"St. Louis man awake during surgery"

[Splenda88]

St. Louis man awake during surgery

Imagine going under the knife and actually feeling the pain.

www.kctv5.com

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[Sandman33]

Someone’s getting a nice payday. 2 people are named in the lawsuit: a CRNA and MD. I’m curious to know who was driving the bus when this happened.

 

[Agast]

Fire them both. MD should be present during induction of anesthesia, this is a university attending. How could you not notice the inhalation agent isn't on???

 

[ryanjmy]

Someone’s getting a nice payday.

Yep. They are on record saying they effed up. At my shop we have a quality control process where cases like this are reviewed and scored. This CRNA and/or MD's privileges would be immediately suspended.

 

[Agast]

Oh snap, the attending anesthesiologist graduated in 2020. Sorry dude. That was way too early to start slacking off.

 

[abolt18]

Oh snap, the attending anesthesiologist graduated in 2020. Sorry dude. That was way too early to start slacking off.

You've never been pulled in 2 directions at once? Emergency overhead page right as the tube goes in, so you figure "we're good" and run off to help because you assume the experienced nurse will remember to turn on the anesthetic like she's done 1000s of times before.

Never had 2 cases starting at almost the same time and this was the healthy dude with no comorbidities so as soon as you saw ETCO2 you ran off to help start the super sick patient or difficult airway case?

Throwing shade when you don't even know the actual circumstances.

 

[abolt18]

Fire them both. MD should be present during induction of anesthesia, this is a university attending. How could you not notice the inhalation agent isn't on???

This is a hospital owned by the university, but not THE WashU hospital. No anesthesia residents there as far as I know but could be wrong.

 

[Agast]

You've never been pulled in 2 directions at once? Emergency overhead page right as the tube goes in, so you figure "we're good" and run off to help because you assume the experienced nurse will remember to turn on the anesthetic like she's done 1000s of times before.

Never had 2 cases starting at almost the same time and this was the healthy dude with no comorbidities so as soon as you saw ETCO2 you ran off to help start the super sick patient or difficult airway case?

Throwing shade when you don't even know the actual circumstances.

Hey, you want the role of Supervisor because CRNAs are unsafe to practice alone?

Then supervise.

 

[Southpaw]

Hey, you want the role of Supervisor because CRNAs are unsafe to practice alone?

Then supervise.

if you can’t trust a CRNA to turn on the gas then what should they be trusted to do? They’re highly paid professionals.

am I absolving the anesthesiologist of his supervision responsibilities? No, not at all.

but if that anesthesiologist left after the patient was intubated with confirmed placement to go start the other 3 rooms he was assigned for the day, he isn’t the first and he certainly won’t be the last.

walk a mile in his shoes before you speak so harshly.

 

[deleted162650]

walk a mile in his shoes before you speak so harshly.

I always try to do this before I criticize someone - so that way, when I do criticize them, I’m a mile away and I have their shoes.

 

[DocVapor]

I always try to do this before I criticize someone - so that way, when I do criticize them, I’m a mile away and I have their shoes.

And their athlete's foot.

 

[GassYous]

I always try to do this before I criticize someone - so that way, when I do criticize them, I’m a mile away and I have their shoes.

I also only talk **** when I am a safe distance away

 

[Agast]

if you can’t trust a CRNA to turn on the gas when what should they be trusted to do? They’re highly paid professionals.

am I absolving the anesthesiologist if his supervision responsibilities? No, not at all.

but if that anesthesiologist left after the patient was intubated with confirmed placement to go start the other 3 rooms he was assigned for the day, he isn’t the first and he certainly won’t be the last.

walk a mile in his shoes before you speak so harshly.

Put yourself in the shoes of the patient. Imagine living through those 13 minutes. If I am your patient and you don't bother to make sure I'm anesthetized, there is no forgiveness or empathy. There is something fundamentally wrong with you.

 

[jw3600]

Put yourself in the shoes of the patient. Imagine living through those 13 minutes. If I am your patient and you don't bother to make sure I'm anesthetized, there is no forgiveness or empathy. There is something fundamentally wrong with you.

