$15 Million Anesthesia Verdict Connecticut

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So the doc died in 2021. He was still young. Age 57 (almost 58)

So the doc couldn’t defend himself in death.
 
Gosh hope the wife didn’t have to foot some of the bill
 
There was a recent outpatient Gi death I know personally in mid Atlantic. MD only. Healthy screening colonoscopy. Stuff happens.

Scary to have it happen. Always be diligent.
 
aneftp said:
There was a recent outpatient Gi death I know personally in mid Atlantic. MD only. Healthy screening colonoscopy. Stuff happens.

Scary to have it happen. Always be diligent.
Click to expand...
Supervising a whole bunch of CRNAs or something?? Or Physcian doing the case.
Something similar happened to me on my own case. End of case patient tanked during colonoscopy. Had to do CPR one round. Got her back quickly. Turns out she had some PEs but did OK till scope was Over.
Whatever the case it was handled quickly.
 
makemoney2024 said:
Supervising a whole bunch of CRNAs or something?? Or Physcian doing the case.
Something similar happened to me on my own case. End of case patient tanked during colonoscopy. Had to do CPR one round. Got her back quickly. Turns out she had some PEs but did OK till scope was Over.
Whatever the case it was handled quickly.
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It was MD only anesthesia.

In my vast experience more things go wrong with colonoscopies than egd.
 
What about the crna? What were the damages against them? I’ve heard rumors that the dr was running 7 rooms for ver some distance. I really wish the press would cover things like this… and the Modesto situation. In this day of Information it’s frustrating when the press doesn’t use their power for some good… where are the patient advocates now?
 
Plaintiffs offered to settle with the anesthesiologist and his group for 1mill each back in 2020.
They declined.

Plaintiff offered to settle with the GI doc for 2mill in 2021 and they reached some kind of agreement

Judgment made against the anesthesia group and the deceased anesthesiologists estate

So summing up,
The anesthesiologist can't be present in GI because he is not called in time and is 1:7 -> his fault
The anesthesiologist can't be present at trial because he is dead -> multimillion dollar judgment against his estate

There is nothing about the CRNA. I assume because he is "just a nurse" with low policy limits and a small estate.
 
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nimbus said:
Ugh it was an ERCP. We do our own cases and stopped doing MACs for those over 20 years ago. They should all be done with GA/ETT. If you’re supervising multiple CRNAs, that’s even more reason to insist on a endotracheal tube. This mishap was completely preventable.
Click to expand...
Let me get this right…. It was a semi prone (swimming position ?) ercp without a tube.
What in the actual ****
 
caligas said:

Could a malpractice mega-verdict wipe you out?

In theory, yes. But in reality, doctors rarely lose their personal assets.
www.medicaleconomics.com www.medicaleconomics.com
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Most doctors assets are in protected 401k or similar

Homestead property.

Those that are taxable are held in trust.

My pain friend did get a crazy 3 million dollar judgment (non jury trial) that was appealed immediately. The judge error. Finally broken down to 1.5 million. 750k his Policy. 750k hospital.
 
amyl said:
Let me get this right…. It was a semi prone (swimming position ?) ercp without a tube.
What in the actual ****
Click to expand...
There are people out there doing this.

Hell, I did it for a while when I was fresh out of residency because that's what I was taught to do. Slick GI doc, a little ketafol, quick and (usually) easy.

No more. I've tubed 100% of them for 15+ years now.

Maybe, with certain patients, and a known good GI, and the anesthesiologist doing the case solo, you could argue it's not unreasonable. I don't see the point though.

Never in a billion years would I do that while directing or supervising. A separate issue is this guy was working 7:1 - that alone speaks volumes.

I don't really want to throw stones at a dead guy but the truth is that he was practicing in a way that most of us don't, because we consider it unsafe.
 
has anyone actually found documentation that he was 7/1 and that the patient wasn’t intubated? I believe it all happened that way but was looking for a verified source instead of hearsay on Reddit
 
With GI you just need to put your foot down. When I started at my current gig the practice was not only MAC for ERCP but they also wanted to do FOOD IMPACTIONS under MAC at bedside in the ED. the rationale being that if they are still in the ED it is the ED’s responsibility to discharge the patient, not the GI nurses. I kid you not. Being a brand new attending i went along for a couple of months until I got sick of putting my license on the line on a daily basis. Once I put my foot down they grumbled but went along. Once a few new anesthesia attendings were hired it just became standard practice to intubate them all.
 
