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Airman Loses Legs in Botched Gallbladder Surgery, Future of Career Uncertain
Monday, July 20, 2009

A Texas Airman stationed at an Air Force Base near Sacramento, Calif. has lost both legs after surgeons reportedly botched a routine surgery to remove his gallbladder.

Colton Read, 20, underwent laproscopic surgery last week at David Grant Medical Center at Travis Air Force Base near Sacramento. Laproscopic surgery is a minimally invasive procedure that involves making a tiny incision to minimize pain and speed recovery time.

About an hour into the surgery, something went wrong. Read's wife Jessica told CBS11TV.com.

"A nurse runs out, 'we need blood now' and she rounds the corner and my gut feelings is 'oh my God, is that my husband?'" Jessica Read said. Read's wife said an Air Force general surgeon mistakenly cut her husband's aortic valve, which supplies blood to the heart, but waited hours to transport Colton Read to a state hospital with a vascular surgeon.

Read, who is still in intensive care, lost both legs as a result of the blood loss. Meanwhile, his gallbladder still has not been removed. Jessica Read said the doctor admitted his mistake, but under federal law the Reads cannot sue.

The future of Colton Read's career is now uncertain, FOX 40 in Sacramento reported.

Jessica Read told FOX 40 she is appalled that the Air Force is even considering medical retirement or medical discharge while Airman Read is incapable of making any type of decision. She said he is not 100 percent lucid and is still heavily medicated.

The Air Force is conducting a review of the case using outside experts.
http://www.foxnews.com/story/0,2933,534050,00.html?loomia_ow=t0:s0:a16:g2:r5:c0.068707:b26547162:z0
 

notdeadyet

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This is not a good news report for those fighting the bill in congress right now to end the Feres Doctrine.

It's tough to make a pitch for why folks shouldn't be able to sue military doctors when the other side wheels out a 20 year old and explains that for the military doctor screw-up costing his legs, he'll receive $800/month for the rest of his life.

Sad case for the kid regardless. He has my condolences...
 

Ziehl-Neelsen

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The Fort-Worth paper says the surgeon cut "the aortic artery."

I'm not a surgeon, but I remember more than a few lap-choles from medical school. What were the surgeons doing that close to the aorta?
 

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Bad things can happen in surgery. I wasn't there, but a trocar into the aorta is a sure fire way to lose a lot of blood. Unclear why he got his legs amp'd. Saw plenty of cold feet on vascular and didn't lose any feet. Just the old diabetic ones.
 

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My only question is: If you're doing abdominal laparoscopic surgery, how the #$%^ do you end up in the thoracic cavity?
It was the abdominal aorta. They might've clamped it to prevent further blood loss, thereby cutting off flow to his legs.
 

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...routine surgery to remove his gallbladder...surgeon mistakenly cut her husband's aortic valve, which supplies blood to the heart,
This is a tragic story in every way. As a slight aside, she may be able to sue the military for loss of consortium (Feres doctrine only prevents the service member themselves from suing to my understanding)

But as a WAY aside: read the above quote. That is some seriously distorted anatomy if his aortic valve lives in his abdomen and it supplies blood to the heart. I've seen some FUBARd hearts, but that would be a first! (yeah, I know, it's a seriously distorted understanding of anatomy, but it is amusingly stupid on the article writer's part)
 

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This is a tragic story in every way. As a slight aside, she may be able to sue the military for loss of consortium (Feres doctrine only prevents the service member themselves from suing to my understanding)

But as a WAY aside: read the above quote. That is some seriously distorted anatomy if his aortic valve lives in his abdomen and it supplies blood to the heart. I've seen some FUBARd hearts, but that would be a first! (yeah, I know, it's a seriously distorted understanding of anatomy, but it is amusingly stupid on the article writer's part)
It was the wife who was quoted and I think she misheard.
 

AF M4

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This is not a good news report for those fighting the bill in congress right now to end the Feres Doctrine.

It's tough to make a pitch for why folks shouldn't be able to sue military doctors when the other side wheels out a 20 year old and explains that for the military doctor screw-up costing his legs, he'll receive $800/month for the rest of his life.

Sad case for the kid regardless. He has my condolences...
This really sucks, and it shouldn't happen to anyone.

And I can understand why those who suffer injuries such as this would feel that the Feres Doctrine robs them of their chance for compensation.

However, if the Feres Doctrine had been repealed prior to the above case, would that have prevented this injury? Probably not. Similar incidents happen all too often in the civilian world, and suing for medical malpractice happens all the time.

