capillaries with walls a single cell thick in the lung. A drug in an artery hits capillaries in end organs at the full concentration, and for drugs that are hyperosmolar or just prone to angering tissues, that can be very bad news.

I'm not saying it can't ever be done. Actually just yesterday I was doing a case in IR, embolizing some liver mets, and the radiologist was having trouble getting a wire into a vasospasmed vessel. I passed off some clevidipine onto his field and he injected some directly into a branch of the hepatic artery. Of course, his intent was to kill that part of the liver anyway ... so I wasn't worried about what that drug would do in high concentrations.

hahaha nice

 

[DrOwnage]

I think the weirdest thing about reading the article and comments is that everyone is just like "oh bad reaction", "very rare." No one seems to question the ability of the providers involved. Almost like the rare cases of deaths associated with these procedure are just acceptable and unpreventable statistics.

 

[LR4Life]

As others have said above, this dental practice (and other hospitals/ascs/etc that use unsupervised CRNAs) have factored these terrible events in as the price of doing business.

 

[IMGASMD]

As others have said above, this dental practice (and other hospitals/ascs/etc that use unsupervised CRNAs) have factored these terrible events in as the price of doing business.

Everything is baked in.

Just like all the new neurology and psychiatry urgent/emergent tele-consults and asking nurses to perform neuro exams at some of the more rural hospitals. If you don’t have the resources to take care of it in house, maybe you shouldn’t be admitting these patients with that particular problems. Had a few run ins when the Internet wasn’t fast enough so the video chat wasn’t feasible.

But it’s all in the name of price of doing business, hopefully you win more than you lose. In this case, just patients lives….. hospital resources and physicians time are finite, can’t have everything all the time I suppose.

 

[propadope]

As others have said above, this dental practice (and other hospitals/ascs/etc that use unsupervised CRNAs) have factored these terrible events in as the price of doing business.

But isn’t a death or any poor outcome bad for business? Reputation, referrals, and word of mouth is so important in private practice. There is so much ignorance involved I don’t even think they realize the risk they are taking.

 

[coffeebythelake]

But isn’t a death or any poor outcome bad for business? Reputation, referrals, and word of mouth is so important in private practice. There is so much ignorance involved I don’t even think they realize the risk they are taking.

They are hoping it happens so rarely that it doesn't matter.
Plenty of CRNAs doing things unsafely but benefit from the fact that it is pretty hard to kill a healthy patient

 

[nimbus]

But isn’t a death or any poor outcome bad for business? Reputation, referrals, and word of mouth is so important in private practice. There is so much ignorance involved I don’t even think they realize the risk they are taking.

Not as bad as you would think.

 

[deleted126335]

But isn’t a death or any poor outcome bad for business? Reputation, referrals, and word of mouth is so important in private practice. There is so much ignorance involved I don’t even think they realize the risk they are taking.

"A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don't do one."

 

[deleted875186]

Well, yes and no.

It's all one circulation, but arterial administration of a drug is very different than venous administration. It's not the thickness of the vessel wall that's the issue.

A drug in a vein gets massively diluted in the vena cava before it hits capillaries with walls a single cell thick in the lung. A drug in an artery hits capillaries in end organs at the full concentration, and for drugs that are hyperosmolar or just prone to angering tissues, that can be very bad news.

I'm not saying it can't ever be done. Actually just yesterday I was doing a case in IR, embolizing some liver mets, and the radiologist was having trouble getting a wire into a vasospasmed vessel. I passed off some clevidipine onto his field and he injected some directly into a branch of the hepatic artery. Of course, his intent was to kill that part of the liver anyway ... so I wasn't worried about what that drug would do in high concentrations.

The IR people inject CCBs all the time for arterial vasospacm, pretty sure it’s a standard practice. They are also injecting baby doses, not 50 mg of rocuronoum.

also, I’m surprised they injected clevidipine, it’s in a lipid carrier, would be very worried about embolizibg something.

 

[propadope]

Not as bad as you would think.

I wonder what happens to these practices after a bad outcome. Do they just continue on?

"A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don't do one."

And then business as usual? What if its in the news?

 

[Vandalia]

I wonder what happens to these practices after a bad outcome. Do they just continue on?

And then business as usual? What if its in the news?

Pretty much. Depends on the precise nature of the practice type. Hopefully, people don't have a long term relationship with an oral surgeon.

The rational people know that rare outcomes are rare.
The gamblers believe that if it happened a month ago then it can't happen again for a long time. (Gambler's fallacy.)
Then there are those who only care about the personal relationship (he can't be a bad doctor/dentist/lawyer because he is such a great guy.)

More to the point, if people are in pain they only care about getting rid of it as soon as possible. In the same vein, if he is the only pediatric dentist or oral surgeon their insurance covers, that is who they are going to go to. "A patient died? Unacceptable! Going to the other dentist will cost me $300?!?! Well, I guess everyone dies eventually..."

Much of American healthcare can be explained by realizing the lengths people will go to to save 20 bucks.

 

[coffeebythelake]

Pretty much. Depends on the precise nature of the practice type. Hopefully, people don't have a long term relationship with an oral surgeon.

The rational people know that rare outcomes are rare.
The gamblers believe that if it happened a month ago then it can't happen again for a long time. (Gambler's fallacy.)
Then there are those who only care about the personal relationship (he can't be a bad doctor/dentist/lawyer because he is such a great guy.)

More to the point, if people are in pain they only care about getting rid of it as soon as possible. In the same vein, if he is the only pediatric dentist or oral surgeon their insurance covers, that is who they are going to go to. "A patient died? Unacceptable! Going to the other dentist will cost me $300?!?! Well, I guess everyone dies eventually..."

Much of American healthcare can be explained by realizing the lengths people will go to to save 20 bucks.

Americans want 1. cheap, 2. convenient, 3. nice

A friendly CRNA might be all these things, even if they are incompetent.

 

[deleted126335]

I wonder what happens to these practices after a bad outcome. Do they just continue on?

And then business as usual? What if its in the news?

Find something to attribute it to. Put a band-aid on. Then business as usual.

This is not an exact science.
The patient was very sick. Had lots of stuff going on.
Stuff happens.
No mistake was made- just one of those things.
Even if a mistake was made, carelessness or incompetence was not present. It was a judgement call.
Allergic reaction.
Unusual anatomy.
God’s will.
We did our best.
The patient was fat, smoked, used drugs. Didn’t take care of themselves.
The equipment failed. Was poorly made.
It was a perfect storm.
It was one individual’s fault. Not a systemic problem.



Etc., etc.,