Anesthesiologist behaving badly

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Blockit said:
I am going to engage in rampant speculation here. I don’t know anybody in Texas. I’ve never practiced there. But let me present a hypothetical situation that could easily be the truth based on my time as an anesthesiologist.
“Why do they ask these questions if they aren’t going to pay attention to the answers“
“How could he have gotten credentialed?”

So it appears that Dr. O is 60 years old or so. Not boarded (red flag) Has been convicted in the past of domestic abuse (red flag) as well as cruelty to an animal (red flag). He has a disciplinary history with the Texas board (red flag).
Quite frankly, he sounds like a sociopath.
But he is practicing at the surgery center. With all these red flags, how? I will tell you how, he had protectors. Maybe it was some CEO or administrator. More likely I think it was a couple of surgeon buddies that he made through the years, possibly fellow sociopaths. These surgeon buddies would likely be significant moneymakers for the surgery center. Every time his past has been brought up or reviewed at the surgery center executive committee, he has skated likely because of the protection of these buddies of his. Maybe they shouted down any objectors with threats of taking their cases elsewhere. Maybe there were no objectors because the other people on that executive committee were weak or lacking in ethics. People who are weak and lacking in ethics are rampant in medicine.

Now why would Dr. O suddenly decide to start surreptitiously spiking IV bags with bupivacaine?? At the same surgery center where he works? My guess would be that the investigation around this recent Texas medical board case involving him awoke new objections from younger members of the surgery center medical staff. Maybe his surgeon buddies finally tired of his incompetence. Maybe one or two of them actually retired, leaving poor Dr. O to fend for himself. So what does a sociopath do when the wolves are at the gate and their livelihood is endangered? He smashes the entire thing.
From what I have read in the comments on this thread it sounds like it has been an open secret in the North Texas Anesthesia Community that there’s an anesthesiologist injuring and killing people. Or maybe it wasn’t that specific, maybe it was more that everyone knew that there was some sort of horrifying problem going on at that particular surgery center.
Guess who didn’t know? The patients.
Thank God there is a free press in this country to dig into stuff like this. Because from what it sounds like, no one else with the actual responsibility to deal with this has actually done their job.

Again, I present a hypothetical situation. I have no actual knowledge of any of the details of this situation other than what I have read from the same Internet sources that everyone else reads.
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Now that I am munching on my popcorn and sipping the tea, how long has this been an open secret? You know, from your speculation? This is getting good. And yeah, I agree with you. He's a sociopath. Sadly there are alot of them in medicine.
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woopedazz said:
Please don't misconstrue this as victim blaming... But I can't imagine taking/being told to take a bag of IVT and cannulation equipment home... That's a proceed directly to the inpatient detox facility, do-not-pass-go scenario until any misuse is completely excluded.

Terrible this happened to her.
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I doubt she was told. She has been a practicing anesthesiologist for many years. She probably decided this on her own. I honestly did this in residency, have seen it done before and never until now, ever thought it was a big deal. Never would have been suspicious that the same bags we give to our patients would be harmful to me.
 
painstop said:
This all seems like speculation so hopefully we will get a follow up story with details of the investigation. Seems odd for a doc (even a shady one) to risk his livelihood 20 plus years into his career when he supposedly still has the contract with his CRNAs. Maybe this is something as stupid as the Surgericenter trying to make cheap bags of tumescent local for their plastics cases and the pharmacy tech or PA messed up on meds and labeling…who knows.
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These bags were not labeled as anything other than IVF bags from my understanding.
Narcisists make up 1% of the population. In high earning fields, even more. I want to say like 3%. I don't know about you but I have legit worked with sociopaths who don't give a rats ass about patients and only care about billing and/or how much money they can make off people's illness. These people have no empathy and can easily lash out and cause harm to others when stuff isn't going right in their lives.
 
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dipriMAN said:
Where I trained IVF for a coworker would not fly. I probably wouldn’t do it. I have an IV bag at home in case of emergency, but would take a real severe illness to have to use it, definitely not for mild dehydration.
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How do you know it was mild, this is just reporting. Could have been severe. And anyway, did you buy the bag from online?
 