Furthermore, the Feres Doctrine itself isn't just something that protects medical professionals. Here's the summation line of the doctrine itself:

"The United States is not liable under the Federal Tort Claims Act for injuries to members of the armed forces sustained while on active duty and not on furlough and resulting from the negligence of others in the armed forces."

http://supreme.justia.com/us/340/135/case.html

So as you can see, repealing the Feres Doctrine doesn't just expose military physicians to lawsuits. It exposes everyone in the military - every drill instructor, SERE instructor, line commander and cook, along with the United States government - to endless reams of litigation. Slip on the mildew in the shower at boot camp? You can sue. Cook undercooks the eggs on a submarine? The crew can sue the US Navy for damages. Line commander makes you run PT while on a profile saying that you shouldn't and your knee starts barking? You can sue the Army.

I admit that the gold rush would be something to see, but I doubt that it's going to happen.
 

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Remember a bad outcome does not equal bad medicine or negligence.

It is important to be careful making conclusions on quality of care based on a potentially isolated outcome. A reasonable guess (as I know nothing other than what is on this site about the case) as to how this played out was - trochar hits aorta - this does happen (fortunately rarely), massive bleeding ensues, surgery has to be converted to open to control bleeding, during the delay the patient exsanguinates, and with no BP to work with while they are trying to get blood and give fluid, patient gets a pressor, that coupled with an aortic cross clamp leads to lower extremity ischemia, rhabdo, ultimately culminating in bilateral BKA's. Horrible no doubt but every surgery has the potential for the patient to die. Patients have died from a cataract replacement, septoplasties, arthroscopies, gastric bypass, C-sec, pretty much any surgery imaginable. - If you've been around long enough you see horrible disasters, some due to negligence others not.

If you are a medical student who thinks bad things wont happen to your patients despite your best attempts you are in for a very rough wakeup.
 

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Does the civilian in hyperlitigation lead to better medicine? No. It leads to defensive medicine and a lot of unnecessary procedures.

Does the military lack of litigation lead to worse medicine? I don't know. There have been a lot of investigative reports of military physicians who would have no business practicing anywhere outside the military, though.

Is there a happy medium? Probably.
However, if the Feres Doctrine had been repealed prior to the above case, would that have prevented this injury? Probably not. Similar incidents happen all too often in the civilian world, and suing for medical malpractice happens all the time.
The point of the lawsuits to prevent future occurrences is the viewpoint of the doctor. Compensation to help someone recover from an injury and still have a modicum of a life is the point of the lawsuit for the family.

Giving the kid $4,000/month instead of $800 month has nothing to do with preventing it. It's so that the airman doesn't spend his life in poverty because of a doctor's screw up.
 

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Furthermore, the Feres Doctrine itself isn't just something that protects medical professionals. Here's the summation line of the doctrine itself:
Yeah, it's intentionally wide-reaching. I don't think many folks want to repeal it unilaterally. But many feel allowing for folks to sue for damages in the case of proven negligence would be fair.
 

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Yeah, it's intentionally wide-reaching. I don't think many folks want to repeal it unilaterally. But many feel allowing for folks to sue for damages in the case of proven negligence would be fair.
Not really. One of the major points of the doctrine is that the US government and its representatives (in this case, military physicians) are in a unique position as far as accounts of negligence go. Meaning that they are required to do unique tasks under circumstances that have no civilian counterpart that is similar enough for effective comparison.

For instance, say that in the above case the problem was caused by one of the techs accidentally dropping an instrument into the surgical wound. In the civilian world, the surgeon is responsible for his team and its training, i.e. this kind of incident would still be his fault. In the military it's different - unlike civilians you can't pick who is assigned to you, and as soon as you have them trained up they're usually rotated somewhere else and you have to train up someone entirely different. And the military doc (given that he's not a contractor) can't just up and leave an undesirable situation whenever he wants.

So demanding the same culpability from both the civilian and military physician is not really fair. And showing that someone did something "proven negligent" makes for a few really obvious cases and a lot of really gray ones as described in the paragraph above.
 

notdeadyet

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Remember a bad outcome does not equal bad medicine or negligence.
Agreed.
It is important to be careful making conclusions on quality of care based on a potentially isolated outcome.
Do a google search and let me know if you really think it's isolated. I don't know whether or not these incidents are more or less rare in the military than in the civilian world, I just know the victims have a chance of recourse and compensation as civilians that they don't have as servicemen.
A reasonable guess (as I know nothing other than what is on this site about the case) as to how this played out was -
Plausible. But I think there's more to it than someone rapidly bleeding out on the table. Read this article, which is more recent and contains more detail:
http://www.dallasnews.com/sharedcontent/dws/news/localnews/stories/072109dnmetairman.3eaab38.html

(from article above, bold mine)
About an hour into the procedure, a nurse rushed from the operating room, yelling out that blood was needed immediately, Read's family said. Shortly after that, the anesthesiologist came out of the operating room and asked Read's wife, Jessica, what his blood type was. She was told complications had come up during surgery.