Your logic...is awful.

I’m an ER doc. I have a young Peds patient in agony. I order IN Fentanyl. The nurse is brain dead and injects saline into the applicator not fentanyl. The patient is still in pain. It takes 13 minutes for me to realize this happened. I attempt to rectify the situation. And you’re conclusion is there is something fundamentally wrong with me because another licensed professional made a major error? Have you thought about your stance on this?
It’s one thing to say the anesthesiologist is liable but to act like they’re a monster? Truly absurd.

 

[DocVapor]

Put yourself in the shoes of the patient. Imagine living through those 13 minutes. If I am your patient and you don't bother to make sure I'm anesthetized, there is no forgiveness or empathy. There is something fundamentally wrong with you.

Username checks out.

 

[Southpaw]

Put yourself in the shoes of the patient. Imagine living through those 13 minutes. If I am your patient and you don't bother to make sure I'm anesthetized, there is no forgiveness or empathy. There is something fundamentally wrong with you.

Then the CRNA shouldn’t even be there, by your logic, for all the rooms I supervise if they aren’t responsible for anything.

There is nothing fundamentally wrong with me for holding an opinion contradictory to yours. Think about that for a minute.

 

[Southpaw]

I always try to do this before I criticize someone - so that way, when I do criticize them, I’m a mile away and I have their shoes.

does one even need shoes in your practice? Can’t you just put shoe covers over your sandals.

 

[GassYous]

Put yourself in the shoes of the patient. Imagine living through those 13 minutes. If I am your patient and you don't bother to make sure I'm anesthetized, there is no forgiveness or empathy. There is something fundamentally wrong with you.

We trust other people to do their jobs. I come in expecting that the techs checked the machine and that the preop nurse went through the patient's medlist. I could go through and do everything myself but there's a reason why different people have different jobs. Sometimes when you are busy and being pulled in multiple directions you forget to do a step. It was a horrible experience for the patient I'm sure but I can see it happening to anyone.

This is why I like to run gas and prop together.

 

[Mehd School]

Anesthesiologist absolutely shares the blame here.


But ... can we seriously not trust a CRNA to turn a knob? *The* knob? Let alone for 13 minutes. Good grief.

 

[deleted162650]

does one even need shoes in your practice? Can’t you just put shoe covers over your sandals.

I may or may not have done a couple C-sections in flip flops under a couple layers of shoe covers.

 

[Agast]

Then the CRNA shouldn’t even be there, by your logic, for all the rooms I supervise if they aren’t responsible for anything.

There is nothing fundamentally wrong with me for holding an opinion contradictory to yours. Think about that for a minute.

You misread my statement as a personal attack. If you are responsible for my anesthesia and I do not receive anesthesia there is something fundamentally wrong with you as the anesthesiologist. I would not forgive the attending for running away after the tube went in and I was left paralyzed and awake. If you did this to me and said you're not responsible for the CRNA, I would be incredibly angry.

I don't really care if you guys disagree with me. This is a "Never" event - it's never supposed to happen. I don't imagine it would happen again. But I honestly doubt if you were the patient, or the patient was your loved one, that you'd be cool with the anesthesiologist.

 

[pjl]

You misread my statement as a personal attack. If you are responsible for my anesthesia and I do not receive anesthesia there is something fundamentally wrong with you as the anesthesiologist. I would not forgive the attending for running away after the tube went in and I was left paralyzed and awake. If you did this to me and said you're not responsible for the CRNA, I would be incredibly angry.

I don't really care if you guys disagree with me. This is a "Never" event - it's never supposed to happen. I don't imagine it would happen again. But I honestly doubt if you were the patient, or the patient was your loved one, that you'd be cool with the anesthesiologist.

I suspect I would punch him in the cock and move on with my life.

