Anesthesiologist identified in Joan Rivers GI death

[aneftp]

http://pagesix.com/2015/01/04/anesthesiologist-in-rivers-fatal-throat-exam-identified/

She may be F'd

300mg of propofol? But she tried to say computer double counted 120mg of propofol?

If I were her and she's knows she's F'd. I'd settled. Throw the center under the bus by being too cheap and not carrying Sux becAuse they are for profit and didn't want to spend $3000/year on MH cart.

Also throw GI docs under the bus by doing illegal kickbacks with company model OIG opinion 12-06.

Sink the entire ship.

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[BLADEMDA]

1. Settle the case- She can't win
2. Claim she wanted SUX available but Cheap-ass center said "no" due to remote (very remote) risk of MH
3. Show she got paid 1 out of every 4 anesthesia dollar and the center/Gi docs got the rest
4. Claim she had to do what the Gi doc said or they would fire her

 

[Brookstacular]

You kill one of the most famous people in the world and don't have the wherewithal to document an accurate record? You then note that the dose of propofol was not really that high?! Was she high?! I'm sure Joan Rivers would be just fine with the cost of ten minutes of extra OR time from the induction dose of sux... Or why not all the roc in the room for that matter?

Holy hell.

 

[BLADEMDA]

While I have no inside information as to what happened at Yorkville Endoscopy on August 28, it’s easy for me to imagine that this was an impossible situation for the anesthesiologist.

She was presented with a celebrity patient who was well known both to Dr. Cohen and to Dr. Korovin. She provided sedation with propofol, though it’s unclear exactly how much propofol was given. The medication administration record states that a total of 300 mg of propofol was given at 9:21 a.m., which would be a very large dose for a small, 81 year old patient. However, the anesthesiologist told the CMS surveyors that she actually gave only 120 mg of propofol.

Upper GI endoscopy and nasal laryngoscopy are stimulating procedures, and it may have been that Ms. Rivers reacted to the stimulation with coughing or movement, thus prompting the anesthesiologist to give more sedation. With propofol, though, there is a very fine line between achieving an appropriate level of sedation, and producing sedation deep enough that breathing stops altogether.

If Ms. Rivers stopped breathing, it may not have been immediately obvious. In a dark room, with other physicians at the head of the table manipulating scopes in the patient’s nose and mouth, the anesthesiologist may have had very limited access to her patient. Even if she recognized that the patient was in distress, the other physicians may have refused to step aside and allow her to take control of the airway.

Once the severity of the problem was recognized, the physicians may have been reluctant to summon emergency personnel immediately, believing that they could manage the situation themselves. They may also have feared the inevitable publicity that would result.

Tragic outcome

At the end of the day, Ms. Rivers was resuscitated from cardiac arrest, but she had sustained irreversible brain damage from lack of oxygen. The tragedy of that outcome has a ripple effect. Inevitably, the lives of the physicians who were responsible for her care will never be the same.

As more information surfaces about the events of August 28, we can only hope that lessons will be learned that will benefit other patients in the future. There are minor surgeries and procedures, but there are no minor anesthetics.

Karen Sibert practices anethesiology in Los Angeles.

 

[Spinach Dip]

http://pagesix.com/2015/01/04/anesthesiologist-in-rivers-fatal-throat-exam-identified/

She may be F'd

300mg of propofol? But she tried to say computer double counted 120mg of propofol?

If I were her and she's knows she's F'd. I'd settled. Throw the center under the bus by being too cheap and not carrying Sux becAuse they are for profit and didn't want to spend $3000/year on MH cart.

Also throw GI docs under the bus by doing illegal kickbacks with company model OIG opinion 12-06.

Sink the entire ship.

Time to call a couple senators/policy makers and go all whistle-blower on the GI establishment.

 

[Consigliere]

Sux would have been helpful but it isn't necessary for intubation. I do floor intubations all the time and usually give NOTHING.

 

[lobelsteve]

While I have no inside information as to what happened at Yorkville Endoscopy on August 28, it’s easy for me to imagine that this was an impossible situation for the anesthesiologist.

She was presented with a celebrity patient who was well known both to Dr. Cohen and to Dr. Korovin. She provided sedation with propofol, though it’s unclear exactly how much propofol was given. The medication administration record states that a total of 300 mg of propofol was given at 9:21 a.m., which would be a very large dose for a small, 81 year old patient. However, the anesthesiologist told the CMS surveyors that she actually gave only 120 mg of propofol.