Two hours after the surgery started, doctors came out and told Jessica about the aorta and the subsequent blood loss. But minutes, then hours ticked away before it was determined that Read needed a specialist at a different hospital.

By the time Read had been transported to UC Davis Medical Center and started receiving treatment, nearly nine hours had elapsed, his family said. And by the next night, July 10, the bottom parts of both legs had been amputated.
(end quote)
If you are a medical student who thinks bad things wont happen to your patients despite your best attempts you are in for a very rough wakeup.
Absolutely. And if you as a military doc you don't see anything unusual in the description above, I'll hold on to my private insurance, thanks.

This article could be inaccurate. But it will never go to court, so we'll probably never know.

But no one in the operating suite knowing the patient's blood type? Knowing the patient was bleeding out and waiting 7 hours to transfer him to a facility with vascular specialists? UCDMC is a 15 minute chopper ride or 45 minute car ride from Travis. This kid came in 7 hours after the docs recognized their screw up and was finally sent to UCDMC in a very sorry state. Military medicine is not exactly getting a lot of positive spin around the halls of Davis right now.
 

notdeadyet

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Not really. One of the major points of the doctrine is that the US government and its representatives (in this case, military physicians) are in a unique position as far as accounts of negligence go. Meaning that they are required to do unique tasks under circumstances that have no civilian counterpart that is similar enough for effective comparison.
Sure. This makes total sense. The military physician who gets a soldier brought to him with shrapnel wounds can't be sued for the soldier dying of an infection or missing a small piece somewhere as he's traigeing. Check.
For instance, say that in the above case the problem was caused by one of the techs accidentally dropping an instrument into the surgical wound. In the civilian world, the surgeon is responsible for his team and its training, i.e. this kind of incident would still be his fault. In the military it's different - unlike civilians you can't pick who is assigned to you, and as soon as you have them trained up they're usually rotated somewhere else and you have to train up someone entirely different. And the military doc (given that he's not a contractor) can't just up and leave an undesirable situation whenever he wants.
Ah. Here's the rub: you're looking at the Feres Doctrine as protecting the military physician. That's incidental. The Feres Doctrine is for the protection of the U.S. government and U.S. military. It's protection of the physician is not the point.
So demanding the same culpability from both the civilian and military physician is not really fair. And showing that someone did something "proven negligent" makes for a few really obvious cases and a lot of really gray ones as described in the paragraph above.
I don't think folks want the Feres Doctrine modified to make the physician more culpable. They want it modified to make the military more culpable. I don't see anyone gunning to sue the physician privately for damages. They want the ability to sue the military.

There are ways to do this logically. Apply some accountability to the military for the care it provides, with a lot of obvious loopholes: combat or even any non-U.S. facility.

Military medicine has a lot of unique factors that prohibit it from being judged exactly the same way as civilian medicine. But a laproscopic cholecystectomy at a base like Travis? The "bombs were going off" card can't be played.

I don't think we can ethically say, well, the military is just "different" and folks will die from a lot of routine surgeries that they wouldn't in civilian world because of inadequate training, or inadequate caseload, or rotating staff, or _______. If things are really in such straits that we view a cholecystectomy as a high risk surgery that because of the way milmed is set up, we need to make changes.
 

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Two hours after the surgery started, doctors came out and told Jessica about the aorta and the subsequent blood loss. But minutes, then hours ticked away before it was determined that Read needed a specialist at a different hospital.

By the time Read had been transported to UC Davis Medical Center and started receiving treatment, nearly nine hours had elapsed, his family said. And by the next night, July 10, the bottom parts of both legs had been amputated.
(end quote)

Absolutely. And if you as a military doc you don't see anything unusual in the description above, I'll hold on to my private insurance, thanks.

This article could be inaccurate. But it will never go to court, so we'll probably never know.