This is for those peeps out there doing locums or thinking about these jobs, I've never been on the receiving end of something like this but have looked at cases for hiring: everymalpractice suit you're named in has to be disclosed for hiring, usually a committee of a few other people who know zilch about anesthesia. If you're looking for a job in the future, even if you're a stud anesthesiologist with experience this will be one big mark against you, this is the risk you take. Even if you're not found at fault it raises suspicion when there's other candidates. Every other person on that committee just sees a risk of a future lawsuit and having to pay out. This is what they see:

" (h) failed to properly monitor the CRNA who said defendant left in charge of the plaintiff decedent's airway management"

"failed to timely...(and) properly intubate the decedent following arrest"
 
amyl said:
has anyone actually found documentation that he was 7/1 and that the patient wasn’t intubated? I believe it all happened that way but was looking for a verified source instead of hearsay on Reddit
Click to expand...


Don’t know about the supervision ratio but this was in the complaint.



IMG_1962.jpeg
 
I looked up the patient who died. She’s kinda of chubby. At least bmi 33 or something like that. I could see how the patient desaturated quickly

The public doesn’t see chubby/fat patients in the way we see them.
 
amyl said:
has anyone actually found documentation that he was 7/1 and that the patient wasn’t intubated? I believe it all happened that way but was looking for a verified source instead of hearsay on Reddit
Click to expand...
I read a bunch of the court documents the patient most certainly wasn't intubated for the procedure. If he was 7:1 perhaps it would come out in his deposition. Sometimes depositions are uploaded to the court filings often they are not. The only uploaded deposition I can find is the GI expert witness which doesn't say much about the anesthetic.
 
nimbus said:
Don’t know about the supervision ratio but this was in the complaint.



View attachment 389176
Click to expand...
Wouldn’t put too much stock into that. It is standard legalese for the plaintiff to claim everything under the sun. No doubt they would claim that this doc is at fault for global warming and foreign wars if it would make them a dime. It is a plaintiffs complaint and is not really subject to reality.
 
pgg said:
There are people out there doing this.

Hell, I did it for a while when I was fresh out of residency because that's what I was taught to do. Slick GI doc, a little ketafol, quick and (usually) easy.

No more. I've tubed 100% of them for 15+ years now.

Maybe, with certain patients, and a known good GI, and the anesthesiologist doing the case solo, you could argue it's not unreasonable. I don't see the point though.

Never in a billion years would I do that while directing or supervising. A separate issue is this guy was working 7:1 - that alone speaks volumes.

I don't really want to throw stones at a dead guy but the truth is that he was practicing in a way that most of us don't, because we consider it unsafe.
Click to expand...

We do all of our own cases and I regularly used to do MAC for ERCPs. We did it that way throughout residency and I continued it into practice. Like most things we do, it's all about being selective in how you apply the tools you have at your disposal. If I'm working with one of my GI guys that I have known for 10+ years and it's a quick choledocholithiasis case that'll take him 10 minutes scope in to scope out, in a stable, normal body habitus patient, intubating them is unnecessary.

I don't see the point though.
Click to expand...

If you have a lineup of scopes, 5-10 minutes added onto each case to intubate, position the patient, extubate at the end, turnover the circuit, etc added onto each one leads to everyone getting home hours later. We have no swing shift, no relief, and we stay until the work is done. The point of doing MAC over GA in a particular case is the same reason why you probably don't preoxygenate every healthy patient for five minutes before induction - it's unnecessary in most cases and slows down your own day. However, if you have a bad looking airway in a morbidly obese patient, I can bet you will take your time to fill their FRC. Same thing here -if there is any concern either from the gastroenterologist side of things or the patient side of things, you intubate. Otherwise, MAC is a perfectly acceptable way of doing them.

