Anesthesiologist sues Salem surgery center for $1.6 million

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TheLoneWolf

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The article isn't entirely clear. A guy directed a circulating nurse to administer propofol to a pediatric patient in a surgery center? That is wild if true.

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Im guessing he likes the nurse to push the meds while he manages airway, etc. Got mad when he was told no on this, created a huge mess for himself.
 
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Im guessing he likes the nurse to push the meds while he manages airway, etc. Got mad when he was told no on this, created a huge mess for himself.
That's my read as well, although for the charge nurse to come in mid-way thru induction and object leading this high risk patient to be only half-induced and at risk for laryngospasm? I can see why he was concerned about patient safety. I don't know what the "rules" are, but I've ha RNs in the ICU push induction meds at my direction. Can't say I've done this in the OR, but if I'm telling them exactly what to do/give, I shouldn't think that would be an issue.
 
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That's my read as well, although for the charge nurse to come in mid-way thru induction and object leading this high risk patient to be only half-induced and at risk for laryngospasm? I can see why he was concerned about patient safety. I don't know what the "rules" are, but I've ha RNs in the ICU push induction meds at my direction. Can't say I've done this in the OR, but if I'm telling them exactly what to do/give, I shouldn't think that would be an issue.
Ya. It’s actually quite helpful doing ICU intubations to have them push meds.
 
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I sometimes find myself having to wrestle the induction meds away from a ICU/ED nurses on the rare occasion I’m helping in those units. It’s pretty standard, at least where I work, for RNs to push induction meds under physician direction in those settings, like every other medication administered in the hospital outside of the OR.

As long as anesthesiologist is standing right there and telling them exactly what and how much, I see no problem here.

Now if there is a specific policy they have in place that precludes this from happening, however stupid it may be, then that’s on him.
 
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Depends on bylaws and state law
Typically Ok to delegate to a nurse as long as you’re immediately available and take full responsibility
 
Looks more like a personality clash and dispute between the nurse and anesthesiologist.

nurse won. doctor lost.

surprise surprise.
 
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Nurse “cant” push meds at direction of anesthesiologist during induction.
Probably “cant” mask the patient either
Probably “can’t” draw up code dose epi
Next up, “cant” do chest compressions

^ I’ve heard and seen all of these first hand. Some nursing cultures just suck simple as that.



Anyway the subtext of this article is this guy tried to make a big fuss out of a disagreement with the charge nurse and got canned for it. Legitimate safety concern or not regarding nursing culture, probably best to resolve these things internally or gtfo if you can’t problem solve something as simple as this.
 

The article isn't entirely clear. A guy directed a circulating nurse to administer propofol to a pediatric patient in a surgery center? That is wild if true.
He sounds egotistical and bat**** crazy. He sounds like a complete bully.
I am trying to picture a pediatric anesthesiologist working alone and how they would mask induce and start the IV and push drugs. I mean if someone objects can have them screw in the drugs to the port and remove them one by one folllowed by another from the head of the bed.
If the manager doesn’t want this done at their facility and they don’t allow it then it can’t and shouldn’t happen.
 
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I’ve never seen an EM physician or a pulmonologist push their own meds for induction/intubation. They put an order in and the nurse pushes meds when everyone is ready. I can’t imagine ever asking a nurse to push my meds but why is it allowed in ER and ICU but not in OR? Circulators can’t read mls on a syringe?
 
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I wish I had a ‘I can’t do that because I feel uncomfortable’ card.
 
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It sounds like he made a series of bad decisions and then decided to double down on them and then triple down and escalate to the state oversight level, which put the facility at risk. So firing seemed a reasonable expectation to me. Having said that, he may have a real case for retaliation and they may have to settle, especially after alleging that he’s a threat to the public. That sounds like the kind of allegation that won’t stand up to scrutiny yet will irreparably damage his reputation. That adds a zero to the ask. I also would never have said I was going to retire in 2 years. The plan would have been retire in 10 years…
Having said that, outside of an emergency or PICU/NICU emergent airways, I don’t recall a nurse pushing drugs for me, and I do my own cases often. The icu and perhaps the ED as well, excepting a true emergency, probably skirts this problem by placing orders for intubation drugs into the system that the nurses simply executes when instructed. I’m sure this dude just gave them verbal orders and expected them to blindly comply. That almost certainly is not allowed at their facility. It’s not at mine, and a planned induction isn’t an emergent situation where verbal orders may be permitted.
The better question is what made this guy snap and start having OR nurses push drugs in routine situations? I’m sure he’s been there a while, pushing his own meds like the rest of us.
Maybe he’s been covering CRNAs for years and is now a victim of understaffing and he doesn’t feel comfortable practicing alone? Sad state of affairs if true.
 
