Anesthesiologist behaving badly

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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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You aren’t actually ever using that hetastarch, are you? If so, the plastic covering should be the least of your worries.
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When you’re reaching for a new bag of IV fluids during a case how many of you are actually inspecting the wrapper first? I’m guessing it’s the same number of people examining condom wrappers for poke holes before they put one on.
 
amyl said:
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
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As I said in my original post, this is what sociopaths are prone to do when they are threatened or angered. Of course it doesn’t make sense to those of us who are not sociopaths.

I am hopeful that there may be still an active law enforcement investigation that could result in him being criminally charged. But as you make reference to, it is another common recipe in the sociopaths cookbook to take the suicide way out.
 
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Agast said:
When you’re reaching for a new bag of IV fluids during a case how many of you are actually inspecting the wrapper first? I’m guessing it’s the same number of people examining condom wrappers for poke holes before they put one on.
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Again, if he did inject the bags he did it with the wrapper completely off. If the wrapper is still on, it is likely safe. If someone hands you a bag of fluid w/o the wrapper, throw that **** away
 
OptionOffense said:
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.
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OptionOffense said:
Again, if he did inject the bags he did it with the wrapper completely off. If the wrapper is still on, it is likely safe. If someone hands you a bag of fluid w/o the wrapper, throw that **** away
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And what evidence do you have that the IV bags were unwrapped? You really like speaking with certainty just to prove your own point.
 
Blockit said:
As I said in my original post, this is what sociopaths are prone to do when they are threatened or angered. Of course it doesn’t make sense to those of us who are not sociopaths.

I am hopeful that there may be still an active law enforcement investigation that could result in him being criminally charged. But as you make reference to, it is another common recipe in the sociopaths cookbook to take the suicide way out.
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He very well may have done it, but we don't know that! We don't have all the evidence. Does it seem probably? Yes. But we don't know that.
 
anaesthetic said:
And what evidence do you have that the IV bags were unwrapped? You really like speaking with certainty just to prove your own point.
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I love that this is a topic where @OptionOffense and I see eye to eye as opposed to the political threads. Even if we both start to sound like crazy conspiracy theorist, the general theme still holds true. You shouldn't trust anything in the field and I'm sorry if that offends colleagues on. here. I've taken over rooms for people and thrown the entire setups out and made new setups because at the end of the day its my Be-Hind if something is mislabeled or misdiluted by accident. Quite honestly, I may be offended if someone does the same for me but in the end I'll understand. I mean, there's a reason why in residency, at least at my place, there was a bucket on the cart where you were supposed to put your empty vials when setting up. It wasn't to organize trash I'll tell you that. It was to double check what you were drawing up.

The general ethos does remain true. Don't trust anything in this field. I'll open my own IV bags and if it looks odd then give me another IV bag to open. If there's condensation in all the IV bags a) fix the A/C because the OR shouldn't be THAT humid and b) squeeze the bag before you use it to make sure it's not tainted.

Sorry folks, I guess I am just a bit paranoid, but there are many sabotage points in what we do
 
abolt18 said:
He very well may have done it, but we don't know that! We don't have all the evidence. Does it seem probably? Yes. But we don't know that.
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He’s definitely been convicted here!
He’s even been named. Just draw up the lethal injection we don’t need anymore proof!
 
The bags were still in the outer wrapper. Under close inspection there were small needle holes through the outer wrapper. They have video of him putting iv bags in the warmer and patients subsequently coding. They analyzed bags from that warmer and some had bupivacaine and some tested positive for other things that were lethal.
This is no longer gossip it has been reported by the media - his license is suspended
 
amyl said:
The bags were still in the outer wrapper. Under close inspection there were small needle holes through the outer wrapper. They have video of him putting iv bags in the warmer and patients subsequently coding. They analyzed bags from that warmer and some had bupivacaine and some tested positive for other things that were lethal.
This is no longer gossip it has been reported by the media - his license is suspended
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I’d be curious to know what these “other things” are. Like half the stuff in our drawer is lethal in sufficient doses.
 
dipriMAN said:
I inject things through a 27 G all the time, it’s not efficient for a large volume, but certainly doable. I imagine this guy wasn’t doctoring up IV bags in broad daylight. All you need is 3 vials of 0.75% bupi for a toxic dose.
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How many mls are in your .75% vials? Ours come with 2mls. That's only 45mg of bupivicaine. Far from toxic.
 
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Ronin786 said:
How many mls are in your .75% vials? Ours come with 2mls. That's only 45mg of bupivicaine. Far from toxic.
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They come in 5 and 10 mls believe, not the hyperbaric, just bupi without dextrose. I personally never use them.
 