I know you said you did it this way for years and one could argue it's not unreasonable so you know all this stuff, but I was just expanding on the reasons why you would choose to do it this way for those who have never done an ERCP under MAC before.
 
dannyboy1 said:
Wouldn’t put too much stock into that. It is standard legalese for the plaintiff to claim everything under the sun. No doubt they would claim that this doc is at fault for global warming and foreign wars if it would make them a dime. It is a plaintiffs complaint and is not really subject to reality.
Click to expand...


Not sure how they can claim a failure to timely and properly intubate if the patient was already intubated.
 
Urzuz said:
We do all of our own cases and I regularly used to do MAC for ERCPs. We did it that way throughout residency and I continued it into practice. Like most things we do, it's all about being selective in how you apply the tools you have at your disposal. If I'm working with one of my GI guys that I have known for 10+ years and it's a quick choledocholithiasis case that'll take him 10 minutes scope in to scope out, in a stable, normal body habitus patient, intubating them is unnecessary.



If you have a lineup of scopes, 5-10 minutes added onto each case to intubate, position the patient, extubate at the end, turnover the circuit, etc added onto each one leads to everyone getting home hours later. We have no swing shift, no relief, and we stay until the work is done. The point of doing MAC over GA in a particular case is the same reason why you probably don't preoxygenate every healthy patient for five minutes before induction - it's unnecessary in most cases and slows down your own day. However, if you have a bad looking airway in a morbidly obese patient, I can bet you will take your time to fill their FRC. Same thing here -if there is any concern either from the gastroenterologist side of things or the patient side of things, you intubate. Otherwise, MAC is a perfectly acceptable way of doing them.

I know you said you did it this way for years and one could argue it's not unreasonable so you know all this stuff, but I was just expanding on the reasons why you would choose to do it this way for those who have never done an ERCP under MAC before.
Click to expand...
I hear you but I've been surprised a couple too many times by ERCPs. Just don't feel like it's worth the stress or risk.

When I was ketafol'ing these people with an excellent GI doc it was a slick, fast thing of beauty. Felt good. I see the appeal. But even with him I had some sphincter clenchers that in retrospect just weren't necessary.


PreO2 + induction + tube = maybe 3 minutes

No opioids. Spontaneous ventilation after the succ wears off. Propofol TIVA.

Can usually extubate within 5 or 6 minutes of the scope coming out. Everyone's busy charting and rearranging furniture then anyway so this time doesn't slow the room.

No anesthesia machine, just a Mapleson circuit on wall O2. As easy to turn over as a nasal cannula. I didn't really like this arrangement when I first started this job, but it's sort of grown on me. It is pretty efficient. We have a machine we can wheel into that room if we think someone really needs a ventilator for it. Occasionally I do.

Anyway, it ain't 3 or 4 tubes for ERCPs keeping the endo salt mines going late. It's the GI goofballs that book a full day of elective stuff on their call days, knowing full well that there will be half a dozen inpatient EGDs and colos and ERCPs to get done at the end of the day.

You can bust your ass and take some risk to get those ERCPs done 20 or 30 minutes earlier in the day, maybe - but for what? So some GI wanker can get used to extra efficiency at the cost of my risk and my work? So he can slip in one more outpatient colonoscopy? Meh. We're already banging out 15 cases. I'm a team player, but I'm not on Team GI RVU.
 
pgg said:
I hear you but I've been surprised a couple too many times by ERCPs. Just don't feel like it's worth the stress or risk.

When I was ketafol'ing these people with an excellent GI doc it was a slick, fast thing of beauty. Felt good. I see the appeal. But even with him I had some sphincter clenchers that in retrospect just weren't necessary.


PreO2 + induction + tube = maybe 3 minutes

No opioids. Spontaneous ventilation after the succ wears off. Propofol TIVA.

Can usually extubate within 5 or 6 minutes of the scope coming out. Everyone's busy charting and rearranging furniture then anyway so this time doesn't slow the room.