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On second thought I don’t push all my own meds. Since I don’t have three hands, the nurse pushes the bupivicaine for me during my blocks. There's more trust involved in pushing bupivicaine than propofol since they need to aspirate adequately and not inject under high pressures. The nurse injecting the bupivicaine isn’t following any written order either - just my immediate verbal instruction.
 
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If he was retiring soon, he was probably a dinosaur that hadn’t learned anything new in 30 years that people generally disliked - bad and slow with blocks, overly rigid and obstructionist. It sounds like they wanted to get rid of him before all this happened.

I did lol at their argument for economic damages being “he hasn’t learned anything new so he is unemployable elsewhere.” Incompetent much?
 
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If he was retiring soon, he was probably a dinosaur that hadn’t learned anything new in 30 years that people generally disliked - bad and slow with blocks, overly rigid and obstructionist. It sounds like they wanted to get rid of him before all this happened.

I did lol at their argument for economic damages being “he hasn’t learned anything new so he is unemployable elsewhere.” Incompetent much?
Ding Ding Ding!!
Harvard Medical School 1982.
 
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Clark was terminated by Northbank for “protected behavior which was taken for the purpose of protecting public safety,” according to the suit, which seeks $1.63 million in damages.
Ah ok. I interpreted that as he was illegally retaliated against for engaging in a “protected” behavior, not that he himself was a threat to public safety.
 
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If he was retiring soon, he was probably a dinosaur that hadn’t learned anything new in 30 years that people generally disliked - bad and slow with blocks, overly rigid and obstructionist. It sounds like they wanted to get rid of him before all this happened.

I did lol at their argument for economic damages being “he hasn’t learned anything new so he is unemployable elsewhere.” Incompetent much?

If his name weren't published, I'd find it plausible that it could have been almost any Boomer anesthesiologist I've worked with.
 
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If he was retiring soon, he was probably a dinosaur that hadn’t learned anything new in 30 years that people generally disliked - bad and slow with blocks, overly rigid and obstructionist. It sounds like they wanted to get rid of him before all this happened.

I did lol at their argument for economic damages being “he hasn’t learned anything new so he is unemployable elsewhere.” Incompetent much?
medical-doctors-anaesthesiologist-operation-surgery-medical-CC124814_low.jpg
 
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I’ve never seen an EM physician or a pulmonologist push their own meds for induction/intubation. They put an order in and the nurse pushes meds when everyone is ready. I can’t imagine ever asking a nurse to push my meds but why is it allowed in ER and ICU but not in OR? Circulators can’t read mls on a syringe?
Because we are anesthesiologists and have four arms!!!
 
If his name weren't published, I'd find it plausible that it could have been almost any Boomer anesthesiologist I've worked with.
Ok mental illness. I mean millenial.
 
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Ok mental illness. I mean millenial.
The irony in boomers hating the millennial generation is that your generation raised us. You raised us, taught us, and created the environments that we grew up in. So what kind of a world did you choose to create?
 
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Ah ok. I interpreted that as he was illegally retaliated against for engaging in a “protected” behavior, not that he himself was a threat to public safety.
Just because they SAID he was a threat to public safety doesn’t make it true. Nearly every time that somebody is illegally canned by a corrupt organization, the reason given is “patient safety“.
 
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You will get “pretty bad” too, whippersnapper!

Probably not. The people I’m think of aren’t just not up to date, but of general low intelligence. Their bodies are also diseased with obesity and sarcopenia making them even less useful. I suppose its always possible I could suffer a freak TBI or CVA, but it’s not likely.
 
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Probably not. The people I’m think of aren’t just not up to date, but of general low intelligence. Their bodies are also diseased with obesity and sarcopenia making them even less useful. I suppose its always possible I could suffer a freak TBI or CVA, but it’s not likely.
personal life melting down, divorce, depression, alcohol, or just hanging on too long gets a fair number of former A-players.
 
I'll probably regret getting in the middle of a boomer vs millennial slap fight, but I'll just throw out the data point that mid-1990s residency grads had a sub-50% board pass rate.

There actually is a cohort of statistically inferior anesthesiologists who are approaching 30 years in practice ...

:)
 
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I'll probably regret getting in the middle of a boomer vs millennial slap fight, but I'll just throw out the data point that mid-1990s residency grads had a sub-50% board pass rate.

There actually is a cohort of statistically inferior anesthesiologists who are approaching 30 years in practice ...

:)
I'm just here lurking, reading all these comments and laughing and appalled at that statistic.
 
I'll probably regret getting in the middle of a boomer vs millennial slap fight, but I'll just throw out the data point that mid-1990s residency grads had a sub-50% board pass rate.