But no one in the operating suite knowing the patient's blood type? Knowing the patient was bleeding out and waiting 7 hours to transfer him to a facility with vascular specialists? UCDMC is a 15 minute chopper ride or 45 minute car ride from Travis. This kid came in 7 hours after the docs recognized their screw up and was finally sent to UCDMC in a very sorry state. Military medicine is not exactly getting a lot of positive spin around the halls of Davis right now.
A couple of points -
1- you don't transfer a patient in extremis - it is bad practice, and the sending doc is liable if he dies enroute. The best place for that patient is the OR with a surgeon immediately patching the hole, something a general surgeon should be able to do.
2- I don't think it is common practice to type and screen prior to a laparoscopy. So his blood type might not be known but is stupid for the anesthesiologist to ask anyway since if he was in that bad of shape you'd give type O blood as you would in trauma
3. I'll tell you in a resuscitation hours can go by in an instant - So for 7 hours you are just trying to get the guy to the point where he will survive and is stable for transfer. Blood's going in, labs being sent, , more blood, drugs hung, more blood, FFP, some platelets, as David Grant doesn't do trauma I bet each step took what seemed like a lifetime.
4. I can assure you they recognized they were in trouble probably a few minutes into the case -
5. Lastly, this is the wife of a 20 year old, who is under extreme stress and likely is not very medically savvy who also has an axe (legitimate) to grind, so I wouldn't go to her for the facts of what really happened especially determinations of what was going on in the OR. Be assured her lawyer will spin it anyway possible for max new coverage regardless of fact.

Ultimately this is a horrible disaster. It will be investigated in spades, and unfortunately because of the media coverage there will be a desire to scapegoat someone regardless of negligence. The surgeon is in a really tough spot and for that I feel for him as well.

Parting shot, we have a million AD plus more family and retirees receiving care in the MHS - Spread over that many patients, surgeries and encounters you will always be able to point to some disaster. Whether that disaster is a reflection of the quality of care in the system you can't tell.
 
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Similar event I witnessed in the 80's in civilian hospital, just when lap chole's were getting started: surgeon put the trochar through a major vessel (probably aorta) and pt died on the table.
 

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A couple of points -
Good points all.

Though I'm surprised about #2. At the hospitals I rotated at, the type and screen were noted on records for all surgical cases, laproscopic or not. And I agree that you'd give O before you'd take the word of a frightened spouse.
Ultimately this is a horrible disaster. It will be investigated in spades, and unfortunately because of the media coverage there will be a desire to scapegoat someone regardless of negligence.
This case isn't getting the press it's getting due to the negligence. It's getting the press it's getting because the family has no recourse for the negligence.

The scapegoat is more a result of the Feres Doctrine than anything. If this happened at Kaiser, you'd get a small blurb on some paper. The story isn't the bad outcome of the surgery, it's the fact you have a family left in the lurch with no recourse.
The surgeon is in a really tough spot and for that I feel for him as well.
Me too. Even if it's directly attributable to a collosal mistake he made, you have to feel for the guy. We're all a couple of bad decisions + bad luck away from having a nightmare day ourselves. Hope the military looks out for him and doesn't toss him under the bus. Very curious to see which way they go.
 

AF M4

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Sure. This makes total sense. The military physician who gets a soldier brought to him with shrapnel wounds can't be sued for the soldier dying of an infection or missing a small piece somewhere as he's traigeing. Check.

Ah. Here's the rub: you're looking at the Feres Doctrine as protecting the military physician. That's incidental. The Feres Doctrine is for the protection of the U.S. government and U.S. military. It's protection of the physician is not the point.

I don't think folks want the Feres Doctrine modified to make the physician more culpable. They want it modified to make the military more culpable. I don't see anyone gunning to sue the physician privately for damages. They want the ability to sue the military.

There are ways to do this logically. Apply some accountability to the military for the care it provides, with a lot of obvious loopholes: combat or even any non-U.S. facility.

Military medicine has a lot of unique factors that prohibit it from being judged exactly the same way as civilian medicine. But a laproscopic cholecystectomy at a base like Travis? The "bombs were going off" card can't be played.

I don't think we can ethically say, well, the military is just "different" and folks will die from a lot of routine surgeries that they wouldn't in civilian world because of inadequate training, or inadequate caseload, or rotating staff, or _______. If things are really in such straits that we view a cholecystectomy as a high risk surgery that because of the way milmed is set up, we need to make changes.
I see what you are saying, and I agree with the concept. I would like the family to have some sort of recourse beyond what is currently available to them.

I've also been an active duty doc in the military for more than a year now. Quite frankly, a lot of things need to change. There's an analogy to invoke here about forest fires destroying the deadwood and being good for the forest in the long run, but I'd also prefer not to be present for the blaze. My experiences with military admin has given me no indication that they'd have the capacity to handle something like this even-handedly. I'm pretty sure that all they'd be able to muster is the knee-jerk reaction, which from what I've seen is always "blame the doc." And as has been discussed at length on this forum before, the military medicine system as a whole is defective. The doc does have some responsibility yes, but the environment that he is forced to practice in is one that foments the likelihood of errors occurring.