No anesthesia machine, just a Mapleson circuit on wall O2. As easy to turn over as a nasal cannula. I didn't really like this arrangement when I first started this job, but it's sort of grown on me. It is pretty efficient. We have a machine we can wheel into that room if we think someone really needs a ventilator for it. Occasionally I do.

Anyway, it ain't 3 or 4 tubes for ERCPs keeping the endo salt mines going late. It's the GI goofballs that book a full day of elective stuff on their call days, knowing full well that there will be half a dozen inpatient EGDs and colos and ERCPs to get done at the end of the day.

You can bust your ass and take some risk to get those ERCPs done 20 or 30 minutes earlier in the day, maybe - but for what? So some GI wanker can get used to extra efficiency at the cost of my risk and my work? So he can slip in one more outpatient colonoscopy? Meh. We're already banging out 15 cases. I'm a team player, but I'm not on Team GI RVU.
Click to expand...

Agree with most of what you said!

One thing to clarify though - I don’t give an F what the GI wanker thinks or wants. I do what I think will give my patient the best outcome while also selfishly wanting to get the hell out of that GI suite ASAP.
 
The asa has not re released any new closed claims studies since 2006??
The vast majority of claims came from remote OR cases as we all are well aware.

Because video scopes has made airway management so much easier. I do not think the Asa feels the need to do such studies to make it known publicly

It’s rare to have an airway issue these days.

Im surprised the Gi doc didn’t get pulled into this lawsuit or gi doc settled before. Who knows if Gi doc refused to pull the scope out when airway issues came about.
 
aneftp said:
The asa has not re released any new closed claims studies since 2006??
The vast majority of claims came from remote OR cases as we all are well aware.

Because video scopes has made airway management so much easier. I do not think the Asa feels the need to do such studies to make it known publicly

It’s rare to have an airway issue these days.

Im surprised the Gi doc didn’t get pulled into this lawsuit or gi doc settled before. Who knows if Gi doc refused to pull the scope out when airway issues came about.
Click to expand...


Disproportionate number of claims nowadays involve nerve blocks too.

GI doc settled.

JOHNBROCHILL said:
Plaintiffs offered to settle with the anesthesiologist and his group for 1mill each back in 2020.
They declined.

Plaintiff offered to settle with the GI doc for 2mill in 2021 and they reached some kind of agreement

Judgment made against the anesthesia group and the deceased anesthesiologists estate

So summing up,
The anesthesiologist can't be present in GI because he is not called in time and is 1:7 -> his fault
The anesthesiologist can't be present at trial because he is dead -> multimillion dollar judgment against his estate

There is nothing about the CRNA. I assume because he is "just a nurse" with low policy limits and a small estate.
Click to expand...
 
aneftp said:
Most doctors assets are in protected 401k or similar

Homestead property.

Those that are taxable are held in trust.

My pain friend did get a crazy 3 million dollar judgment (non jury trial) that was appealed immediately. The judge error. Finally broken down to 1.5 million. 750k his Policy. 750k hospital.
Click to expand...
Unfortunately, there is precedence in the state of Connecticut for a law firm to seize personnel property including bank accounts and lien against house.

 
aneftp said:
I looked up the patient who died. She’s kinda of chubby. At least bmi 33 or something like that. I could see how the patient desaturated quickly

The public doesn’t see chubby/fat patients in the way we see them.
Click to expand...
No. Because obesity is normalized. Commenting on it any way shape or form and how this leads to any kind of health issues is considered “fat shaming”. It’s such Bull****.
 
aneftp said:
The asa has not re released any new closed claims studies since 2006??
The vast majority of claims came from remote OR cases as we all are well aware.

Because video scopes has made airway management so much easier. I do not think the Asa feels the need to do such studies to make it known publicly

It’s rare to have an airway issue these days.

