Anesthesiologist behaving badly

[Greenbayslacker]

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if you’re sick enough to need IV fluids then you shouldn’t be at work.

What if you're just hungover, nauseous, and need some fluids to keep chugging along your day without feeling like death?

 

[deleted875186]

What if you're just hungover, nauseous, and need some fluids to keep chugging along your day without feeling like death?

Shouldn’t be coming to work hungover. Your blood alcohol level could still be elevated if you were up all night drinking.

 

[deleted643396]

What if you're just hungover, nauseous, and need some fluids to keep chugging along your day without feeling like death?

You’re still impaired. Can you think clearly when you are in any of those situations? Do you want a hungover anesthesiologist taking care of your mother, spouse, or child?

 

[markneil]

In residency, I never came to work hungover, but I went to Chipotle (never again) the night before and all night I was on the toilet for maybe 5 hours that night having felt like I had a bowel prep. It was around 4 am when I realized that I was really too weak and should stay home. But I went to work, talked to the OOD (who's now the chair) about the situation and she told me I looked like **** and to have someone place an IV and give me some fluids in the call room. Slept all day and went home.

 

[deleted641888]

You’re still impaired. Can you think clearly when you are in any of those situations? Do you want a hungover anesthesiologist taking care of your mother, spouse, or child?

I agree with you 100%, but we do a lot of things in medicine that are unsafe, unfortunately, for our patients and to ourselves. Not defending it at all. Just saying it’s cultural, and it’s embedded in most of us from day #1 of medical school, perpetuated by the “old guard” who somehow retire yet are still wandering the hospital halls and hospital admins and the powers beyond who expect undying loyalty under the guise of “whatever it takes for the patient,” even if it means expecting us to work for 24-30 hours straight or wearing cloth t-shirts/bandanas over our faces and garbage bags as a means for protection.

None of it is safe. I don’t know what the answer is other than to work my ass off, invest well, and semi-retire ASAP.

 

[Maz777]

I never ever thought of myself as medically conservative but I cannot imagine a world where I start an IV and administer any medication to a co-worker unless they were actively dying. And there are training institutions where this is still going on?!! Y’all are crazy.

Clueless. You would honestly turn away a colleague and tell them to sit/wait in the ED for 4-6 hours for a simple LR bolus after a GI bug? That's an incredible waste of time, money, and resources. You must be a peach of a colleague.

 

[UscGhost]

This is normal in America.

It's like a plumber taking home his equipment to fix his own toilet. Not a big deal.

 

[deleted875186]

Clueless. You would honestly turn away a colleague and tell them to sit/wait in the ED for 4-6 hours for a simple LR bolus after a GI bug? That's an incredible waste of time, money, and resources. You must be a peach of a colleague.

Most people do not need an IV bag for a GI illness, they manage with oral fluids at home.

 

[Arch Guillotti]

Clueless. You would honestly turn away a colleague and tell them to sit/wait in the ED for 4-6 hours for a simple LR bolus after a GI bug? That's an incredible waste of time, money, and resources. You must be a peach of a colleague.

The problem is that someone sees is or hears about it or whatever, they get a bug up their butt and “report” it. Watch out for land mines.

 

[deleted643396]

Clueless. You would honestly turn away a colleague and tell them to sit/wait in the ED for 4-6 hours for a simple LR bolus after a GI bug? That's an incredible waste of time, money, and resources. You must be a peach of a colleague.

I have absolutely no problem putting in an IV and administering some fluids to a colleague who needs it. Then I want them to go home. What I have a problem with is someone getting a fluid bolus and then returning to work. We puff our chest and talk all the time about vigilance and how we differentiate ourselves from midlevels. What does it say about our specialty that even someone so hungover they need IV fluids can do it?

 

[OptionOffense]

I dont use an IV bag unless it is pristine in its wrapper. If it is out of the wrapper, i move on to the next one. I refuse to even use anyone elses medication

 

[Greenbayslacker]

You’re still impaired. Can you think clearly when you are in any of those situations?

Yes still 100% functional, just miserable

 

[Greenbayslacker]

Your blood alcohol level could still be elevated if you were up all night drinking

These days it doesn't take a whole night of drinking to give me a hangover 🙁

 

[deleted643396]

These days it doesn't take a whole night of drinking to give me a hangover 🙁

I think there is a difference between having 2 glasses of wine the night before and having a headache the next day that resolves with an Advil or two and a hangover that requires an IV fluid bolus to function.

I’ve said enough on this. I can’t even imagine how the lawyers would love to find out that an anesthesiologist was getting fluid boluses and then administering anesthesia. Maybe ask your malpractice insurance what they think of it?

 

[AMEHigh]

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.

Hmm, is it really that unusual?