Upper GI endoscopy and nasal laryngoscopy are stimulating procedures, and it may have been that Ms. Rivers reacted to the stimulation with coughing or movement, thus prompting the anesthesiologist to give more sedation. With propofol, though, there is a very fine line between achieving an appropriate level of sedation, and producing sedation deep enough that breathing stops altogether.

If Ms. Rivers stopped breathing, it may not have been immediately obvious. In a dark room, with other physicians at the head of the table manipulating scopes in the patient’s nose and mouth, the anesthesiologist may have had very limited access to her patient. Even if she recognized that the patient was in distress, the other physicians may have refused to step aside and allow her to take control of the airway.

Once the severity of the problem was recognized, the physicians may have been reluctant to summon emergency personnel immediately, believing that they could manage the situation themselves. They may also have feared the inevitable publicity that would result.

Tragic outcome

At the end of the day, Ms. Rivers was resuscitated from cardiac arrest, but she had sustained irreversible brain damage from lack of oxygen. The tragedy of that outcome has a ripple effect. Inevitably, the lives of the physicians who were responsible for her care will never be the same.

As more information surfaces about the events of August 28, we can only hope that lessons will be learned that will benefit other patients in the future. There are minor surgeries and procedures, but there are no minor anesthetics.

Karen Sibert practices anethesiology in Los Angeles.

I do anxiolysis or light sedation in my office. Fentanyl and Versed. Reversal agents and cart on hand. How about pulse ox and pther monitoring? You guys are the pros and I refuse to believe that an Anesthesiologist would not know if a patient was apneic or starting to crump.

 

[btbam]

Sux would have been helpful but it isn't necessary for intubation. I do floor intubations all the time and usually give NOTHING.

Right, hypoxemia also breaks laryngospasm.

 

[deleted171991]

Right, hypoxemia also breaks laryngospasm.

Here comes the $64K question: then why do we need/use sux?

Because only profound hypoxia may break laryngospasm.

 

[BuzzPhreed]

http://directory.theaba.org/Searchdetail.aspx?id=35839795

Boarded in 1998. Not new to the game.

 

[deleted171991]

http://directory.theaba.org/Searchdetail.aspx?id=35839795

Boarded in 1998. Not new to the game.

Doctor, but why hasn't she recertified in the 16 years since? She is obviously not up to date. </sarcasm>

 

[BuzzPhreed]

Doctor, but why hasn't she recertified in the 16 years since? She is obviously not up to date. </sarcasm>

Yeah, "certified indefinitely". Just like CRNAs. While the rest of us have to do MOCA and re-prove ourselves every ten years. Hmm... maybe not such a terrible idea after all?

 

[NoFreeLunch]

With all of the intense public focus on this case, it seems odd that the anesthesiologist named today was able to keep her anonymity for 4+ months.

For anyone interested, here is the full article written today by Karen Sibert, MD (LA-based anesthesiologist) which offers of good recap of many case-related details from a physician's perspective...
http://thehealthcareblog.com/blog/2...-story-new-details-emerge-in-the-rivers-case/

 

[Planktonmd]

Although I hate to speculate but I think this is an example of a mommy track anesthesiologist who found herself in a situation that requires a non mommy track type of action.

 

[criticalelement]

Yeah, "certified indefinitely". Just like CRNAs. While the rest of us have to do MOCA and re-prove ourselves every ten years. Hmm... maybe not such a terrible idea after all?

Do you really believe her NOT RECERTIFYING had anything do with this unfortunate tragic event that is really our worst nightmare. A fiasco. And this docs career is pretty much RUINED. This is what happens when other people tell us what safe anesthesia is..

"You dont need Anectine in the room. Just use ROCUronium"

Im not necessarily saying that anectine would have saved her life because I do not know. It is possible though.
I bet you this anesthesiologist was getting paid peanuts to do this case and be available that day. . This underscores the dillemma we find ourselves in. ALL THE RISK, very little reward.

The doc in question has a new rochelle address which is con incidentally somnias headquarters address. I wonder if somenia employed her to go to that center or if this is an old address. New Rochelle is a suburb of NYC just north of the city.