For instance, at my base right now (and others too I've heard), AHLTA has gotten so chock-ful of junk that it's randomly dumping data from patients' charts. Luckily my clinic prints everything off, but I saw some patients today whose electronic charts are missing notes, consults, labs and so forth. It's all just poof! and gone, never to be seen again. But the docs are still expected to see the full load and function at the same level despite the hurdles placed in their way by an incompetent system.

So I suppose that's my main objection. Milmed admin has shown no compunction in the past about throwing their providers under the bus, and at times seem eager to do so at the first opportunity. With that in mind the idea of repealing or altering the Feres Doctrine makes me queasy because I don't trust the people in charge to think things through. I think that they'll simply slap milmed docs with the same liabilities as their civilian counterparts, blow off improving the milmed system, and tell the docs to go suck eggs when we ask for increased salaries to cover malpractice premiums.

So again I agree with your points conceptually; I simply don't think that the ideas would be implemented in any reasonable way.
 

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Good points all.

Though I'm surprised about #2. At the hospitals I rotated at, the type and screen were noted on records for all surgical cases, laproscopic or not. And I agree that you'd give O before you'd take the word of a frightened spouse.

. . . . .

Me too. Even if it's directly attributable to a collosal mistake he made, you have to feel for the guy. We're all a couple of bad decisions + bad luck away from having a nightmare day ourselves. Hope the military looks out for him and doesn't toss him under the bus. Very curious to see which way they go.
Make no mistake, they are very well practiced at throwing practitioners under the bus. Whether you like it or not, there is always someone who will gather kindling and another who will find the matches. A sick and cruel kind of moralism makes it easy for some careerists to do this and feel justified about it afterwards.
 

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As a former surgeon at travis, I am surprised these sentinel events don't happen more often.
while I was there... a 27 yr old healthy man died getting shoulder surgery- blamed on ephedra

there was the airway mishap on the 30 yr old appendectomy healthy male
and another airway issue resulting in calamity by the same nurse anesthetist

a 5 year old died post op from Tonsillectomy

the whole system there is so incredibly broken....

morale has been low for years...
it is all about promotions, blame shifting, and responsibility dodging...
the emphasis is rarely on the right things.
there is no team work...

nobody wants to consult on other doctor's patients
 

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start thinking iatrogenic aortic dissection and delay to restore blood flow to distal extremeties
 

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Well, instead of morbidity details, what kind of effects are you thinking?
 

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No, jeez. Well when you exclaim you have details, it's almost like you want to divulge. I thought you might have a public (media) source.
I've seen public sources that aren't missing a lot of significant details. Like other similar cases, I've been sworn to secrecy by my source. So quit PMing me everyone!

AF Med is a pretty small community. With an investigation this big I'm surprised most of you active duty AF guys don't have someone from your hospital involved in it or don't know someone at Travis. Something like this doesn't stay secret for long.
 

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Everyone is quick to demonize the surgeon but I want to know more about what happened. Maybe the surgeon just got back from a 13 month deployment where he did nothing and was rusty. Maybe he was a subspecialist who was ordered to do the surgery due to short staffing. I'm curious how many surgeons were at Travis and what was the workload like?
 

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Is this something that would be reported in the national media if it happened at a civilian hospital to a non-service member?
I was going to say no, but wasn't there a big broohaha over amputating the wrong leg a few years back?

Not quite the same, but a big screw up in a civ hospital on a civ patient.
 

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I've seen public sources that aren't missing a lot of significant details. Like other similar cases, I've been sworn to secrecy by my source. So quit PMing me everyone!

AF Med is a pretty small community. With an investigation this big I'm surprised most of you active duty AF guys don't have someone from your hospital involved in it or don't know someone at Travis. Something like this doesn't stay secret for long.
The family's website has posted a complete timeline of the day's tragic events.

http://www.coltonread.com/coltons-story.html

There is currently a bill in Senate subcommittee that would repeal the medical malpractice restrictions for military medical providers. Essentially, military physicians would have to carry malpractice insurance and could get sued like everyone else.

Meaning that most bases could no longer offer medical care, since doctors, PAs and nurse practitioners simply couldn't afford to practice. I looked it up, and the malpractice premiums for me would consume most of my paycheck, and those are the ones with a huge deductible. If they repealed the Feres Doctrine and the military didn't foot the bill for malpractice insurance, then military physicians - especially GMOs - literally couldn't afford to work.
 

