Kaiser Portland

[nimbus]

The future of anesthesia practice?? The present?


http://media.oregonlive.com/portland_impact/other/kaiser.doc.suit.pdf

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[GravelRider]

I think this is a good lawsuit that will draw people's attention to the assembly line mentality of the OR. However, I don't think Dr. Franck has a chance of winning. Kaiser is too well connected politically and it will be hard to prove that these policies cause any direct harm to patient outcomes. In the end, I hope more media outlets pick this story up and this encourages more docs to come forward and help break this system.

 

[SitraAchra]

Wow, what a read.

 

[repititionition]

holy ****. I expected better from Kaiser.

 

[BlackDiamond4]

What a nightmare.

 

[kidthor]

It IS a nightmare... but don't we tolerate many of the described issues on a daily basis? I'm just glad he's trying to take Kaiser to the cleaners for doing what's clearly against patient safety - even if what they're doing is the new normal.

 

[PressureSupport]

Seems like the plaintiff is going to have to prove that his contract was not renewed because he was a whistleblower. It sounds like Kaiser will have a lot of their own reasons to support the failure to renew his contract.

 

[IlDestriero]

Sounds like that place is a disaster run by sell out company men. I hope he takes them to the cleaners and gives them the negative publicity they deserve for this series of obviously corporate centered care policies that place patients at risk and leave them in pain and vomiting on the curb.
PS don't forget to save copies of all the emails, policies and guidelines if you're in the same boat.

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Il Destriero

 

[kidthor]

PS don't forget to save copies of all the emails, policies and guidelines if you're in the same boat.

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Il Destriero

Absolutely. The quotes in his complaint (from his email) are key to his case.

 

[Man o War]

Let the nurses and techs run that s@@thole, sounds like they do anyway. It sounds like they're doing a bang up job for patients.
Maybe I've just been lucky, but I can't imagine a workplace where a tech dictates how I do things. It doesn't get much worse than that.

 

[ProRealDoc]

Never heard anything good about Kaiser. Sounds like a nightmare employer.

 

[IlDestriero]

Let the nurses and techs run that s@@thole, sounds like they do anyway. It sounds like they're doing a bang up job for patients.
Maybe I've just been lucky, but I can't imagine a workplace where a tech dictates how I do things. It doesn't get much worse than that.

I had the same thought. Who gives a **** what the tech thinks about your technique? Get me what I ask for and hand me the probe the way I want or get the **** out. He's an expense to the hospital. Frightening.
$20/HR high school drop outs don't tell double boarded physicians how to do things.

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Il Destriero

 

[deleted126335]

These are allegations in a complaint from a guy who was fired. I have read two lawsuits from guys that I personally knew who deserved to be fired. They were filled with bull**** attempting to portray themselves as the only one advocating for patient safety against a heartless bureaucracy that compromised care in the name of $$. The complaint acknowledges that he couldn't get his first case preops done by 07:30. If a doc in your practice was an outlier in this regard, it would be a bad sign. The bit about prepping for blocks, I agree is a personal preference thing, but I also believe in adapting to local customs and picking your battles. Everyone else in the department wants to do a more extensive prep/drape and colleagues cutting me up for the tegaderm over the probe thing... Fine... I'll do it your way. No big deal.
1:4 coverage. Yeah it sucks. I hate it. But that is the world in which many if not most of us live. This is pretty thin.

 

[IlDestriero]

The 730am start thing doesn't make a lot of sense to me. Just pre screen them the day before, or at home if you can, or come in 15 or 20 minutes earlier. I'm sure the patients get there at around 6 for the first case. The emails and policies he refers to are what concerns me.


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Il Destriero

 

[Mman]

The 730am start thing doesn't make a lot of sense to me. Just pre screen them the day before, or at home if you can, or come in 15 or 20 minutes earlier. I'm sure the patients get there at around 6 for the first case. The emails and policies he refers to are what concerns me.


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Il Destriero

Lots of stuff doesn't make sense. A policy to place spinals in preop holding? Really? There is no difference in surgery start time for GA vs spinal if you do the spinal in the room. Just doesn't matter and it is potentially dangerous to routinely do them in preop holding.

Being told not to enter the room during a c-section? Seriously?

I realize this is from his POV and attempting to make him look as good as possible, but if there is a paper trail with that sort of stuff it is almost indefensible.