Im surprised the Gi doc didn’t get pulled into this lawsuit or gi doc settled before. Who knows if Gi doc refused to pull the scope out when airway issues came about.
Click to expand...
Looks like the GI doc settled beforehand and the anesthesia group refused to settle based on the above.
 
nimbus said:
Not sure how they can claim a failure to timely and properly intubate if the patient was already intubated.
Click to expand...
Already intubated by whom? If the doc intubated the patient, then it still falls on him since the responsible nurse waited to intubate. It’s the CRNAs fault all day long but of course who gets the shaft???
Thank God I have found a locums practice where the CRNAs believe in teamwork and call for help in a timely fashion. But as a locums I have seen some scary things from some scary, incompetent, and most importantly egotistical CRNAs.
 
Urzuz said:
Agree with most of what you said!

One thing to clarify though - I don’t give an F what the GI wanker thinks or wants. I do what I think will give my patient the best outcome while also selfishly wanting to get the hell out of that GI suite ASAP.
Click to expand...
Me too.
Them: It’s a food bolus I will be in and out in two minutes. Are you sure we need a tube?? Come on!!!
Me: Yeah, they do. It’s my job to make sure nothing bad happens to them under anesthesia. I need to protect their airway you are working next to. Bye!!

And I walk away smiling. No Fs given.

Aging is so awesome!!!
 
jwk said:
Connecticut law only applies in Connecticut.
Click to expand...
Sure, but this case is in Connecticut. His estate could be responsible. This is a 15 million dollar verdict, if it is held up on appeal, his estate could be responsible.

I would just advise everyone to look up/speak to a lawyer on what their own state liability laws are, you can not assume your malpractice alone will always shield you from a verdict. Asset protection.
 
nimbus said:
Ugh it was an ERCP. We do our own cases and stopped doing MACs for those over 20 years ago. They should all be done with GA/ETT. If you’re supervising multiple CRNAs, that’s even more reason to insist on a endotracheal tube. This mishap was completely preventable.
Click to expand...
A few years back an adult attending anesthesiologist, who I don’t know, came into the room where I was doing a complex ERCP on a teen at the adult hospital to loudly and obnoxiously criticize my resident for intubating the patient and that is not how he taught him to do an ERCP, etc. He had no idea that I was in the room 5 feet away on the side behind the door. I opened with “who the F are you and why are you talking to my resident about MY anesthesia plan?” It went down hill from there.
I intubate them all, since day one as an attending. I think trying to do them with a MAC and natural airway is zero benefit with added risk. If the scope jockey doesn’t like it he can pound sand. Routine EGD, sure, unless you’re morbidly obese, etc. then you get the tube.
 
IlDestriero said:
A few years back an adult attending anesthesiologist, who I don’t know, came into the room where I was doing a complex ERCP on a teen at the adult hospital to loudly and obnoxiously criticize my resident for intubating the patient and that is not how he taught him to do an ERCP, etc. He had no idea that I was in the room 5 feet away on the side behind the door. I opened with “who the F are you and why are you talking to my resident about MY anesthesia plan?” It went down hill from there.
I intubate them all, since day one as an attending. I think trying to do them with a MAC and natural airway is zero benefit with added risk. If the scope jockey doesn’t like it he can pound sand. Routine EGD, sure, unless you’re morbidly obese, etc. then you get the tube.
Click to expand...


The only benefit might be a marginal increase in efficiency in exchange for more stress to me and more risk for the patient. Not worth it. I’d rather intubate and put my feet up. Thankfully all my partners and all our GIs are on board. It’s not even a topic of discussion where I work.
 
dA pilot said:
Sure, but this case is in Connecticut. His estate could be responsible. This is a 15 million dollar verdict, if it is held up on appeal, his estate could be responsible.

I would just advise everyone to look up/speak to a lawyer on what their own state liability laws are, you can not assume your malpractice alone will always shield you from a verdict. Asset protection.
Click to expand...
Not sure why you would think personal assets are not at risk. It is a judgement like any other. What can complicate matters is who has the right to agree to a settlement. The physician or the insurance company. From my understanding, if a settlement is offered and the insurance company advises the physician not to accept then the insurance company becomes liable for the full amount even in excess of policy limits. Or else the physician can sue the insurance companies attorney for legal malpractice for advising against the settlement. I could be wrong though….
 
makemoney2024 said:
Me too.
Them: It’s a food bolus I will be in and out in two minutes. Are you sure we need a tube?? Come on!!!
Me: Yeah, they do. It’s my job to make sure nothing bad happens to them under anesthesia. I need to protect their airway you are working next to. Bye!!