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I've seen public sources that aren't missing a lot of significant details. Like other similar cases, I've been sworn to secrecy by my source. So quit PMing me everyone!

AF Med is a pretty small community. With an investigation this big I'm surprised most of you active duty AF guys don't have someone from your hospital involved in it or don't know someone at Travis. Something like this doesn't stay secret for long.
Come on bro, you started it with your "I know a secret" post. What response did you expect?

If AD members are ultimately allowed to sue, it will create real challenges in everyday practice (med boards, deployment avoiders, etc). But, malpractice won't be an issue. DoD already covers malpractice for military physicians and most of our patients already can sue.
 

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Is this something that would be reported in the national media if it happened at a civilian hospital to a non-service member?
I think it would get a couple column inches and be quickly forgotten. It's not the medical error that makes it so compelling, it's the human aspect to it. You have a serviceman trying to serve his country who loses both legs due to a medical error that happened on a military base; but the serviceman has no recourse for compensation and will be limited to about $800/month for the rest of his life.

I think that's what's keeping the story talked about. The medical error isn't very interesting to John Q. Public. The thought of a vet scrounging for work with the government turning his back on it tugs folks' heartstrings.
 

AF M4

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I think that's what's keeping the story talked about. The medical error isn't very interesting to John Q. Public. The thought of a vet scrounging for work with the government turning his back on it tugs folks' heartstrings.

Hmm. They certainly shouldn't write him off too quickly - he's trained in intel, and I know of several jobs where the medical standards would not limit him and he could stay on active duty in a nondeployable billet, still get paid the standard enlisted salaries all the way up through the ranks until he retires, at which point he would receive VA benefits and still do his previous job for a higher salary in the civilian world in addition to having his retirement pay. All this while having access to physical rehabilitation centers that could be civilian if he prefers. None of this would be particularly difficult or unusual to do, and I actually know of soldiers who have been injured by IEDs who have gone on to accomplish these things. That scenario certainly sounds a lot better than what I've heard the family being told.

I can certainly see why the family is very confused and upset about his future - from what I hear they've had five or six people trying to do everything from medically retire him immediately while he's still in the ICU to start teeing up his $1600/month disability and booting him out the door as soon as he recovers. I'd be ready to tar and feather someone too.

Whoever's running the administrative portion of this thing should be fired, and they need to find someone who has the sensitivity/compassion/brains to not start shoving disability papers down the family's throat while their loved one is still in surgery.
 

Gastrapathy

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Whoever's running the administrative portion of this thing should be fired, and they need to find someone who has the sensitivity/compassion/brains to not start shoving disability papers down the family's throat while their loved one is still in surgery.
So simple from the armchair.

Although this is no longer true (and recently so), it used to be that benefits were better if you retired someone before they died. Anyone who's been around for any length of time has heard stories of doctors staying on the phone for hours trying to retire a critically ill patient. I even remember a code that wasn't called until this was accomplished.

Would it have been more sensitive to wait and cost those families money?

Since no one here knows whats going on (or is dumb enough to acknowledge that they do), maybe you should back off a little. Families ask questions, people try to answer them. If I were asked if this airman was going to be medically retired, an honest answer is "almost certainly." Should I lie to them or "shove disability papers down their throat?"

I work in a specialty that is likely to harm people on occasion. If you don't do procedures for a living, its really easy to get all indignant when bad things happen. From my glass house, I feel bad for the patient and for the doctor. Whether someone should be fired, as you propose, is not something you or I have any perspective to assess. Next time you get a pimp question wrong, make an error on a note, piss off a patient's family on accident, ask yourself if you should be fired. Administrators are an easy target for anger for the family, no matter how well they handle a situation.
 

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So simple from the armchair.

Although this is no longer true (and recently so), it used to be that benefits were better if you retired someone before they died. Anyone who's been around for any length of time has heard stories of doctors staying on the phone for hours trying to retire a critically ill patient. I even remember a code that wasn't called until this was accomplished.

Would it have been more sensitive to wait and cost those families money?

Since no one here knows whats going on (or is dumb enough to acknowledge that they do), maybe you should back off a little. Families ask questions, people try to answer them. If I were asked if this airman was going to be medically retired, an honest answer is "almost certainly." Should I lie to them or "shove disability papers down their throat?"