 

[criticalelement]

I just want to take some time out of my day to give a big EFF yout o Jeffrey BLOOM from Gair GAIR who will be handling the case. I think you will LOSE BIG TIME BECAUSE THAT IS WHAT ALL YOU MEDICAL MALPRACTICE Attorneys are . scum of the earth. Happy reading Jeff you DICK. you should sue the center and not the anesthesiologist. Happy reading JEFF.

 

[deleted59964]

"You dont need Anectine in the room. Just use ROCUronium"

wtf is anectine ?

 

[deleted171991]

wtf is anectine ?

http://lmgtfy.com/?q=anectine

 

[deleted126335]

A lawyer with his briefcase can steal more than a hundred men with guns.

Mario Puzo

 

[deleted59964]

http://lmgtfy.com/?q=anectine

really - is a trade name for sux necessary, does criticalelement have shares or something?

 

[deleted171991]

really - is a trade name for sux necessary, does criticalelement have shares or something?

You never say tylenol, aspirin, neo(synephrine), zofran, versed, dilaudid, or zemuron...? Or whatever else is well-known by the brand name in your country?

 

[BLADEMDA]

Right, hypoxemia also breaks laryngospasm.

Hypoxemia can lead to Brain death in the elderly when combined with hypotension. Anyone taking care of 80 year old plus patients knows that hypoxemia combined with hypotension is a disaster in this age group.

Rocuronium is NOT a substitute for SUX in the GI setting. I have been there in my career and SUX saves lives.

 

[deleted59964]

honestly - it's pretty rare here ...
generally considered poor form to use trade names.
The drug companies try to make that as difficult as possible --- dexmeditomidine is a mouthful ... of course we mostly just use another drug in protest.

OK - end highjack

 

[powermd]

You know, I've always wondered why some people refer to sux by it's trade name. I never really cared enough to ask, but here I am.

My pet theory is that people still use the term because they are either 1) old as dirt and still remember the name of the drug better by it's original marketing circa 1950s, or 2) were trained by the same stubborn old farts. Or it's some kind of hipster retro anesthesiologist thing.

 

[KLPM]

honestly - it's pretty rare here ...
generally considered poor form to use trade names.

Except for Keppra because no one can say levetiracetam.

 

[deleted171991]

You know, I've always wondered why some people refer to sux by it's trade name. I never really cared enough to ask, but here I am.

My pet theory is that people still use the term because they are either 1) old as dirt and still remember the name of the drug better by it's original marketing circa 1950s, or 2) were trained by the same stubborn old farts. Or it's some kind of hipster retro anesthesiologist thing.

Or they don't want to call it "sucks", especially in public. Anectine is shorter than succinylcholine.

 

[deleted171991]

Except for Keppra because no one can say levetiracetam.

Or aspirin = acetylsalicylic acid.

 

[powermd]

Or they don't want to call it "sucks", especially in public. Anectine is shorter than succinylcholine.

Yeah, but in an anesthesiology forum where we all know what drug you're referring to when you write the even shorter and non-capitalized "sux"?

 

[Baller MD]

InB4 the trolls.

 

[deleted171991]

Yeah, but in an anesthesiology forum where we all know what drug you're referring to when you write the even shorter and non-capitalized "sux"?

It's a matter of habit, I guess. It used to bother me, too. Same for zemuron, instead of roc. It's really no big deal.

 

[Baller MD]

Question for anesthesiologists out there: If the gas doc and GI clinic did everything by the book, can they still lose the lawsuit?

 

[deleted171991]

Question for anesthesiologists out there: If the gas doc and GI clinic did everything by the book, can they still lose the lawsuit?

Yes. Because American juries tend to punish bad outcomes, not dereliction of duty. This is why, in certain counties, malpractice premiums are sky-high.

And because, in a civil case, the evidence-level needed is only "more likely than not".

 

[Baller MD]

Yes. Because American juries tend to punish bad outcomes, not dereliction of duty. This is why, in certain counties, malpractice premiums are sky-high.

And because, in a civil case, the evidence-level needed is only "more likely than not".

Thanks.

 

[Spinach Dip]

Question for anesthesiologists out there: If the gas doc and GI clinic did everything by the book, can they still lose the lawsuit?

Im not an anesthesiologist, but the fact that sux was (allegedly) not on site means things weren't done 'by the book'.

 

[criticalelement]

I like to write sublimaze on my charts as well.

Question for anesthesiologists out there: If the gas doc and GI clinic did everything by the book, can they still lose the lawsuit?