If the evidence is as airtight as has been suggested here he would have been arrested and charged. The legal proof of guilt requires a preponderance of the evidence.
In the case of department of health proceedings public safety requires action to be taken to protect the public and the evidence is necessarily of a lesser degree.
He may well be guilty but he certainly hasn’t been convicted. In a court of law he is presumed innocent until proven otherwise.
If it ends up that he for whatever reason is not responsible. The anonymity of this board might not be sufficient to protect one from legal action.
 
Very recently after loosing on appeal Oberlin has agreed to pay the small family owned Gibson bakery 36 million for slander by students at oberlin.
Quite an interesting read!
 
pro-propofol said:
Very recently after loosing on appeal Oberlin has agreed to pay the small family owned Gibson bakery 36 million for slander by students at oberlin.
Quite an interesting read!
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Do you happen to know how this figure was determined? NPV of lost future cash flows or something?
 
pro-propofol said:
If the evidence is as airtight as has been suggested here he would have been arrested and charged. The legal proof of guilt requires a preponderance of the evidence.
In the case of department of health proceedings public safety requires action to be taken to protect the public and the evidence is necessarily of a lesser degree.
He may well be guilty but he certainly hasn’t been convicted. In a court of law he is presumed innocent until proven otherwise.
If it ends up that he for whatever reason is not responsible. The anonymity of this board might not be sufficient to protect one from legal action.
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"Preponderance of evidence" is less than you think.

"Preponderance of evidence" means the evidence proves there is 51% chance that it may be true, Legal scholars back me up plz.
 
dchz said:
"Preponderance of evidence" is less than you think.

"Preponderance of evidence" means the evidence proves there is 51% chance that it may be true, Legal scholars back me up plz.
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“Preponderance of evidence” is often the standard for civil trials, e.g., medical malpractice.

“Beyond a reasonable doubt” is the standard for criminal trials for conviction.

Hypothetically, this guy could get charged criminally and the prosecution might lose because they couldn’t make “reasonable doubt”.
But he might lose at a civil trial because of the lower standard to find for a plaintiff.
 
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Dr. Rude said:
“Preponderance of evidence” is often the standard for civil trials, e.g., medical malpractice.

“Beyond a reasonable doubt” is the standard for criminal trials for conviction.

Hypothetically, this guy could get charged criminally and the prosecution might lose because they couldn’t make “reasonable doubt”.
But he might lose at a civil trial because of the lower standard to find for a plaintiff.
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Like they acquitted OJ Simpsen criminally but he lost the civil suit. Certain things are admissible in a civil trial that aren’t allowed in a criminal trial… the rules for jury selection, etc.
 
Twiggidy said:
I love that this is a topic where @OptionOffense and I see eye to eye as opposed to the political threads. Even if we both start to sound like crazy conspiracy theorist, the general theme still holds true. You shouldn't trust anything in the field and I'm sorry if that offends colleagues on. here. I've taken over rooms for people and thrown the entire setups out and made new setups because at the end of the day its my Be-Hind if something is mislabeled or misdiluted by accident. Quite honestly, I may be offended if someone does the same for me but in the end I'll understand. I mean, there's a reason why in residency, at least at my place, there was a bucket on the cart where you were supposed to put your empty vials when setting up. It wasn't to organize trash I'll tell you that. It was to double check what you were drawing up.

The general ethos does remain true. Don't trust anything in this field. I'll open my own IV bags and if it looks odd then give me another IV bag to open. If there's condensation in all the IV bags a) fix the A/C because the OR shouldn't be THAT humid and b) squeeze the bag before you use it to make sure it's not tainted.

Sorry folks, I guess I am just a bit paranoid, but there are many sabotage points in what we do
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When I was a CA-1, I drew up atropine and other drugs and had them ready to go for every case - sitting on top of my cart.

The start of CA-2, a wise staff asked me, how many times have you given atropine? I think it was maybe once or twice.

He said, I think the probability of someone grabbing this (atropine) and giving it inadvertently to a patient because you have it sitting here is much greater than the probability of you needing it.

It was a good lesson. We do things to mitigate risk, and forget that our actions to do that bring new risks.