I’ve had several pregnant colleagues who work in outpatient surgical centers get some IVF from work when their nausea and vomiting was at its worse during pregnancy.

I feel like I heard this happening in residency as well (although never personally witnessed it).

 

[VA Hopeful Dr]

Hmm, is it really that unusual?

I’ve had several pregnant colleagues who work in outpatient surgical centers get some IVF from work when their nausea and vomiting was at its worse during pregnancy.

I feel like I heard this happening in residency as well (although never personally witnessed it).

I think there's a difference between a colleague giving you a liter of NS or LR while at work and doing it yourself at your house. In the former case, if a super rare problem should happen you're in a medical facility and not your house.

 

[anbuitachi]

A good source told me they have 3000 hours of video they have turned into the police. I have also hear that the events have correlated with when dr O has been in town and not occurred when he wasn’t. I am hoping they have more evidence that they aren’t sharing right now.
That second article loosely linking dr o to the center seems like a little bit of a plant from the last plaintiffs attorney. Steckler is a well known and aggressive malpractice attorney here. That article suggested a link without really saying there is one. It’s not really news- it’s juicy gossip carefully worded to avoid actually implicating him. Praying more concrete details come out this week

i imagine unless there is video evidence or concrete evidence dr O did it, hes not going to be charged.

 

[anbuitachi]

You’re still impaired. Can you think clearly when you are in any of those situations? Do you want a hungover anesthesiologist taking care of your mother, spouse, or child?

do you want an anesthesiologist working 24 hours straight to be taking care of your mother, spouse or child? i dont. but it still happens. plenty of research showing working that much is equivalent to working under some influence of etoh.

 

[Beeftenderloin]

I dont use an IV bag unless it is pristine in its wrapper. If it is out of the wrapper, i move on to the next one. I refuse to even use anyone elses medication

This would be tough to consistently abide by at my shop. Pre-op nurses start IV and hang a bag for all OR patients. If you want a second IV one of the techs brings a bag they spiked and primed in the work room. If a bag runs dry the Or nurse gets a bag that had its wrapper removed some time ago and is sitting in a warmer in the inner-core.

You’re still impaired. Can you think clearly when you are in any of those situations? Do you want a hungover anesthesiologist taking care of your mother, spouse, or child?

You seem very passionate about preventing/avoiding practicing while impaired, which I agree with. Just curious if you/your group still takes 24 hr calls?

Per CDC sources, working 18 hours is like having a BAC of 0.05 and at hr 24 you’re closer to 0.1 (legally too impaired to drive). So if you’re willfully working any shift 18 hrs or more, you’re just as bad as they are, maybe even even worse since you’re actually drunk, not hung over.

 

[AMEHigh]

I think there's a difference between a colleague giving you a liter of NS or LR while at work and doing it yourself at your house. In the former case, if a super rare problem should happen you're in a medical facility and not your house.

Ahh got it. I missed the nuance that people were talking about.
But the person who I know recently did it due to pregnancy nausea and vomiting, the IV was started at work (presumably because they couldn’t do their own IV) and then they drove home with it. So yes something bad could’ve happened, but to be honest that would have never even crossed my mind. What a sad and tragic series of events.

 

[Southpaw]

I went to a residency where no one would’ve blinked if a sick resident were getting a bag of fluids. However it seems like this anesthesiologist took a bag home? Does that mean she started an IV on herself at home? Or drove home w an IV already started. Either way the story is odd. It’s a very sad story.

 

[Maz777]

I have absolutely no problem putting in an IV and administering some fluids to a colleague who needs it. Then I want them to go home. What I have a problem with is someone getting a fluid bolus and then returning to work. We puff our chest and talk all the time about vigilance and how we differentiate ourselves from midlevels. What does it say about our specialty that even someone so hungover they need IV fluids can do it?

Not everyone has the luxury of sick days or a person to cover for us at the drop of a dime (especially when many of us aren't in a supervision model). Can blame us all you want. A pregnant person with hyperemesis that can't keep anything down is a perfect example. Just send them home every day? That seems reasonable.

 

[deleted87051]

Not everyone has the luxury of sick days or a person to cover for us at the drop of a dime (especially when many of us aren't in a supervision model). Can blame us all you want. A pregnant person with hyperemesis that can't keep anything down is a perfect example. Just send them home every day? That seems reasonable.

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.

 

[deleted643396]

This would be tough to consistently abide by at my shop. Pre-op nurses start IV and hang a bag for all OR patients. If you want a second IV one of the techs brings a bag they spiked and primed in the work room. If a bag runs dry the Or nurse gets a bag that had its wrapper removed some time ago and is sitting in a warmer in the inner-core.