Res ipsa loquitur:
This will probably appear somewhere in the lawsuit. The thing speaks for itself.

 

[BuzzPhreed]

Do you really believe her NOT RECERTIFYING had anything do with this unfortunate tragic event that is really our worst nightmare.

I dunno.

She was board-certified in 1998, which means that she probably completed residency in 1997. This wasn't exactly the stretch of "strong years" of program recruitment into our specialty. But she did train at an Ivy League program.

Far be it from me to cast aspersions. I wasn't there. I don't know her capabilities, training, or overall skill level. I chalk a lot of this up to "celebrity syndrome" still. But there is some merit to not having some people in our profession "granfathered" (or in this case "grandmothered") out of training requirements that the rest of us have to maintain.

I applaud those physicians who were "certified indefinitely" but still re-upped and took the exam again. Probably wise in this era of litigation and current witch-hunting and blaming, sometimes for things that happened decades ago.

 

[criticalelement]

I dunno.

She was board-certified in 1998, which means that she probably completed residency in 1997. This wasn't exactly the stretch of "strong years" of program recruitment into our specialty. But she did train at an Ivy League program.

Far be it from me to cast aspersions. I wasn't there. I don't know her capabilities, training, or overall skill level. I chalk a lot of this up to "celebrity syndrome" still. But there is some merit to not having some people in our profession "granfathered" (or in this case "grandmothered") out of training requirements that the rest of us have to maintain.

I applaud those physicians who were "certified indefinitely" but still re-upped and took the exam again. Probably wise in this era of litigation and current witch-hunting and blaming, sometimes for things that happened decades ago.

You are buying into the BS of MOCA.
MOCA is complete and UTTER horse ****. You certify once and thats it.
The only people MOCA is helping is the ABA officers creating a huge bureacracy.

 

[Stank811]

It is interesting that the address associated with her name is the address of Somnia, an anesthesia management company. I would imagine it would be hard for an individual anesthesiologist to keep their name hidden for 4 months but much less difficult if you had a large management company behind you attempting to clean up your mess.

 

[BuzzPhreed]

You are buying into the BS of MOCA.
MOCA is complete and UTTER horse ****. You certify once and thats it.
The only people MOCA is helping is the ABA officers creating a huge bureacracy.

No, no. Just the double-standard of those "grandfathered" in vs. those of us who aren't.

Other than that I have no clue whether re-certification would've made a difference in this situation. I have no clue whether or not this particular anesthesiologist had been in an actual OR and confronted this situation since residency. I have no clue whether or not she was a part-timer or "mommy tracker" or whatever else you may want to speculate. For all I know she did everything exactly perfectly and the outcome was still catastrophic. For all I know she may work there one day a month, and the rest of the time she's taking care of sick preemies or doing the most complex cardiac cases and liver transplants up the street.

I just don't know. I do know that there are currently some people who don't have to re-certify, and then there are those of us that do. And I know those of us that do are far more likely to pick-up an anesthesia book and study some of the stuff that's a little dusty so we can brush off the mental cobwebs and pass the test. Other people don't have to do this. That's all.

 

[PlutoBoy]

I think she is kind of cute

 

[Gastrapathy]

You guys are a trip. I told you there was an anesthesiologist there. Last thread conclusion "can't have possibly been one of us involved." New conclusion "sink the entire ship" "call congress to tattle on GI" "those other doctors wouldn't get out of the way." I thought the old joke was that surgeons blamed anesthesia for everything. I'd never considered hiring CRNAs before because I always had some general sense of physician community. It wasn't because you all are better at endoscopy sedation. Its becoming clear to me that this doesn't exist in your world. You can't sink my ship if you aren't on board. Guess its time for me to reconsider (you've made my practice manager's day).

 

[PlutoBoy]

You guys are a trip. Last thread conclusion "can't have possibly been one of us involved." New conclusion "sink the entire ship." I thought the old joke was that surgeons blamed anesthesia for everything. I'd never considered hiring CRNAs before because I always had some general sense of physician community. It wasn't because you all are better at endoscopy sedation. Its becoming clear to me that this doesn't exist in your world. You can't sink my ship if you aren't on board. Guess its time for me to let it go too.

It is exactly that sense of physician community that should lead you to drown with everyone else when **** hits the fan

 

[Gastrapathy]

It is exactly that sense of physician community that should lead you to drown with everyone else when **** hits the fan

Just like you stepped up to drown with the general internists?