 

[abolt18]

You misread my statement as a personal attack. If you are responsible for my anesthesia and I do not receive anesthesia there is something fundamentally wrong with you as the anesthesiologist. I would not forgive the attending for running away after the tube went in and I was left paralyzed and awake. If you did this to me and said you're not responsible for the CRNA, I would be incredibly angry.

I don't really care if you guys disagree with me. This is a "Never" event - it's never supposed to happen. I don't imagine it would happen again. But I honestly doubt if you were the patient, or the patient was your loved one, that you'd be cool with the anesthesiologist.

Nevertheless we don't know the actual circumstances. The FAULT and the BLAME ultimately should fall on the nurse IMO, but he, as the anesthesiologist is ultimately partially RESPONSIBLE.

I think the most important part here after the fact is that they never tried to hide it. The anesthesiologist owned it completely, immediately told the patient and his mother what happened, and documented it appropriately.

Your account says you're an anesthesiologist but based on your posts it looks like you're in pain. Do you do any anesthesia? Have you ever? Do/did you supervise? Or do/did you do your own cases?

 

[GassmanMD]

Oh snap, the attending anesthesiologist graduated in 2020. Sorry dude. That was way too early to start slacking off.

Hey, you want the role of Supervisor because CRNAs are unsafe to practice alone?

Then supervise.

You are conflating supervision with medical direction. Only in the latter is the anesthesiologist required to be present at induction. Induction ends when the ETT is safely secured and the patients’ vital signs are stable. Assuming they even operate under a medical direction model, the attending is not expected to stick around .

 

[BLADEMDA]

You are conflating supervision with medical direction. Only in the latter is the anesthesiologist required to be present at induction. Induction ends when the ETT is safely secured and the patients’ vital signs are stable. Assuming they even operate under a medical direction model, the attending is not expected to stick around .

No way your version is believed by a jury. If this case goes to trial the plaintiff’s experts will testify under oath a very different standard than the one you are claiming here. who will the jury believe? The experts who state the anesthesiologist should have stayed in the room for an extra 30-45 seconds to verify the anesthesia was actually turned on or the other experts who say the nurse anesthetist was 100 percent at fault here. If you were the attending Anesthesiologist would you risk a trial based on the known facts of this case?

This is one of those situations where “you own it” and accept partial blame for the outcome. To be honest, the CRNA and AANA should both step up on this case and admit the CRNA was 100 percent responsible for the total recall in the room. The idea that a provider of anesthesia whose organization claims equivalency wouldn’t accept 100 percent of the blame for this case just exposes the blatant hypocrisy of the AANA.

if I screwed up a case you can rest assured I would be willing to make certain the CRNA did not incur any liability for my error. Is it asking too much of the CRNA to do the same thing for me?

 

[deleted697127]

This is one of those situations where “you own it” and accept partial blame for the outcome. To be honest, the CRNA and AANA should both step up on this case and admit the CRNA was 100 percent responsible for the total recall in the room. The idea that a provider of anesthesia whose organization claims equivalency wouldn’t accept 100 percent of the blame for this case just exposes the blatant hypocrisy of the AANA.

if I screwed up a case you can rest assured I would be willing to make certain the CRNA did not incur any liability for my error. Is it asking too much of the CRNA to do the same thing for me?

This is the exact reason why in my opinion the ASA should take a look at this case and consider supporting it going to trial should the details support that a fully licensed CRNA was alone in the room and unable to turn on the gas.

but hey let’s say the facts turn out to say they’re both in the room, gas turned on with an empty Cannister...we don’t know all the details but i believe the future of our specialty lies in the court system for cases like this

 

[anbuitachi]

the sad thing is...the MD has a higher chance of losing his job than the CRNA. the MD also has a higher chance of losing more $ in the lawsuit. And MD also has higher chance of losing his license.

I agree this should be a never event, but like above said, if we cant trust a trained CRNA (not a student) to turn on anesthesia... then thats a huge issue.

this is one of those events that could happen to any one of us supervising multiple CRNAs, dragged in different directions.. to do the job, you have to have some trust. this anesthesiologist is super unfortunate

 

[dannyboy1]

Oh snap, the attending anesthesiologist graduated in 2020. Sorry dude. That was way too early to start slacking off.

