BIll CLintons mother's incompetence

[maceo]

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http://www.mail-archive.com/[email protected]/msg32159.html


This is what we are trying to prevent... sad that 2 un suspecting citizens were tragically a victim of such incompetence and negligence

 

[omniatlas]

Scary.

 

[Idiopathic]

Still, its a 20 year old story, and every one of us will probably have a case like this, if we practice long enough (although hopefully we wont argue at deposition how we can read the racing form and deliver anesthesia).

 

[maceo]

Still, its a 20 year old story, and every one of us will probably have a case like this, if we practice long enough (although hopefully we wont argue at deposition how we can read the racing form and deliver anesthesia).

You think if you can practice long enough you will have 2 young girls die under anesthesia during elective operations? CMON dude .. do you really believe that?

 

[Idiopathic]

i did say a case and one thing im learning is not to throw stones because i dont really know how protected my glass house is. essentially you are saying that incompetence led to an aspiration event and or a failed airway and i think that argument is hard to make because any of us could end up in that situation.

i understand you are trying to take rhetoric and make it applicable to this debate but it could just as easily be so-and-so MD in that article. ive met plenty that I wouldnt trust to take care of me or my family.

 

[omniatlas]

Still, its a 20 year old story, and every one of us will probably have a case like this, if we practice long enough (although hopefully we wont argue at deposition how we can read the racing form and deliver anesthesia).

Anyone here have actual numbers?

I wouldn't want the death of anyone under my conscience (the biggest deciding factor if I should go into gas or not).

 

[lushmd]

Anyone here have actual numbers?

I wouldn't want the death of anyone under my conscience (the biggest deciding factor if I should go into gas or not).

Then avoid clinical medicine altogether.

 

[omniatlas]

Then avoid clinical medicine altogether.

You're probably well aware anaesthesiology service provider(s) have (as outlined by the OP article) a natural propensity to be squarely blamed for the death of a patient because of the autonomy they have in practice.

 

[SleepIsGood]

i did say a case and one thing im learning is not to throw stones because i dont really know how protected my glass house is. essentially you are saying that incompetence led to an aspiration event and or a failed airway and i think that argument is hard to make because any of us could end up in that situation.

i understand you are trying to take rhetoric and make it applicable to this debate but it could just as easily be so-and-so MD in that article. ive met plenty that I wouldnt trust to take care of me or my family.

Difference though is an anesthesiologist would not ventilate a patient for a long period of time. An anesthesiologist, unlike a CRNA, would recognize rather quickly the ETT is not in the a/w and rather in the esophagus.

That's the difference. The CRNA (Bills mother in this case) put the tube in and then kicked back and relaxed and looked at her racing magazine. THATS the gross negligence. This case should be broadcasted nationally, since she is the one responsibe for Bill creating that law that favored CRNA on his last days of office.....

 

[Idiopathic]

Difference though is an anesthesiologist would not ventilate a patient for a long period of time. An anesthesiologist, unlike a CRNA, would recognize rather quickly the ETT is not in the a/w and rather in the esophagus.

That's the difference. The CRNA (Bills mother in this case) put the tube in and then kicked back and relaxed and looked at her racing magazine. THATS the gross negligence. This case should be broadcasted nationally, since she is the one responsibe for Bill creating that law that favored CRNA on his last days of office.....

an amazing statement. i get that you guys hate nurses but your reasoning will have to get a little bit less linear or the nurses wont have much trouble winning all the arguments.

 

[pgg]

Difference though is an anesthesiologist would not ventilate a patient for a long period of time. An anesthesiologist, unlike a CRNA, would recognize rather quickly the ETT is not in the a/w and rather in the esophagus.

You know, I really can't agree with this.

I've got no elective ASA 1 intraop deaths on my scorecard to date, but I'm not so smug in my superiority to think I'll never ever bump someone off through simple error, tunnel vision, bad judgment, or anything else that will turn out to be unequivocally, totally, preventably, inexcusably, my fault.

I don't think this is a productive or valid line of criticism for CRNAs in general.

 

[GoodmanBrown]

You're probably well aware anaesthesiology service provider(s) have (as outlined by the OP article) a natural propensity to be squarely blamed for the death of a patient because of the autonomy they have in practice.

Wait, so you don't want to be blamed for a patient's death? Or you don't want to cause it? Either way, you're screwed, IMHO.