My point is, I think it is great you throw away everything and get new IV bags, and new stuff each time you take over a case. However, I would only ask you to consider that this has risk as well (you drawing up a wrong medicine, spiking a wrong fluid bag, infectious risks from changing everything) and it’s possible these risks are greater than the probability of someone in your hospital being a serial killer. 😜
 
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OptionOffense said:
Again, if he did inject the bags he did it with the wrapper completely off. If the wrapper is still on, it is likely safe. If someone hands you a bag of fluid w/o the wrapper, throw that **** away
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I’ve been doing this wrong the whole time. And frankly, I’m gonna keep doing it wrong.

Every bag of fluid started on every patient in our hospital was spiked and setup by the tech (someone else).

I should also point out, every bag of blood and platelets and ffp wasn’t wrapped and it was filled by someone else in another room by someone I don’t know.

Unfortunately, we HAVE to trust our co-workers. We just have to.
 
This thread is weird. On the one hand it’s cool to be severely dehydrated from illness and be administering anesthesia after a quick IV fluid bolus, but on the other hand everyone is using microscopes to examine for holes in the outer bag of IV fluid before giving that fluid to a patient.

Which is more likely to cause harm to a patient: a physician who is impaired either from illness or a rad night partying or a serial killer maliciously contaminating IV fluid?
 
GravelRider said:
This thread is weird. On the one hand it’s cool to be severely dehydrated from illness and be administering anesthesia after a quick IV fluid bolus, but on the other hand everyone is using microscopes to examine for holes in the outer bag of IV fluid before giving that fluid to a patient.

Which is more likely to cause harm to a patient: a physician who is impaired either from illness or a rad night partying or a serial killer maliciously contaminating IV fluid?
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To be clear- the anesthesiologist in question (my partner) did not give herself fluids and then go take care of people when she wasn’t feeling well. She was leaving early for the day after she began not feeling well after a known exposure to a gi bug. She took the tainted bag back to her house where she gave it to herself. She was in no way impaired and taking care of patients. I’m sure she was trying to get better so she could return to work the next day. She was universally loved and respected and would never have practiced impaired as suggested on here.
 
Give it a rest, guys. She was an Anesthesiologist, who took a bag of IV fluid home, rather than feel miserable or subject herself to a $5000/6-hour ER visit, just like an FP or IM Doc would’ve gone to the “sample closet” to get a Celebrex/etc, if they had a headache.

If she wouldn’t have used that bag, a patient would’ve just as easily have gotten it, and nobody’s differential diagnosis in the OR would’ve been “Hey, maybe some crazy a-hole spiked the IV bag with bupivacaine!”.

Somebody was going to end up having this bag administered to them, one way or another.
 
I could be wrong... but I have always been under the impression the bags on the outside of fluid bags are humidified inside ON PURPOSE to prevent the actual fluid bags from developing desiccation cracks that would compromise the inner medication bag's fidelity.

I don't have a source, it was one of those things I learned in school/residency that has stuck with me.
 
amyl said:
To be clear- the anesthesiologist in question (my partner) did not give herself fluids and then go take care of people when she wasn’t feeling well. She was leaving early for the day after she began not feeling well after a known exposure to a gi bug. She took the tainted bag back to her house where she gave it to herself. She was in no way impaired and taking care of patients. I’m sure she was trying to get better so she could return to work the next day. She was universally loved and respected and would never have practiced impaired as suggested on here.
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My colleagues and I have done the same thing over the years. The difference is we used sealed IV bags, not opened ones, for fluid boluses. This is reminder to us all about "assuming safety" with fluid bags, syringes, needles, etc we have not personally drawn up; we have a duty to avoid cross-contamination whenever possible so this can serve as a lesson in vigilance and safety.

Of course, in no way am I implying that "murder" or "poison" is a day to day issue for any of us; in fact, the chance of dying from a lightning strike or car accident is far greater than being poisoned by your anesthesiologist or CRNA.
 
BLADEMDA said:
My colleagues and I have done the same thing over the years. The difference is we used sealed IV bags, not opened ones, for fluid boluses. This is reminder to us all about "assuming safety" with fluid bags, syringes, needles, etc we have not personally drawn up; we have a duty to avoid cross-contamination whenever possible so this can serve as a lesson in vigilance and safety.

Of course, in no way am I implying that "murder" or "poison" is a day to day issue for any of us; in fact, the chance of dying from a lightning strike or car accident is far greater than being poisoned by your anesthesiologist or CRNA.
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How far does that logic go? Did you personally synthesize the drug? Did you personally sterilize the needle? Did you draw back on the IV and waste it to ensure there was no in line contamination? Thinking that a bag of saline that is not expired or spiked is contaminated by virtue of it not being in a sealed box is insane. This level of paranoia is not practiced anywhere else in the hospital and if it is considered the standard then why wouldn't it be?
 
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