You might only be hearing about this because he is a new grad. Could be he was called to the room and started making a big deal about it and letting the surgeons and the nurses know all about it. A more seasoned doc might just “keep calm and carry on” give some versed, give a ton of propofol at the end of the case so he is out of it when he gets to PACU, then see if the patient mentions anything. Just a bad dream buddy.
just saying....

 

[coffeebythelake]

You might only be hearing about this because he is a new grad. Could be he was called to the room and started making a big deal about it and letting the surgeons and the nurses know all about it. A more seasoned doc might just “keep calm and carry on” give some versed, give a ton of propofol at the end of the case so he is out of it when he gets to PACU, then see if the patient mentions anything. Just a bad dream buddy.
just saying....

Versed provides anterograde amnesia, not retrograde. I think it'd be hard to convince a patient he has been dreaming when he felt cold steel against his skin, trocars being plunged jnto his abdomen, and hearing people talking during the surgeryn. That would be the ultimate gaslighting if the anesthesiologist could convince the patient it was all a dream

 

[coffeebythelake]

the sad thing is...the MD has a higher chance of losing his job than the CRNA. the MD also has a higher chance of losing more $ in the lawsuit. And MD also has higher chance of losing his license.

I agree this should be a never event, but like above said, if we cant trust a trained CRNA (not a student) to turn on anesthesia... then thats a huge issue.

this is one of those events that could happen to any one of us supervising multiple CRNAs, dragged in different directions.. to do the job, you have to have some trust. this anesthesiologist is super unfortunate

The doc isn't going to lose his job or his license. The CRNA should lose her job, but I doubt she would lose her license. The hospital likely pays for both their malpractice and will settle this. In PP where they buy their own malpractice, agree that the anesthesiologist liability would likely pay out more than the CRNA because it is a bigger pot

 

[Lidolover]

This is so unfortunate for all: the patient first, the anesthesiologist and the mid-level provider. A Swiss cheese situation that we pray every day not to happen to anyone. Lesson: DONT RUSH TO or FOR ANYTHING and TRUST NOONE.

 

[dannyboy1]

Versed provides anterograde amnesia, not retrograde. I think it'd be hard to convince a patient he has been dreaming when he felt cold steel against his skin, trocars being plunged jnto his abdomen, and hearing people talking during the surgeryn. That would be the ultimate gaslighting if the anesthesiologist could convince the patient it was all a dream

Yes. But if the patient slowly comes around in PACU with an oral airway in his mouth he can’t deny that he was sleeping at some point. In any event it’s far better than just walking in and admitting it to the patient. It’s almost like you are working for the plaintiffs attorney.....

 

[MirrorTodd]

Yes. But if the patient slowly comes around in PACU with an oral airway in his mouth he can’t deny that he was sleeping at some point. In any event it’s far better than just walking in and admitting it to the patient. It’s almost like you are working for the plaintiffs attorney.....

Bro, what you are talking about is so ****ing unethical and immoral. Guys like you are the reasons we have to pass laws to protect the little guy.

 

[GaseousClay]

The doc isn't going to lose his job or his license. The CRNA should lose her job, but I doubt she would lose her license. The hospital likely pays for both their malpractice and will settle this. In PP where they buy their own malpractice, agree that the anesthesiologist liability would likely pay out more than the CRNA because it is a bigger pot

Union nurse working for a university. Her job will be just fine.

 

[BLADEMDA]

The doc isn't going to lose his job or his license. The CRNA should lose her job, but I doubt she would lose her license. The hospital likely pays for both their malpractice and will settle this. In PP where they buy their own malpractice, agree that the anesthesiologist liability would likely pay out more than the CRNA because it is a bigger pot

You seem confident about the fact that the board of medicine will not sanction the physician. In this case, the board of nursing should sanction the CRNA and she should get her license Suspended for a few months. Her actions were several deviations from the standard of care. She should be required to do course work in the PTSD which may result from lack of anesthesia.