I work in a specialty that is likely to harm people on occasion. If you don't do procedures for a living, its really easy to get all indignant when bad things happen. From my glass house, I feel bad for the patient and for the doctor. Whether someone should be fired, as you propose, is not something you or I have any perspective to assess. Next time you get a pimp question wrong, make an error on a note, piss off a patient's family on accident, ask yourself if you should be fired. Administrators are an easy target for anger for the family, no matter how well they handle a situation.
Certainly, I do not have the perspective to see the entire situation clearly. The only perspective available is that of the family, which has been posting its perspective online. The intent of the admin was almost certainly different from the impression that the family has apparently received, but the family does still have the impression that the AF tried to boot a sick airman out the door shortly after he was injured at an AF facility, and the only thing that stopped them was the family bringing on the media coverage. Good intentions gone awry or not, this is still a bad result and no amount of perspective can change that.

And no, it would not have been more sensitive to wait and cost a dying patient's family more money by waiting to file the papers. That is ridiculous. However, it WOULD be more sensitive to tell the family exactly what you were doing and why you were doing it. That is what I am getting at and why I am being critical of the admin - there are things you have do or look at doing such as medical retirement and disability, but there are also ways of going about doing them that respect and involve the family, i.e. spelling out the different paths and ramifications of each one.
 

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So, basically, you're saying you don't know the true situation, but, who cares, might as well suggest that someone should lose their job. OK. Hopefully the people who make those decisions will be less capricious if you ever end up in a bad spot.
 

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i operated at Travis for 5 years.
I can tell you a few things ... getting blood in a hurry is unlikely to happen.
we were all bewildered by this and it seemed unfixable.

in fact, nobody cared about fixing problems per se... they were more interested in glossing over the issues to pass JCAHO.. If JCAHO really new how things ran they would never have passed us... it was a giant facade.

i remember being told I could not have a suture cart in the OR... a nurse would have to leave the OR each time I needed a random or unforseen suture
transferring a patient- I am sure this took a lot longer than it should have.
there was no accountabilty into having the right equipment in the room. If you yelled about it you just got in trouble...

getting people to move and do things is exceedingly frustrating.

if you think about it... what is an AF general surgeon real purpose? To treat trauma in a wartime situation. Then ask, would you be safer being stabbed in the abdomen walking around in green zone, iraq or OR room #4 at DGMC?
What does that tell you about readiness?
 

The White Coat Investor

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Come on bro, you started it with your "I know a secret" post. What response did you expect?

If AD members are ultimately allowed to sue, it will create real challenges in everyday practice (med boards, deployment avoiders, etc). But, malpractice won't be an issue. DoD already covers malpractice for military physicians and most of our patients already can sue.
Yea, sorry about that. In between my first post and the one you cited my source came back and said basically that on further reflection they shouldn't have told me what they did and asked me to keep it a secret. I told the person I would. So I am. But after searching the internet about it, most of what I learned from the "source" is already out there.
 

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Does anyone recall this PowerPoint about Air Force surgery that Galo(?) posted a while back:
http://www.medicalcorpse.com/Apoptosis lecture.ppt

I wonder if the PowerPoint is relevant to the recent situation.

I know it seemed like in psychiatry the Navy was cutting and cutting and it seemed like there was a point where things got cut too far. The senior staffers would say at meeting that Navy psychiatrists were "redlined". I really think they need to facilitate a climate of retention and things will improve rapidly.
 

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So, basically, you're saying you don't know the true situation, but, who cares, might as well suggest that someone should lose their job. OK. Hopefully the people who make those decisions will be less capricious if you ever end up in a bad spot.
Mmm, hope so. You've got an interesting read on the whole situation. What do you think needs to happen for someone to get fired? I mean, you've got a major medical mistake embarrassing the AF that's being blasted across the evening news. SOMEONE'S head has to roll.

Compare this to the time that a load of live nukes was accidentally flown across the nation's heartland. Different setting but same type of situation - a huge mistake arose because human beings were stuck working in an environment that foments mistakes and then a mistake happened. Heads rolled then and although few people know exactly what happened, I think that we can all agree that someone deserved the guillotine because, y'know, nuclear weapons were accidentally flown across the country. This airman lost his legs in a routine surgery and then someone freaked out his family enough that they called in the national media.

Someone's head has to roll in this mess, and it's either going to be the doc's or the admin's. I've worked with plenty of surgeons and I know that mistakes can happen even in the best of situations, and it sounds like Travis is far from the best. So I tend to be more forgiving of the doc. Which leaves admin, both for not handling the immediate situation more delicately and for allowing a poor working environment that makes situations like this more likely to exist. How is that capricious?
 