I did it due to medicine that caused me severe GI issues. And it was overnight and on a weekend I think, where I didn't have to go to work.
But lets face it, in medicine how many of us actually can afford to call in sick when we are sick. Because our partners, the hospital make us feel like crap and Ors shut down. I am with you 100% and my family often wonders how this is allowed in medicine, but what do we do?
How many severe colds have you worked thru where you couldn't breathe, headache, lethargic but you pushed through? Or GI issues? Or pain of whatever?
This is medicine, and honey it can be toxic. The masochism is real and so are the expectations.

GravelRider said:
My point is that if you’re sick enough to need IV fluids then you shouldn’t be at work. I don’t even think that’s debatable. Would you want that person caring for your family member? I think it’s absolutely absurd the amount of people raising their hand saying they’ve given or received IV fluid in order to complete a shift. In my mind that person is no different than someone who has had a couple drinks before coming in to do a case. The machoism in medicine gets really stupid at times.
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Arantius said:
WOW. When I was in residency I heard about an anesthesiologist who intentionally gave patients LAST so he would look like a hero to save them with intralipid... think this is the same? OR is he a homicidal maniac?!
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The rumor at my old job was that there was a doc who did something similar and liked to play the hero. Every case became complicated, every patient had some intervention and that person stepped in to save the day. Apparently it was this strange set of circumstances and overall poor clinical skills that led this person to get fired.
 
nimbus said:
We’re MD only and we’ve had more than a few people call in sick last minute when they’re Covid+. Might be a precall (our calls start at 5pm) or postcall person, but we always find someone. Haven’t closed any rooms yet due to sick call. We are self insured so it’s a liability for us when we have sick people work.
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This is interesting. How was the call in rate before Covid?
 
chocomorsel said:
This is interesting. How was the call in rate before Covid?
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Good point. It was very low before, maybe a half dozen times/year among 20+ people. COVID probably affected our attitude toward calling in sick. We just had someone looking for coverage for her night call last night because she was feeling sick with a non-COVID URI. Someone else picked up her call. They swapped call nights and she is doing his call tonite. He probably wouldn’t have minded doing both nights because he didn’t work past 11pm last night and our calls are decently stipended.
 
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agammaglobulin said:
My take away (besides some people are F***ing crazy) - Use 10x 100ml individually wrapped bags if you need fluid at home. Much harder for your sociopath partner to get drugs into.

edit: another option - 100X 10ml flushes.
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I propose the particularly unorthodox method of “drinking a %{*~ing Gatorade”
 
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I agree with you. Physicians of all sorts should be able to take sick leave easily. However, that is not the world we live in and it's frowned upon unless one literally is in the ED trying to die. Very sad.
GravelRider said:
Let me pose a different question. Do you think it’s fair game for a lawyer to ask you during a malpractice case that occurred at 3am, how long you had been awake and working?



I don’t care the different scenarios that people come up with. I’m telling you that physician is impaired and cannot possibly be giving his or her full attention to patient care. Do you want a surgeon who has hyperemesis (or 50 other scenarios that require medical attention) to begin a neurosurgical procedure on you? Why do we sell ourselves short and say anesthesia is so easy that an impaired physician can do it.

Honestly, I think this discussion is bizarre. I wonder if you would be shrugging it off if you found out the anesthesiologist taking care of your mother or child was getting IV boluses in between cases to keep functioning. What would you do or say in that scenario?
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Maz777 said:
Sorry. It's delusional to think that all of your physicians are healthy each and every day. Unless you only hire genetically superior people that do not have children in school or are blessed without chronic medical conditions that may flare up. People work sick all the time. We aren't plug-and-play nurses who have the capacity to call out with every sniffle (or, for that matter, every Monday after a long weekend).
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This is one of the reasons that people get burn out and frustrated with their jobs. We aren't just talking the sniffles here. There needs to be an understanding that sometimes people have moderate acute illness that need a couple of days of hydration/NSAIDs/rest to improve instead of guilting people to work thru gastroenteritis, severe cold/flus, severe pain. We need to normalize that doctors also need sick days. Doesn't make us plug and play whatever the **** that means.
 
nimbus said:
You’re right, we get sick and call in sick. I never said we don’t get sick. But we have mechanisms in place when people inevitably call in sick or their kid is sick and they have no childcare, or someone needs to go to a funeral. I was out for 3 months last winter due to an unexpected illness. Lately we’ve had a lot of people call in due to Covid and we still cover everything. I can’t imagine a place that doesn’t.
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Lots of places run super lean and probably make tons more money than you mere mortal who thinks of these mundane things like illness.
LOL
 
Twiggidy said:
I will make this side comment even if it sounds like victim blaming.....