 

[PlutoBoy]

Just like you stepped up to drown with the general internists?

Nah. Never had that sense of community

xD

 

[criticalelement]

Just like you stepped up to drown with the general internists?

If someone who would have saved joans life applied for the anesthesiologist job wanted 100 dollars more per day he/she would have been passed over. There is no meritocracy in that particular arrangement with the center. They made a business decision and they are living with it. Im not condemning this particular anesthesiologist btw

 

[criticalelement]

None of those exams matter at this point.. Yes bd certification matters. MOCA means nothing. Experience means EVERYTHING. Yes the old bastards dont have to do it. Is it duplicitous? sure.. MOCA is a money making operation just like the endo business across the country. Does quality really matter as long as at the end of the day nobody is dead and everyone is getting paid? Full stomachs? ASA 3s and 4s. Sleep apnea? Does it matter if the wrong or right thing is done as long as the outcome is the same? So the center saved 100-200 dollars on an anesthesia provider, and maybe 3500 dollars on dantrolene.. WAS it worth it? I cant answer that.. The folks at the center have to.
As an aside,I worked at a center just like this one where no ANECTINE was allowed. What did i do? I had two vials in my briefcase at all times ready to use if i needed it. When I told the powers that be that I needed the ability to use sux. They rolled their eyes.. Why? Because some as s hole who is not even doing cases said zemuron is an acceptable alternative.. in an outpatient setting.. We are our worst enemy.

 

[Gastrapathy]

Of course you aren't condemning her. But then, you'd like to see the gastroenterologist sued and she somehow get a free pass. At least I think thats what you wrote earlier.

If there is one thing I've learned from these threads, its that the degree of anesthesiologist angst is so high that it creates a risk for practice of gastroenterology. That's pretty interesting.

 

[PlutoBoy]

Of course you aren't. But then, you'd like to see the gastroenterologist sued and she somehow get a free pass. At least I think thats what you wrote earlier.

No, man. I was only kidding. It's kind of dickish to try and take the other docs down if the anesthesiologist is the one that ****ed up. It would be comparable to trying to get an anesthesiologist down with you if you perforate the colon.

If the endoscopy clinic wasn't providing a safe practice environment she shouldn't have worked there. Why risk your license and the well being of your patients?

Oh. And I was also joking about the sense of community.

 

[urge]

I just want to take some time out of my day to give a big EFF yout o Jeffrey BLOOM from Gair GAIR who will be handling the case. I think you will LOSE BIG TIME BECAUSE THAT IS WHAT ALL YOU MEDICAL MALPRACTICE Attorneys are . scum of the earth. Happy reading Jeff you DICK. you should sue the center and not the anesthesiologist. Happy reading JEFF.

Do you want to talk about what these people did to you in the past, that you know by name and despise?

 

[pgg]

You guys are a trip. I told you there was an anesthesiologist there. Last thread conclusion "can't have possibly been one of us involved." New conclusion "sink the entire ship" "call congress to tattle on GI" "those other doctors wouldn't get out of the way." I thought the old joke was that surgeons blamed anesthesia for everything. I'd never considered hiring CRNAs before because I always had some general sense of physician community. It wasn't because you all are better at endoscopy sedation. Its becoming clear to me that this doesn't exist in your world. You can't sink my ship if you aren't on board. Guess its time for me to reconsider (you've made my practice manager's day).

I don't recall any such conclusion from previous threads.

I recall a lot of "we don't know" and some surprise and confusion that no anesthesiologist or CRNA was in the press at all, because most of us would have expected one or the other to be present. And any statements that there probably wasn't an anesthesiologist present stemmed from disbelief that a patient would die of laryngospasm with an anesthesiologist present - implying that we'd blame one if one was present.

Today, based on what we know, which isn't everything, my opinion is that a patient who dies from layrngospasm with an anesthesiologist and ENT right there was not managed correctly by either. Probably the only person in the room I wouldn't hold responsible is the GI doc.


Tell your practice manager what you like; spend what you like for the service that you like and the risk you can tolerate. You're a smart guy. But don't pretend your business decisions were or will be made with any other calculus, least of all some vague fellow-physician-loyalty hippie crap. We're smart guys too; we know the score. It's all cost and risk, in the end.