The physician may also find himself in trouble with the Board. While I am empathetic to his situation and the fact he is brand new at his job the Board may require he perform course work in this area.

whenever you cover CRNAs your legal risk goes way way up. You still have your own risk but also assume partial responsibility for those working under you.

 

[anbuitachi]

The doc isn't going to lose his job or his license. The CRNA should lose her job, but I doubt she would lose her license. The hospital likely pays for both their malpractice and will settle this. In PP where they buy their own malpractice, agree that the anesthesiologist liability would likely pay out more than the CRNA because it is a bigger pot

Agree with blade. Especially now media is covering it.

Also who knows how much they'll sue for. It's hard to put a price on this.

 

[deleted126335]

Bro, what you are talking about is so ****ing unethical and immoral. Guys like you are the reasons we have to pass laws to protect the little guy.

I know of a similar case happened a long time ago. Nearly identical set of facts. For some reason doc came back in room shortly after incision. Noted that vaporizer wasn’t on. He quickly turned it on at high flows and Gave 10 mg of midazolam. Checked on patient in PACU and next day. Patient had no questions or complaints. He chose not to disclose what happened to patient. Never heard from them again. Not sure if he involved risk management. Not sure that I would disclose in that scenario.

 

[BLADEMDA]

I know of a similar case happened a long time ago. Nearly identical set of facts. For some reason doc came back in room shortly after incision. Noted that vaporizer wasn’t on. He quickly turned it on at high flows and Gave 10 mg of midazolam. Checked on patient in PACU and next day. Patient had no questions or complaints. He chose not to disclose what happened to patient. Never heard from them again. Not sure if he involved risk management. Not sure that I would disclose in that scenario.

I can’t count the number of times I’ve informed providers their vaporizer was almost empty.

 

[Mehd School]

I can’t count the number of times I’ve informed providers their vaporizer was almost empty.

Say they let the vaporizer run completely dry (I've done it myself - drager, please stop hiding your fill levels). Would you expect the average person to take nearly 15 minutes to figure that out with such obvious signs right in front of them?

 

[chocomorsel]

You might only be hearing about this because he is a new grad. Could be he was called to the room and started making a big deal about it and letting the surgeons and the nurses know all about it. A more seasoned doc might just “keep calm and carry on” give some versed, give a ton of propofol at the end of the case so he is out of it when he gets to PACU, then see if the patient mentions anything. Just a bad dream buddy.
just saying....

I call BS. This is THIRTEEN minutes. He will remember and if you try to convince him otherwise, then you ought to be disgusted with yourself. I bet he could describe the conversations he heard. Bad dream my ass. What if that were you on the table? Or your family?
This is not 1-2 minutes here.
I truly hope you are joking.
Versed doesn’t work that way BTW as has been mentioned above.

 

[chocomorsel]

Yes. But if the patient slowly comes around in PACU with an oral airway in his mouth he can’t deny that he was sleeping at some point. In any event it’s far better than just walking in and admitting it to the patient. It’s almost like you are working for the plaintiffs attorney.....

You really need to get some help if you truly think this way. Seriously. This is very disturbing coming from a professional. Are you still in residency? Is this what they teach you or what you learned in residency?
**** happens. Admit mistakes and move on.

 

[coffeebythelake]

Agree with blade. Especially now media is covering it.

Also who knows how much they'll sue for. It's hard to put a price on this.

What would be the supposed purpose of board action. There is no professionalism issue. There is no knowledge deficit. There is no clinical management deficit that can be clearly determined. This was simply CRNA who is supposedly monitoring the patient who forgot to turn on anesthetic while the anesthesiologist was in another OR. I didn't realize medical boards take action based solely on the whims of media coverage. That sounds like an AANA thing to do when there js something they want to hide.

 

[coffeebythelake]

I can’t count the number of times I’ve informed providers their vaporizer was almost empty.