I wont start IVs or administer drugs to colleagues unless as said above, we're coding that colleague. This came to light when I was a resident in two situations. The most obvious, a surgeon pulled us aside because he saw a resident give another resident some IV zofran because he was feeling sick (I can confirm it was Zofran). He said we shouldn't be doing that because it was "a bad look" and in hindsight everyone thought about it and agreed. The next was an OB attending asked me to start an IV for her to get fluids when I was a resident and I just did it without think because, whatever, doing a nice thing to help an ill colleague. Thing is, if I leave the room, I have no idea what she's going to decide to put through that IV. Those were the lessons I learned.

If you're that sick, go to the ER where you'll get treated like a VIP, and get treated with nurses and ER physicians monitoring you. Back door treatments by anesthesiologists, as my surgical colleague implied, is not a good look.
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Very good point. But I bet some people can start their own IVs after taking the supplies home. Just a thought. You not wanting to be involved, super and smart for you. I can dig.
 
chocomorsel said:
Very good point. But I bet some people can start their own IVs after taking the supplies home. Just a thought. You not wanting to be involved, super and smart for you. I can dig.
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Yes. I'm basically getting at "don't be an unknowing accessory or enabler". If someone wants to do shady stuff on their own that's on them, but don't involve me.
 
chocomorsel said:
Well in this case, the wrapper was still on. And I have seen plenty of IVF without wrappers. Are wrappers standardized across all manufacturers?
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All of our IV bags are in wrappers and I have seen cases where there is "wetness" inside some of the bags. Maybe the sprung a random leak, but I can assure I didn't use that bag. I trust no one
 
chocomorsel said:
This is one of the reasons that people get burn out and frustrated with their jobs. We aren't just talking the sniffles here. There needs to be an understanding that sometimes people have moderate acute illness that need a couple of days of hydration/NSAIDs/rest to improve instead of guilting people to work thru gastroenteritis, severe cold/flus, severe pain. We need to normalize that doctors also need sick days. Doesn't make us plug and play whatever the **** that means.
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Good luck changing that at every practice. Wish you the best. Do you understand what the typical nurse call out rate is? My large multi-hospital system publishes the sick call rate daily. It was ~10% today. You think that would be sustainable with how most practices operate razor thin.
 
chocomorsel said:
Lots of places run super lean and probably make tons more money than you mere mortal who thinks of these mundane things like illness.
LOL
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Yeah I guess some places work precall and/or postcall. We use those people as occasional emergency manpower. If we have to work those positions too often, we tend to get grumpy.
 
nimbus said:
Yeah I guess some places work precall and/or postcall. We use those people as occasional emergency manpower. If we have to work those positions too often, we tend to get grumpy.
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Working pre-call gets people grumpy???
 
In most PP groups if you don't work you don't get paid. So if staying home for that runny nose is worth thousands of dollars a day, go ahead and stay home. I think that's a more powerful driver in most groups vs making another colleague pick up your shift. Conversely, if you are an employee and are given X number of sick days, NOT taking those sick days is working for free.

Personally, I think working (mildly) sick is about the same mental handicap as doing anything between 10pm and 6am on call.
 
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Maz777 said:
Good luck changing that at every practice. Wish you the best. Do you understand what the typical nurse call out rate is? My large multi-hospital system publishes the sick call rate daily. It was ~10% today. You think that would be sustainable with how most practices operate razor thin.
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I am not saying calling in for BS. The nurses are on the extreme end and we are on the other end. Somewhere in the middle is a good spot. Seems like @nimbus practice has it figured out.
Of course I don't think it would work in a lot of greedy ass practices that operate on skeleton crews all day everyday.
 
chocomorsel said:
I am not saying calling in for BS. The nurses are on the extreme end and we are on the other end. Somewhere in the middle is a good spot. Seems like @nimbus practice has it figured out.
Of course I don't think it would work in a lot of greedy ass practices that operate on skeleton crews all day everyday.
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It’s true that nobody works where I work for the big bucks 😂
 
agammaglobulin said:
In most PP groups if you don't work you don't get paid. So if staying home for that runny nose is worth thousands of dollars a day, go ahead and stay home. I think that's a more powerful driver in most groups vs making another colleague pick up your shift. Conversely, if you are an employee and are given X number of sick days, NOT taking those sick days is working for free.