 

[Man o War]

Lots of stuff doesn't make sense. A policy to place spinals in preop holding? Really? There is no difference in surgery start time for GA vs spinal if you do the spinal in the room. Just doesn't matter and it is potentially dangerous to routinely do them in preop holding.

Being told not to enter the room during a c-section? Seriously?

I realize this is from his POV and attempting to make him look as good as possible, but if there is a paper trail with that sort of stuff it is almost indefensible.

One of the ortho groups at my old hospital had it in their heads that it saves time to do spinals in pre op, despite us showing them again and again it made no difference. It was a CONSTANT point of contention. At least monthly we got a nasty gram copied to all of hospital administration about it. So ridiculous.

 

[Mman]

One of the ortho groups at my old hospital had it in their heads that it saves time to do spinals in pre op, despite us showing them again and again it made no difference. It was a CONSTANT point of contention. At least monthly we got a nasty gram copied to all of hospital administration about it. So ridiculous.

our orthopods felt the same. We have to the 15 second increment data from room enter time to prep start time for either way showing no significant difference. Sure they have to sit there and watch us screw around for a few minutes in their back. Under GA, they ignore the time for preoxygenation and hooking up monitors and ventilating and (god forbid) the difficult airway that takes time they don't pay attention to.

When the patient rolls in the room for a spinal, we get them sitting up and I start prepping their back while CRNA starts hooking up monitors. Once the spinal is complete and we lay them down the surgeon can start to prep as soon as they want. It's often well under 10 minutes from entering the room until they can begin prepping.

 

[needachange2017]

our orthopods felt the same. We have to the 15 second increment data from room enter time to prep start time for either way showing no significant difference. Sure they have to sit there and watch us screw around for a few minutes in their back. Under GA, they ignore the time for preoxygenation and hooking up monitors and ventilating and (god forbid) the difficult airway that takes time they don't pay attention to.

When the patient rolls in the room for a spinal, we get them sitting up and I start prepping their back while CRNA starts hooking up monitors. Once the spinal is complete and we lay them down the surgeon can start to prep as soon as they want. It's often well under 10 minutes from entering the room until they can begin prepping.

Isn't this what pisses off you guys the most?
Surgeons and the hospital expects the anesthesiologists to start the case exactly on time for every patient, complicated or not, yet, most surgeons will dick around during the case and a scheduled lap chole becomes open cause it was tough gallbladder to get to. None of the OR staff says anything. Yet when an anesthesiologist has a difficult IV, epidural, spinal, or line to do, it becomes a huge dog and pony show.

 

[Man o War]

These are allegations in a complaint from a guy who was fired. I have read two lawsuits from guys that I personally knew who deserved to be fired. They were filled with bull**** attempting to portray themselves as the only one advocating for patient safety against a heartless bureaucracy that compromised care in the name of $$. The complaint acknowledges that he couldn't get his first case preops done by 07:30. If a doc in your practice was an outlier in this regard, it would be a bad sign. The bit about prepping for blocks, I agree is a personal preference thing, but I also believe in adapting to local customs and picking your battles. Everyone else in the department wants to do a more extensive prep/drape and colleagues cutting me up for the tegaderm over the probe thing... Fine... I'll do it your way. No big deal.
1:4 coverage. Yeah it sucks. I hate it. But that is the world in which many if not most of us live. This is pretty thin.

You have valid points, on time starts have been a metric that anesthesia gets paid on at every place I've worked. You just have to figure it out.
I guess I've heard so much negative about the work environment at Kaiser that I am giving the guy the benefit of the doubt.

 

[GravelRider]

The 730am start thing doesn't make a lot of sense to me. Just pre screen them the day before, or at home if you can, or come in 15 or 20 minutes earlier. I'm sure the patients get there at around 6 for the first case. The emails and policies he refers to are what concerns me.


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Il Destriero

But why is this rush through a patient preop the new normal? Even if you get there at 6am and have 4 or 6 patients to see, you are not truly doing a thorough preop. Most patients don't need that, but occasionally you have a complicated patient or a patient who is truly nervous and needs a little extra "verbal anxiolysis" from a DOCTOR. The whole point of this is that we are continually being forced out of our role as physicians and into the role of a worker on an assembly line. This is what is destroying the profession and allows them to systematize everything and bring in cheaper replacements. This corporate trimming of margins is also largely responsible for the increasing burnout and dissatisfaction with medicine. It is also bad for patients. Kaiser is a corporation like any other. If they could ship the work overseas to Chinese sweatshops, they would.