There actually is a cohort of statistically inferior anesthesiologists who are approaching 30 years in practice ...

:)
Thank god. That's Generation X. I was worried there for a minute.
 
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I'll probably regret getting in the middle of a boomer vs millennial slap fight, but I'll just throw out the data point that mid-1990s residency grads had a sub-50% board pass rate.

There actually is a cohort of statistically inferior anesthesiologists who are approaching 30 years in practice ...

:)
Genuinely curious…in the mid 90s was board certification required to maintain hospital privileges like it is almost everywhere these days?
 
Genuinely curious…in the mid 90s was board certification required to maintain hospital privileges like it is almost everywhere these days?
Except for academic programs, nope.
At regular old community hospitals, Board certification was crafted as a merit badge of distinction. The phrase was a “consultant” It was never intended to be a “minimum standard” although that is what has evolved into.
 
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Except for academic programs, nope.
At regular old community hospitals, Board certification was crafted as a merit badge of distinction. The phrase was a “consultant” It was never intended to be a “minimum standard” although that is what has evolved into.
Thanks. So once there became a pressing need to pass, people actually started studying for the board exam and/or the passing threshold was lowered cause you can’t have 50% of graduates not be able to maintain hospital privileges.
 
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I'll probably regret getting in the middle of a boomer vs millennial slap fight, but I'll just throw out the data point that mid-1990s residency grads had a sub-50% board pass rate.

There actually is a cohort of statistically inferior anesthesiologists who are approaching 30 years in practice ...

:)


Mid 90s graduates entered a very bad job market. Many “desirable” practices were offering 110-120k starting salaries and endless partnership tracks. Med students took notice so anesthesia programs had a hard time attracting qualified applicants starting in the mid 1990s. Early 2000s actually had the lowest pass rates but it recovered by the late 2000s.





IMG_1582.jpeg



 
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Genuinely curious…in the mid 90s was board certification required to maintain hospital privileges like it is almost everywhere these days?
No


The mid-90s slump was a result of catering interest in anesthesiology, during the Clinton years when the CRNA boogeyman first reared its head. The job market sucked, and med students stayed away. Programs didn't fill, and would take any desperate applicant no matter how bad.


Mid 90s graduates entered a very bad job market. Many “desirable” practices were offering 110-120k starting salaries and endless partnership tracks. Med students took notice so anesthesia programs had a hard time attracting qualified applicants starting in the mid 1990s. Early 2000s actually had the lowest pass rates and it recovered by the late 2000s.

View attachment 386119



You're right, I misremembered the timing of the worst results.

ABA said:
From 1994 to 1998, the overall pass rate on the ABA written examination varied from 61 percent-71 percent. In 2000, however, along with the lowest number of candidates, the written examination pass rate sunk to a nadir of 46 percent, climbing back to 55 percent in 2001 and then to 62 percent in 2002. Those who passed the written examination experienced similar overall oral examination pass rates to prior years 70 percent-74 percent for the period between 1997 and 2002 with a consistent pass rate between 79 percent-83 percent for the subset of new American medical graduates.
 
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Probably not. The people I’m think of aren’t just not up to date, but of general low intelligence. Their bodies are also diseased with obesity and sarcopenia making them even less useful. I suppose its always possible I could suffer a freak TBI or CVA, but it’s not likely.
Low intelligence but they have doctorate degrees?
Diseased with obesity? Less useful?
Do you have some type of High Functioning Autism?
 
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Low intelligence but they have doctorate degrees?
Diseased with obesity? Less useful?
Do you have some type of High Functioning Autism?

Someone of apparent general low intelligence denies that someone with a doctorate degree can be of low intelligence. Two lines down he accuses someone with a doctorate degree of having an intellectual disability. This is the kind of stupid Boomer sh1t I'm talking about. I doubt he/she will be able to wrap his/her head around the irony even with me spelling it out.
 
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Someone of apparent general low intelligence denies that someone with a doctorate degree can be of low intelligence. Two lines down he accuses someone with a doctorate degree of having an intellectual disability. This is the kind of stupid Boomer sh1t I'm talking about. I doubt he/she will be able to wrap his/her head around the irony even with me spelling it out.
Who the hell told you I was a Boomer?
Clearly you don’t know what a High Functioning autistic person is because there are plenty of physicians and people with PhDs who have this condition. And it is not an intellectual disability as some have very high IQs; they are just socially awkward poor communicators can’t read social cues.
So no you don’t need to spell it out to me to see the irony of anything Boomer Offspring. 😂😂😂😂

But you are right. I was wrong. But clearly the physician with low intermittence here is you based on your response to me. 🤣🤣
 