Personally, I think working (mildly) sick is about the same mental handicap as doing anything between 10pm and 6am on call.
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And if you are skeleton crew how is someone to find a partner/associate to cover for them?
 
Part of being a good partner is not dumping on your partners - I think we need to be realistic about when we are fine and when we are really not ok. I personally called off once in residency - and this was a my a program where they (half joked) that if you call in you had better be calling from the icu… if you call off bc you’re admitted in the RNF you’re in trouble. What didn’t kill me made me stronger - and I’m thankful for my training… but it didn’t work out that way for everyone
 
amyl said:
Part of being a good partner is not dumping on your partners - I think we need to be realistic about when we are fine and when we are really not ok. I personally called off once in residency - and this was a my a program where they (half joked) that if you call in you had better be calling from the icu… if you call off bc you’re admitted in the RNF you’re in trouble. What didn’t kill me made me stronger - and I’m thankful for my training… but it didn’t work out that way for everyone
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Both my internship and residency were like this and they didn’t even imply it, they said it. Calling in sick meant they better see your name on the ER census. Im not sure how much that would fly in a post COVID world
 
amyl said:
Part of being a good partner is not dumping on your partners - I think we need to be realistic about when we are fine and when we are really not ok. I personally called off once in residency - and this was a my a program where they (half joked) that if you call in you had better be calling from the icu… if you call off bc you’re admitted in the RNF you’re in trouble. What didn’t kill me made me stronger - and I’m thankful for my training… but it didn’t work out that way for everyone
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Did someone die?😉
 
Twiggidy said:
All of our IV bags are in wrappers and I have seen cases where there is "wetness" inside some of the bags. Maybe the sprung a random leak, but I can assure I didn't use that bag. I trust no one
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I'm more surprised when I see a bag without some "wetness" in the outer wrapper. I've almost never seen a dry bag with a few brands.
 
Euripides said:
Like maybe they were receiving general anesthesia with propofol as an induction agent and possibly the propofol formulation mitigated the bupivicaine?
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Propofol is a 10% lipid emulsion so you'd need twice as much by volume as 20% intralipid to "treat" LAST. Bolus dose for LAST is 1.5 mL/kg intralipid followed by an infusion. 3 mL/kg of propofol for an adult is on the order of 200 mL - ten bottles of propofol. So of course no sane person would try using propofol as a treatment.

To your point, I wouldn't expect one bottle used for induction to luckily prevent or meaningfully mitigate LAST. Especially since every mL of propofol also brings some negative inotropic and SVR-decreasing effects, not really helpful effects during an arrest from LAST.
 
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Holes in the plastic wrapper of the iv bag. Always check that ****.. Unless i unwrap the iv bag. I aint usin it. My question is what motivation does this guy have for killing people he doesnt know?
 
Dr ortiz had been reprimanded by this center recently for a poor outcome with a patient that had to be shipped to the hospital. People suspect he was doing this to show that other anesthesiologists had issues - it wasn’t just him. It doesn’t make sense to me but then I don’t have the brain of a homicidal maniac.
I suspect that Ray will give up his license. I hope they consider him a flight risk. At a minimum it sounds like the civil suits will bankrupt him. I wouldn’t be surprised if he takes his own life - his reputation has been ruined but then he never really had a great one anyway.
Sorry to vent here on sdn but this doesn’t feel like near enough justice for Mel. I’m thankful that her family has an answer but what a terrible answer.
I suppose it’s at least something that he cannot take care of patients anymore. There’s just not punishment enough for this
 
dipriMAN said:
Check it?!