 

[Man o War]

Isn't this what pisses off you guys the most?
Surgeons and the hospital expects the anesthesiologists to start the case exactly on time for every patient, complicated or not, yet, most surgeons will dick around during the case and a scheduled lap chole becomes open cause it was tough gallbladder to get to. None of the OR staff says anything. Yet when an anesthesiologist has a difficult IV, epidural, spinal, or line to do, it becomes a huge dog and pony show.

Yep. Different rules for them.

 

[Arch Guillotti]

Just doesn't matter and it is potentially dangerous to routinely do them in preop holding.

What's the big deal with being dangerous in preop versus the OR? Something can go wrong either place. So long as you have the right equipment/drugs should something bad happen I really don't know why it matters.

 

[Mman]

What's the big deal with being dangerous in preop versus the OR? Something can go wrong either place. So long as you have the right equipment/drugs should something bad happen I really don't know why it matters.

What do you do if the patient gets their high spinal while walking down the hallway unmonitored? Push the bed faster? Also worth noting that placing the spinal constitutes the start of the anesthetic and if a policy is in place to not continuously monitor the patient (EKG, pulse ox, etc) during an anesthetic it is violating ASA standard of care.

 

[Man o War]

What do you do if the patient gets their high spinal while walking down the hallway unmonitored? Push the bed faster? Also worth noting that placing the spinal constitutes the start of the anesthetic and if a policy is in place to not continuously monitor the patient (EKG, pulse ox, etc) during an anesthetic it is violating ASA standard of care.

Same reason as above and does not improve turnovers at all, so why take any extra risk?

 

[Psai]

Holy jesus Kaiser sounds like such a ****hole

I'm considering leaving anesthesiology for a subspecialty because of nonsense like this. Can you imagine a tech or a nurse trying to tell a surgeon that they can't do a procedure or that their patients were cleared for surgery by a nurse? Or a surgical department throwing a surgeon under the bus for a nurse? Shocking behavior by the anesthesiologists there.

Try telling a surgeon to pick up his own tools without a circulator or a scrub tech. Or that they must sign charts for 4 different pas doing surgery under their name while being barred from the OR. Unbelievable. I came into medicine to take great care of my patients, not to follow stupid rules made by stupid people.

 

[GravelRider]

I came into medicine to take great care of my patients, not to follow stupid rules made by stupid people.

You are going to be severely disappointed then.

I like that slogan, though: Medicine: where you get to follow stupid rules made by stupid people.

 

[Scotty_G]

Kaiser smeisher....it's just another AMC!!

 

[Ezekiel2517]

This guy may be a fine anesthesiologist but he is delusional if he thinks he will win this. It's gonna end up costing him a lot of time and money.

 

[Mman]

This guy may be a fine anesthesiologist but he is delusional if he thinks he will win this. It's gonna end up costing him a lot of time and money.

Not necessarily. Lawyer might be working for nothing more than a percentage of any collection if the lawyer thinks they have a reasonable chance.

 

[Robotic Wis-Hipple]

And if he has emails explicitly stating things like "do not go into OB ORs that you are supervising" Kaiser may prefer to bury those with a settlement instead of letting the media and jurors run with them.

 

[lakersbaby]

everyone just hating on Kaiser without knowing anything about it. Also each Kaiser runs pretty much independently from each other. Always two sides to every story, could it just be this guy was terrible and is just being bitter about his termination?

 

[San Marzano]

I can see this case going one of two ways: Kaiser offers a settlement to avoid going through litigation and the plaintiff accepts and moves on with his life, or the plaintiff rejects the settlement and then crashes and burns in court as he is bent over and violated repeatedly by the multibillion dollar Kaiser legal department.

 

[repititionition]

Holy jesus Kaiser sounds like such a ****hole

I'm considering leaving anesthesiology for a subspecialty because of nonsense like this. Can you imagine a tech or a nurse trying to tell a surgeon that they can't do a procedure or that their patients were cleared for surgery by a nurse? Or a surgical department throwing a surgeon under the bus for a nurse? Shocking behavior by the anesthesiologists there.

Try telling a surgeon to pick up his own tools without a circulator or a scrub tech. Or that they must sign charts for 4 different pas doing surgery under their name while being barred from the OR. Unbelievable. I came into medicine to take great care of my patients, not to follow stupid rules made by stupid people.

Really thinking of leaving already?