My machines alarm like crazy when that happens. Don't yours?. And if not the aevo% on gas analyzer should point that out. Or I'd not the patients hemodynamics. There are a lot of steps here to awareness.

 

[Lawpy]

St. Louis man awake during surgery

Imagine going under the knife and actually feeling the pain.

www.kctv5.com

The CRNA should be fired and punished. They are completely responsible for this

 

[Lidolover]

I have absolute empathy for this patient but what I frequently wonder is how can you tell if a pt is not being honest and is well prepared in anticipation of some “refund”?!?! For example, u have here some vitals that could support this but how many times we do encounter tachycardia or HTN or lacrimation without awareness?

 

[coffeebythelake]

I have absolute empathy for this patient but what I frequently wonder is how can you tell if a pt is not being honest and is well prepared in anticipation of some “refund”?!?! For example, u have here some vitals that could support this but how many times we do encounter tachycardia or HTN or lacrimation without awareness?

There are grey area cases and there are slam dunk cases. This is the latter

 

[chocomorsel]

I know of a similar case happened a long time ago. Nearly identical set of facts. For some reason doc came back in room shortly after incision. Noted that vaporizer wasn’t on. He quickly turned it on at high flows and Gave 10 mg of midazolam. Checked on patient in PACU and next day. Patient had no questions or complaints. He chose not to disclose what happened to patient. Never heard from them again. Not sure if he involved risk management. Not sure that I would disclose in that scenario.

I have worked in some places solo where room to incision time was about 10 minutes. Maybe there are places like this in ACT models. In that respect the awareness time could be just 2-4 minutes.

 

[DrOwnage]

I have absolute empathy for this patient but what I frequently wonder is how can you tell if a pt is not being honest and is well prepared in anticipation of some “refund”?!?! For example, u have here some vitals that could support this but how many times we do encounter tachycardia or HTN or lacrimation without awareness?

Young healthy patients should rarely have sustained hypertensive crises shortly after induction if a proper induction was done. 13 minutes is a very long time for sustained hypertension. I do agree that a young healthy person will sometimes shoot their HR up to the 110-120s that will take a couple of minutes to come down. Occasionally you will have the diabetic, hypertensive, chronic pain patients who shoot up their BP after induction even with a good induction. The CRNA just wasnt paying attention. I'm usually looking at the patient for sometime afterward. I bet this persons eye tape came loose from all the lacrimation and he was sweating his balls off.

 

[GassYous]

I know of a similar case happened a long time ago. Nearly identical set of facts. For some reason doc came back in room shortly after incision. Noted that vaporizer wasn’t on. He quickly turned it on at high flows and Gave 10 mg of midazolam. Checked on patient in PACU and next day. Patient had no questions or complaints. He chose not to disclose what happened to patient. Never heard from them again. Not sure if he involved risk management. Not sure that I would disclose in that scenario.

Agree. I don't think it's an unethical or immoral action to try to prevent a negative outcome after the fact. If nothing bad happened, there's nothing to disclose. I've also had cases where I thought the patient may be at risk of recall and pushed versed after the fact. The textbooks can say versed doesn't provide retrograde amnesia but if you talk to patients afterwards you'll find that that isn't the case.

Would you disclose to the patient if they had hypotension (which happens all the time) or if you ran the antibiotic faster than recommended by pharmacy?

 

[DrOwnage]

Agree. I don't think it's an unethical or immoral action to try to prevent a negative outcome after the fact. If nothing bad happened, there's nothing to disclose. I've also had cases where I thought the patient may be at risk of recall and pushed versed after the fact. The textbooks can say versed doesn't provide retrograde amnesia but if you talk to patients afterwards you'll find that that isn't the case.

Would you disclose to the patient if they had hypotension (which happens all the time) or if you ran the antibiotic faster than recommended by pharmacy?

I would say that's not a fair comparison. Those are dynamic factors that are usually inconsequential and fixable. This was an all or nothing phenomenon. I would say a fair comparison would be if the patient got a bad surgical site infection and it turns out the anesthesiologist didn't give the antibiotics at all.