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Someone's head has to roll in this mess, and it's either going to be the doc's or the admin's. I've worked with plenty of surgeons and I know that mistakes can happen even in the best of situations, and it sounds like Travis is far from the best. So I tend to be more forgiving of the doc. Which leaves admin, both for not handling the immediate situation more delicately and for allowing a poor working environment that makes situations like this more likely to exist. How is that capricious?
I really think it is important for everyone to sit down and conduct a root cause analysis in a non-blaming way. Although its possible, I suspect the situation is a lot more complicated then a simple physician error. Wonder what all the factors in play were...
 

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I really think it is important for everyone to sit down and conduct a root cause analysis in a non-blaming way. Although its possible, I suspect the situation is a lot more complicated then a simple physician error. Wonder what all the factors in play were...
Certainly. As former military indicated, it sounds like there are a lot of things wrong with the general situation in the surgery department that led to this. In addition to things like not having blood readily accessible or the right equipment in the room, there have also been stories about residents being pushed far beyond the working hour limits and things of that nature that contribute to medical errors. When things like that are happening in a program or department, you have to look to the folks who run that department and ask (1) why things like that happen and (2) why they should be allowed to stay in charge when bad things happen on their watch.
 

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Certainly. As former military indicated, it sounds like there are a lot of things wrong with the general situation in the surgery department that led to this. In addition to things like not having blood readily accessible or the right equipment in the room, there have also been stories about residents being pushed far beyond the working hour limits and things of that nature that contribute to medical errors. When things like that are happening in a program or department, you have to look to the folks who run that department and ask (1) why things like that happen and (2) why they should be allowed to stay in charge when bad things happen on their watch.

The worst thing about this is that it has happened before, and until there is radical change, events like this will continue to happen. Just over 10 yrs ago, the pulitzer prize articles related sentinel events and the general mismanagement of military medicine that drives us to these forums to warn prospective physicians what military medicine is really like.

http://www.pulitzer.org/works/1998-National-Reporting


Now here you have a young surgeon who graduated med school in 2000, trained there at that program, and is listed as a pediatric surgeon, which puts her out of training and fellowship at max 2-3 yrs, and she makes one of the most horrific mistakes for what should be routine access for any general surgeon in this day and age, in a hospital that seemingly has no capacity to take care of such a terrible complication.

I hope that there are inquiries deeper than this single incident. Will this be the drop that spills the glass on military medicine? I doubt it. This young surgeon, and the patient are unlikely to have good outcomes, and it will be at the protection of some high ranking officers career as it always has, and likely will be till there is radical change. No doubt about it.

What was reported over a decade ago, seems not to have changed much, and publicity then did not make the change that was needed, why should it do it now?
 

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typically at travis, after an event like this (death in healthy patient under 30)... which as I said above aren't all that rare, the admin calls a safety day.

this means everyone gets to go in on a saturday at 730 a.m on their day off and listen to a few hours of a safety briefing, then have some breakout sessions to brainstorm... Of course, this is all BS spin... so the command can give the appearance of working on the problem...

so instead of going to your kid's soccer or baseball game you can listen to some command person that garners zero respect give you a lessen on communication, attention to detail, and problem solving.

There is a gigantic difference between what i can get the nurses and techs to do for me and the pacu and postop nurses and even the anesthesia to do for me as a surgeon outside of the military then what I could as a surgeon at Travis.

Remember the hospital commander, medical chief of staff, chief of surgery turn over ever 2-3 years. Their goal isn't to run that particular hospital. The goal is to make colonel or general and they know that means hopping ship soon for some other assignment. This crazy death situation isn't new. the only difference is that as more people become internet, message board, website friendly, civilian and military people get more of the story and it is more widely talked about. It is harder to sweep under the rug- like the other deaths at travis.

that is why I think "firing" one person or a few isn't going to work... the problem is... the command don't measure success by successful health care.. they measure it by managing their hospital money and numbers on a step to promotion. the next suit in is going to be just the same.
 

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There are a lot of sad stories in military medicine and civilian medicine, but does any one honestly think that allowing military members to sue the government is somehow going to change the care they get?

#1) I don't know a doctor (and I know a lot) who is motivated to provide better care by lawsuits. Yes we document better. Yes we order more tests. But I don't know anyone for whom the threat of lawsuits is a motivation to practice more carefully. People go into medicine to help people, not to hurt them.

#2) Why would a suit against the government affect the way a military doc practices? It doesn't cost a military doctor anything. He can get reported to the database with or without a suit.

#3) These are all mostly a case of someone trying to capitalize on a bad event happening. Well, I lost my legs. Might as well try to make a couple mil off it. The money isn't going to give him his legs back. It isn't going to make this less likely to happen to the next guy. All it is going to do is give the family some money. While I suppose that's nice to have, why would we give someone who died in the OR more money than someone who died on the street in Baghdad?