You seem very passionate about preventing/avoiding practicing while impaired, which I agree with. Just curious if you/your group still takes 24 hr calls?

Per CDC sources, working 18 hours is like having a BAC of 0.05 and at hr 24 you’re closer to 0.1 (legally too impaired to drive). So if you’re willfully working any shift 18 hrs or more, you’re just as bad as they are, maybe even even worse since you’re actually drunk, not hung over.

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?

Not everyone has the luxury of sick days or a person to cover for us at the drop of a dime (especially when many of us aren't in a supervision model). Can blame us all you want. A pregnant person with hyperemesis that can't keep anything down is a perfect example. Just send them home every day? That seems reasonable.

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?

 

[Beeftenderloin]

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?

Of course. I would absolutely expect it from an attorney that’s done their homework. This seems like low hanging fruit from a legal standpoint. Blame the bad outcome on the substandard care provided by the “impaired” anesthesiologist. Plenty of data they can cite supporting this.

1. Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000;57(10):649-55.
2. Arnedt JT, Wilde GJ, Munt PW, MacLean AW. How do prolonged wakefulness and alcohol compare in the decrements they produce on a simulated driving task? Accid Anal Prev. 2001;33(3):337-44.
3. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature. 1997;388(6639):235.
4. Lamond N, Dawson D. Quantifying the performance impairment associated with fatigue. J Sleep Res. 1999;8(4):255-62.

 

[OptionOffense]

This would be tough to consistently abide by at my shop. Pre-op nurses start IV and hang a bag for all OR patients. If you want a second IV one of the techs brings a bag they spiked and primed in the work room. If a bag runs dry the Or nurse gets a bag that had its wrapper removed some time ago and is sitting in a warmer in the inner-core.




You seem very passionate about preventing/avoiding practicing while impaired, which I agree with. Just curious if you/your group still takes 24 hr calls?

Per CDC sources, working 18 hours is like having a BAC of 0.05 and at hr 24 you’re closer to 0.1 (legally too impaired to drive). So if you’re willfully working any shift 18 hrs or more, you’re just as bad as they are, maybe even even worse since you’re actually drunk, not hung over.

Tell them for safety purposes, do not take the wrapper off the iv bags unless you are literally about to use it. That is how its designed to be

 

[Maz777]

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.

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).

 

[deleted1111114]

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

What if they are having a period?

 

[repititionition]

It’s clear that reasonable people can disagree about nearly everything under discussion here, however I think this should all be moved to the private forum.

 

[forchinet121]

It’s always either texas or Florida

 

[woopedazz]

It’s clear that reasonable people can disagree about nearly everything under discussion here, however I think this should all be moved to the private forum.

Nah, I don't get to read any of the good stuff when you move it there. No fair!

 

[deleted87051]

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).

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.

 

[amyl]

I went to a residency where no one would’ve blinked if a sick resident were getting a bag of fluids. However it seems like this anesthesiologist took a bag home? Does that mean she started an IV on herself at home? Or drove home w an IV already started. Either way the story is odd. It’s a very sad story.

Took a bag of fluid home with her and started her own iv at home. Her husband was there. There are places where I work that this would be an issue… and others where it wouldn’t. Understanding the dynamic in that surgery center it is hard for someone who isn’t local. She may have even had permission to do what she did - I don’t know but I wouldn’t be surprised… as she was very well loved by all.
I’m so sad for her husband… her death was so unexpected and sudden only to be compounded by autopsies and toxicology, press involvement and speculation. I hope for a resolution soon

the worst thing is there is likely a homicidal insane person on the loose.

 

[Arantius]

What's super scary is it's common to have condensation between the thick plastic outer bag and the actual IV bag. Terrifying. I've called the pharmacy many times to ask if it's okay, and they always say yes. NOW who is to say it's not from a needle prick in the IV bag?

 

[Arantius]

A good source told me they have 3000 hours of video they have turned into the police. I have also hear that the events have correlated with when dr O has been in town and not occurred when he wasn’t. I am hoping they have more evidence that they aren’t sharing right now.
That second article loosely linking dr o to the center seems like a little bit of a plant from the last plaintiffs attorney. Steckler is a well known and aggressive malpractice attorney here. That article suggested a link without really saying there is one. It’s not really news- it’s juicy gossip carefully worded to avoid actually implicating him. Praying more concrete details come out this week

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?!

 

[Euripides]

Rumor is that only the anesthesiologist died - at home with an IV as pointed out earlier. Many patients in this ASC had suspicious cardiac events resulting in hospital transfer but from what I hear none of them died. Is it access to resuscitation alone that saved them or something else? Like maybe they were receiving general anesthesia with propofol as an induction agent and possibly the propofol formulation mitigated the bupivicaine?