And I walk away smiling. No Fs given.

Aging is so awesome!!!
Click to expand...

30 minutes later while still picking at pieces of chicken
"I guess it was a good idea to tube this patient"
 

Envision Healthcare Acquires Connecticut Anesthesia Group

We represented the physician services division of Envision Healthcare Corporation (NYSE: EVHC) in its acquisition of the Connecticut-based Meriden-Wallingford Anesthesia Group. Terms of the transaction were not publicly disclosed. Envision Healthcare Corporation (NYSE: EVHC) is a leading...
www.bassberry.com www.bassberry.com


takeover before or after ?
 
From the lawsuit papers and the Reddit thread from someone who knew about the case, the anesthesiologist was staffing 7:1 and on the other side of the building. The CRNA named in the lawsuit claimed that he was left to take care of the airway himself and seems like blamed the anesthesiologist. If you are staffing 7:1 ratio and on the other side of the building far away, it is going to be challenging to run to the emergency, flip the patient over (since most ERCPs are done prone) and manage the airway. Who knows, maybe the anesthesiologist had another complex patient case where he couldn't leave to go to the ERCP emergency. Militant CRNAs who do whatever they want and ignore your requests, get into trouble or an emergency from their own anesthetic management, then when there is a lawsuit the militant CRNA claims innocence, that they are just a nurse under your supervision. Since CRNAs want to practice independently then they should practice independently and have their malpractice insurance cover any issues that occur. Most of these anesthesia practices where you are the supervising attending 4:1 to 7-8:1 and you are preop & PACU paperwork, signing the charts, the anesthesiologist is basically a liability sponge when militant CRNAs claim they are just a nurse after the fallout
 
IVdoc said:
From the lawsuit papers and the Reddit thread from someone who knew about the case, the anesthesiologist was staffing 7:1 and on the other side of the building. The CRNA named in the lawsuit claimed that he was left to take care of the airway himself and seems like blamed the anesthesiologist. If you are staffing 7:1 ratio and on the other side of the building far away, it is going to be challenging to run to the emergency, flip the patient over (since most ERCPs are done prone) and manage the airway. Who knows, maybe the anesthesiologist had another complex patient case where he couldn't leave to go to the ERCP emergency. Militant CRNAs who do whatever they want and ignore your requests, get into trouble or an emergency from their own anesthetic management, then when there is a lawsuit the militant CRNA claims innocence, that they are just a nurse under your supervision. Since CRNAs want to practice independently then they should practice independently and have their malpractice insurance cover any issues that occur. Most of these anesthesia practices where you are the supervising attending 4:1 to 7-8:1 and you are preop & PACU paperwork, signing the charts, the anesthesiologist is basically a liability sponge when militant CRNAs claim they are just a nurse after the fallout
Click to expand...
Luckily I am in a practice now where CRNAs are competent and believe in teamwork even in an independent state. Some do go to the little hospitals out in the country and practice independently. Places that have one or two ORs but our shop they play nice in the sand box.
All these militant CRNAs who love to be independent why the hell don’t they go out and be independent? Because so far, credentialing won’t allow it at most hospitals and admin hasn’t pushed back enough. There are places I am sure where they have got rid of us and replaced us with CRNAs but then you hear of bad outcomes and admin tucks their tails in and begs for docs back. They better pay a premium for that mess up.
I have worked w militant CRNAs for a brief locums assignment and it was downright dangerous. People were dying but in a small town it’s easy to cover up or make it par for the course. I did two weeks there and jumped ship because CRNAs were calling each other for help and ordering the nurses to do stuff without letting us know when bad **** was happening. These militant CRNAs bully the circulators into not calling for help and many RNs of course want to support their fellow RNs. Horrible practice and will never go back. And this is in a non independent state.

Lastly why the hell did the CRNA not start any ACLS on their own as they waited for help?? Because this is some BS.
 
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