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we often have nurses push meds here at the direction of anesthesiologist.
when we block , we often have them push the meds
as long as we tell them exactly how many ml to push, i dont see what the problem is. they do it everywhere else. in other places they often dont do it infront of the physician...

when i order 50mcg of fentanyl, i assume the pacu nurse knows how to give it, without anesthesiologist standing next to them watching.

what the charge nurse did was ridiculous n my opinion
 
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I’ve never seen an EM physician or a pulmonologist push their own meds for induction/intubation. They put an order in and the nurse pushes meds when everyone is ready. I can’t imagine ever asking a nurse to push my meds but why is it allowed in ER and ICU but not in OR? Circulators can’t read mls on a syringe?
Visiting from EM… when I started the policy was that the docs HAD to push sedation meds, the nurses could not. It was very odd as the docs are literally not empowered to give a PO Tylenol or zofran and we never give any other medications. After a while we were able to persuade the sedation committee that it wasn’t always practical for us to give meds, for example if we are also doing the procedure we are sedating for, so now the nurses are allowed and generally give the meds.

Most of our procedures are short .. a shoulder reduction with one dose of etomidate or a short peds procedure with one dose of ketamine. When we do longer procedures (generally ortho for ankle or hip reductions) typically I just have myself, the ortho and one RN so I will go over with the nurse prior to starting the sedation, how much we will bolus to start and how much extra we will give PRN boluses and what the concentration is.. so it is smooth during the procedure if the nurse is holding the foot for ortho or I am, we both will be capable to quickly give another dose if needed. I only push meds in about 1/20 sedations though.

Idk why your circulators wouldn’t be allowed to give meds as ordered by the physician?
 
Doing a block is the only time I would consider having anyone else push drugs for me ever. Maybe in a really bad laryngospasm and I don't have a free hand...

Otherwise no one is touching my stuff...
I do 80% cardiac and icu. Lots of sick people and periarrest situations. Especially in those, no one is touching my stuff, or my patients... They would kill them
 
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I'll probably regret getting in the middle of a boomer vs millennial slap fight, but I'll just throw out the data point that mid-1990s residency grads had a sub-50% board pass rate.

There actually is a cohort of statistically inferior anesthesiologists who are approaching 30 years in practice ...

:)
I followed those stats fairly closely. I believe that the oral board pass rate for one year was something like 56%. I don’t think it went lower than that and it recovered quickly back to normal (high 80s and low 90s). The ABA did not change the expectations or lower the bar to adjust for the seemingly lower quality candidates who were entering the specialty at the time, and the pass rates reflected that dip in quality of the pool of candidates.
The standardized test passing game is also very different now. It’s big business and Q-banks and hand held devices make it possible to study in much more efficient ways than were available back in the day. So it is a very different world compared to that time. That being said, I believe the candidates that I work with who are of a significantly younger generation than myself are significantly smarter than I am. However, I think there are also many things that are different for them, some good and some bad. With the duty hours rules, they get significantly more time off now and a far better work life balance than the older generations. When you arrive in the work force and suddenly are forced to work 100 hour weeks when you’re used to 60, it can be eye opening. But today’s residents must deal with so much useless stuff as well such as logging everything and so much data entry of rubbish. They have protocols that they are not allowed to vary from. For good or bad, they don’t get to be as adventurous and learn as many outside the box techniques. They’ve got duty hours, milestones, and all kinds of other stuff that turns into busy work data entry. Often, they don’t get autonomy until after they graduate (that can be both a good and bad thing). There also new stressors such as the idea that you can graduate med school and not get a residency program…at all. That happens to many who are bottom quartile or don’t choose wisely based upon how competitive they are. Students frequently no longer have ways to distinguish themselves as quality students as med schools have gone to great lengths to try and hide their worst students by going to pass fail and now with step scores doing the same. Many Dean‘s letters do a very good job making a 4th quartile student look like middle of the road.
So, if believe that, even with certain things to try to make a trainee’s life better, the younger generation actually has it worse, with more stressors and wash out points that can occur. With Q banks and grade inflation on standardized exams, it raises the bar significantly so that the old “average” is no longer good enough. People have to fight to over achieve in order to make the cut. The ramifications of NOT doing that can be graduating and not having a job. I’ve seen it happen way too many times. I think it was extremely rare 2-3 decades ago.
So, I think the younger people are extremely bright and have to deal with a lot of things that the olders never did.
Then there is the fact that the older generation sold out to private equity and killed opportunities for the younger generation.
So, each generation has their own goods and bads and it isn’t as simple as saying whippersnappers vs boomers and being a clear cut difference with one being better than the other. It’s just a totally different pathway.
 
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