I think they probably mean needle holes, like a pinpoint hole that they found on very close inspection, no way anyone is going to catch that.
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The wrapper is pretty thick, it is not easy poking a hole there without seeing it and if they do the needle has to go through the bag which will cause the bag to spring a leak in which case when you unwrap it there will be the tell tale sign of tampering... wetness upon ripping the wrapper. In order to not get fluid, you would have to somehow get your needle into the stopper where you inject medicine into the bag and that stopper is covered with a rip-away thingy which you can really only rip away by unwrapping the bag. It is not easy tampering with iv bags, unless you do what most preops do which is have a tech unwrap 60 bags the night before to save the lazy day of surgery nurses the trouble of unwrapping the iv bags. This practice(poor) gives the dr death types full opportunity to tamper with Iv fluid. This is really a basic safety thing. I am not saying anything new here.
iv-bag.jpg
 
OptionOffense said:
The wrapper is pretty thick, it is not easy poking a hole there without seeing it and if they do the needle has to go through the bag which will cause the bag to spring a leak in which case when you unwrap it there will be the tell tale sign of tampering... wetness upon ripping the wrapper. In order to not get fluid, you would have to somehow get your needle into the stopper where you inject medicine into the bag and that stopper is covered with a rip-away thingy which you can really only rip away by unwrapping the bag. It is not easy tampering with iv bags, unless you do what most preops do which is have a tech unwrap 60 bags the night before to save the lazy day of surgery nurses the trouble of unwrapping the iv bags. This practice(poor) gives the dr death types full opportunity to tamper with Iv fluid. This is really a basic safety thing. I am not saying anything new here.
iv-bag.jpg
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Your nuts, can easily get a needle through the stopper. But honestly, even if you just poked a tiny hole with a 27 or 30 G needle at the top of the bag, probably still wouldn’t notice when hanging it. A 27G hole is not goi g to leak too much, especially when the bag is hung right side up.
 
OptionOffense said:
The wrapper is pretty thick, it is not easy poking a hole there without seeing it and if they do the needle has to go through the bag which will cause the bag to spring a leak in which case when you unwrap it there will be the tell tale sign of tampering... wetness upon ripping the wrapper. In order to not get fluid, you would have to somehow get your needle into the stopper where you inject medicine into the bag and that stopper is covered with a rip-away thingy which you can really only rip away by unwrapping the bag. It is not easy tampering with iv bags, unless you do what most preops do which is have a tech unwrap 60 bags the night before to save the lazy day of surgery nurses the trouble of unwrapping the iv bags. This practice(poor) gives the dr death types full opportunity to tamper with Iv fluid. This is really a basic safety thing. I am not saying anything new here.
iv-bag.jpg
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I’m confused here. You really think a psychopath couldn’t figure out how to wiggle a needle into the injection port through a plastic bag if they had enough ill-intent? It’s a needle. Needles go through things. It’s not mission impossible. There are IV bags that have a big, round injection port right in the lower center of the bag. Not hard at all.

The reason your comment even exists is because somebody injected cardiotoxic medications through the plastic and into the IV bag in a subtle way where an anesthesiologist who deals with IV bags all day every day took some home and died as a result. It’s not “a basic safety thing.” It’s a psychopath committing murder.
 
anaesthetic said:
somebody injected cardiotoxic medications through the plastic and into the IV bag in a subtle way where an anesthesiologist who deals with IV bags all day every day took some home and died as a result. It’s not “a basic safety thing.” It’s a psychopath committing murder.
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The more likely scenario is that somebody unwrapped the iv bags for later use and he profited by injecting the bags.

You are correct, you cannot completely prevent psychopaths but you can deter them and not unwrapping the iv bags deters them. And, it IS a basic saftey thing.
 
dipriMAN said:
Your nuts, can easily get a needle through the stopper. But honestly, even if you just poked a tiny hole with a 27 or 30 G needle at the top of the bag, probably still wouldn’t notice when hanging it. A 27G hole is not goi g to leak too much, especially when the bag is hung right side up.
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You ever try to inject through a 27 g needle? It is not easy. Unlikely scenario. He used a 20 g needle or larger.
 
OptionOffense said:
You ever try to inject through a 27 g needle? It is not easy. Unlikely scenario. He used a 20 g needle or larger.
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I inject things through a 27 G all the time, it’s not efficient for a large volume, but certainly doable.
 
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