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We do a lot of endoscopy, EBUS, bronchs, etc. at my current gig. A lot of times I'm 2:1 and (rarely) 3:1 supervision. For EGDs we almost never intubate unless there are extenuating circumstances (food bolus impaction, severe varices, etc.).
Below is a case where the anesthesiologist and the CRNA, in this case the hospital employing and indemnifying said CRNA, were successfully sued following a disaster with an EGD for a Mallory-Weiss tear. The assumption was that intubation was "standard of care" for this type of case and the fault lies with the anesthesia team who failed to recognize this. There were other mitigating factors we'll discuss downstream. But, here are the facts as presented...
If you have an actively bleeding patient nothing can be worse in this situation. If they are not paralyzed and still breathing sometimes it's just look for where the bubbles are coming from. The only cric case I've been involved in was in a similar situation in the ICU when I was a resident.
Okay. Wait a minute. This implies that Crane, the CRNA, was discussing the procedure beforehand, just not the risks. Does this mean he was obtaining informed consent? It also suggests that Crane "didn't know there was a risk for aspiration". What? There is always the risk for aspiration in an EGD. Any EGD. Sure it doesn't happen most of the time. But there's always a risk. Where was Dr. Williams in this discussion? I'm not sure how things go in Texas but I always discuss the risk, benefits, and plan with the patient myself. Whatever the CRNA reiterates or wants to add to that is fine provided they don't contradict what I said. It is certainly not their job to get consent. I can forgive him that he didn't know about the tear because a lot of times the reason you're doing the procedure is to diagnose the very thing you suspect.
I can't get to the actual court documents. So I don't know who the expert was. But does everyone (or anyone) agree with this statement? It also implies that Williams wasn't immediately present for the portions of the procedure where Crane (rightfully so) chose to intubate. I'd hope he came to the room when the 'stuff' hit the fan (I'm sure he did). It's not clear to me what the writer of this article meant.
The hospital indemnified the CRNA. So it was a 50/50 liability case.
http://www.outpatientsurgery.net/ou...wards-widow-1-9m-in-intubation-case--02-27-13
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Below is a case where the anesthesiologist and the CRNA, in this case the hospital employing and indemnifying said CRNA, were successfully sued following a disaster with an EGD for a Mallory-Weiss tear. The assumption was that intubation was "standard of care" for this type of case and the fault lies with the anesthesia team who failed to recognize this. There were other mitigating factors we'll discuss downstream. But, here are the facts as presented...
Clearing the airway for successful intubation took 7 minutes, court records show. After the procedure, Mr. Ross's heart stopped and he developed brain damage due to lack of oxygen. He was taken off life support 3 days later.
If you have an actively bleeding patient nothing can be worse in this situation. If they are not paralyzed and still breathing sometimes it's just look for where the bubbles are coming from. The only cric case I've been involved in was in a similar situation in the ICU when I was a resident.
Mr. Ross's widow, Carol, sued Longview (Texas) Regional Medical Center; Mark J. Williams, MD, the attending anesthesiologist; and Kenneth R. Crane, CRNA, a hospital employee. According to the summary, Mr. Crane testified that "he did not discuss the risks of the procedure beforehand with Williams, and that he was unaware Ross suffered a Mallory-Weiss tear, or that there was a risk for aspiration."
Okay. Wait a minute. This implies that Crane, the CRNA, was discussing the procedure beforehand, just not the risks. Does this mean he was obtaining informed consent? It also suggests that Crane "didn't know there was a risk for aspiration". What? There is always the risk for aspiration in an EGD. Any EGD. Sure it doesn't happen most of the time. But there's always a risk. Where was Dr. Williams in this discussion? I'm not sure how things go in Texas but I always discuss the risk, benefits, and plan with the patient myself. Whatever the CRNA reiterates or wants to add to that is fine provided they don't contradict what I said. It is certainly not their job to get consent. I can forgive him that he didn't know about the tear because a lot of times the reason you're doing the procedure is to diagnose the very thing you suspect.
The plaintiff's expert witness testified that intubation should have been the standard of practice for such a case, but that Dr. Williams's discretion on whether to direct intubation was also standard of care.
I can't get to the actual court documents. So I don't know who the expert was. But does everyone (or anyone) agree with this statement? It also implies that Williams wasn't immediately present for the portions of the procedure where Crane (rightfully so) chose to intubate. I'd hope he came to the room when the 'stuff' hit the fan (I'm sure he did). It's not clear to me what the writer of this article meant.
In November, the jury found the hospital and Dr. Williams each half-liable for Mr. Ross's death, awarding the plaintiffs $1.9 million...
The hospital indemnified the CRNA. So it was a 50/50 liability case.
http://www.outpatientsurgery.net/ou...wards-widow-1-9m-in-intubation-case--02-27-13
More next...