 

[Arantius]

Here is the article from France about the anesthesiologist who would poison patients with BUPI just so he could heroically bring them back! INSANE. WHO WANTS A CODE?! OR LAST?! wtf... French doctor accused of killing 9 patients

 

[pro-propofol]

Tamper evident ports needed!
The ancient glass IV bottles with flip tops would work.
The plastic over wrapper is not tamper evident.

 

[Arantius]

Tamper evident ports needed!
The ancient glass IV bottles with flip tops would work.
The plastic over wrapper is not tamper evident.

Seriously. We need something different

 

[amyl]

Rumor is that only the anesthesiologist died - at home with an IV as pointed out earlier. Many patients in this ASC had suspicious cardiac events resulting in hospital transfer but from what I hear none of them died. Is it access to resuscitation alone that saved them or something else? Like maybe they were receiving general anesthesia with propofol as an induction agent and possibly the propofol formulation mitigated the bupivicaine?

I think it was resuscitation - from
What I’ve heard the events occurred well into the case - not on induction- after a second bag of fluid from the warmer “in the back” not preop, unlike the first bag hung.
I wasn’t there so it’s rumor - but most of what I hear is from my fellow partners that were there on a regular basis - Mel’s autopsy results I know to be fact (she was my partner).

 

[pro-propofol]

This whole situation is full of innuendo and irrelevant details used to impune an individual for reasons that may not be altruistic.
If my partner died and had an autopsy how with I know the autopsy results?
I wouldn’t have access to that information except as hearsay.
I think the investigation should proceed without people coming to some pretty slanderous conclusions.

 

[Blockit]

This whole situation is full of innuendo and irrelevant details used to impune an individual for reasons that may not be altruistic.
If my partner died and had an autopsy how with I know the autopsy results?
I wouldn’t have access to that information except as hearsay.
I think the investigation should proceed without people coming to some pretty slanderous conclusions.

You are yourself slandering by implying that Amyl knows this information through any other means then just being close to the doctors family. Not to mention the fact that the cause of death being bupi toxicity was published in the news media.

You are however correct that there is a lot of innuendo here but there’s also a lot of suspicious coincidence. Speculation in a thread on some forum website is just that. Any reasonable adult knows that.

Amyl, I realize that I have never offered my condolences to you for the loss of your partner. I’m sure it must be very traumatic, and I’m sure you would like to see justice done. I’m sorry for your loss.

 

[Agast]

I think if a doctor died it would be reasonable for the family to asks their fellow doctors how to interpret an autopsy report. Especially if there was concern for foul play. Partly for closure and partly for a free medical opinion. You may not know what bupivicaine is but you know your wife’s coworkers do.

 

[Twiggidy]

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.

 

[IlDestriero]

The handful of times I’ve done IVs on colleagues were all surgeons who 1. Passed out and went to the ED for work up. 2. Were in “all day” kind of cases and obviously working with a migraine. Going to the ED for the vip experience isn’t an option there.

 

[Twiggidy]

The handful of times I’ve done IVs on colleagues were all surgeons who 1. Passed out and went to the ED for work up. 2. Were in “all day” kind of cases and obviously working with a migraine. Going to the ED for the vip experience isn’t an option there.

I get what your saying but now that more and more news stories come out about “physicians behaving badly” and quite honestly the growing number of drug addicts, physicians included, im just not putting IVs in anyone and walking away. I guess I just don’t trust people as much as I used to, and I’m certainly not going to sit there and monitor their IV therapy.

 

[IlDestriero]

I get what your saying but now that more and more news stories come out about “physicians behaving badly” and quite honestly the growing number of drug addicts, physicians included, im just not putting IVs in anyone and walking away. I guess I just don’t trust people as much as I used to, and I’m certainly not going to sit there and monitor their IV therapy.

Well when they’re the surgeon in your OR, you’re kind of stuck with them anyway. 😆

 

[Twiggidy]

Well when they’re the surgeon in your OR, you’re kind of stuck with them anyway. 😆

Oh you’re talking mid case? Maybe it’s time to finish up or phone a friend. I don’t want major surgery from a surgeon who needs an IV break

We’re derailing at this point but people get what I’m saying….

 

[Agast]

Realistically, the presence of an IV bag attached to your arm is NOT the limiting factor for whether an anesthesiologist can start self-injecting fentanyl.

 

[chocomorsel]

Regardless, is it normal practice to send patients home with a spare bag of IVF? I’ve never seen it. Sadly this may not just be a case of malicious sabotage, but also VIP syndrome. If that tainted IV bag was administered in the surgery center while the patient was being monitored, she may have survived. At home the chance of survival was much lower.

I have done that. In residency. I am sure I am not the only one. But yeah, makes you think about it when this happens.