 

[Arch Guillotti]

Difference though is an anesthesiologist would not ventilate a patient for a long period of time. An anesthesiologist, unlike a CRNA, would recognize rather quickly the ETT is not in the a/w and rather in the esophagus.

This is idiotic.

This is not a physician versus nurse issue.

I know someone who had an unrecognized esophageal intubation during a hectic code while in residency. He's a great guy and a great physician.

 

[hoyden]

Difference though is an anesthesiologist would not ventilate a patient for a long period of time. An anesthesiologist, unlike a CRNA, would recognize rather quickly the ETT is not in the a/w and rather in the esophagus.

That's the difference. The CRNA (Bills mother in this case) put the tube in and then kicked back and relaxed and looked at her racing magazine. THATS the gross negligence. This case should be broadcasted nationally, since she is the one responsibe for Bill creating that law that favored CRNA on his last days of office.....

How would you know what actually happened there? You were not there to start with...
the story reminds me an old kid's game "the dead phone"...

If you trust whatever is written in the media you should be ashamed.

This has nothing to do with MD/CRNA issue.

 

[jwk]

You know, I really can't agree with this.

I've got no elective ASA 1 intraop deaths on my scorecard to date, but I'm not so smug in my superiority to think I'll never ever bump someone off through simple error, tunnel vision, bad judgment, or anything else that will turn out to be unequivocally, totally, preventably, inexcusably, my fault.

I don't think this is a productive or valid line of criticism for CRNAs in general.

Agreed - and let's remember, almost nobody was using EtCO2 monitoring in 1981 (Emory did it with a mass spec), and pulse oximetry didn't come along till a couple years after that. The young pups here have no idea how good they've got it, and most couldn't do an anesthetic without their monitors.

 

[proman]

Agreed - and let's remember, almost nobody was using EtCO2 monitoring in 1981 (Emory did it with a mass spec), and pulse oximetry didn't come along till a couple years after that. The young pups here have no idea how good they've got it, and most couldn't do an anesthetic without their monitors.

That's a little unfair. ASA 1s aren't routinely getting boxed now either.

 

[jwk]

That's a little unfair. ASA 1s aren't routinely getting boxed now either.

I didn't say they were. I said most couldn't do an anesthetic without their monitors - it would be too far outside their comfort zone. A few of us are old enough to remember doing it without monitors except for a bouncing ball EKG.

 

[pgg]

Agreed - and let's remember, almost nobody was using EtCO2 monitoring in 1981 (Emory did it with a mass spec), and pulse oximetry didn't come along till a couple years after that. The young pups here have no idea how good they've got it, and most couldn't do an anesthetic without their monitors.

Well, that's like saying a young whippersnapper like you couldn't keep a horse & buggy in the middle of a muddy rut-riddled country road ... 🙂

I think we're all well aware of the safety and technological strides the field has made. Just because we've never used methoxyflurane or a copper kettle doesn't mean we don't know how good we've got it.

In general though I agree we should be cautious about casting stones and appling modern standards to cases that occured 30 years ago. That said, she was reading a racing form, whatever that is. If that was considered 'OK' by most people back then, I've got a bucket of rocks for those old buggy-driving farts.

 

[jwk]

Well, that's like saying a young whippersnapper like you couldn't keep a horse & buggy in the middle of a muddy rut-riddled country road ... 🙂

I think we're all well aware of the safety and technological strides the field has made. Just because we've never used methoxyflurane or a copper kettle doesn't mean we don't know how good we've got it.

In general though I agree we should be cautious about casting stones and appling modern standards to cases that occured 30 years ago. That said, she was reading a racing form, whatever that is. If that was considered 'OK' by most people back then, I've got a bucket of rocks for those old buggy-driving farts.

Jeez, I feel old, since we used both MOF and copper kettles at Grady in the late 70's.

Old or new, one should be able to recognize esophageal intubations quickly, fancy monitors or no. BTW, I assume the racing form she was reading would be for horse racing - checking the odds, etc.

 

[proman]

Jeez, I feel old, since we used both MOF and copper kettles at Grady in the late 70's.

Old or new, one should be able to recognize esophageal intubations quickly, fancy monitors or no. BTW, I assume the racing form she was reading would be for horse racing - checking the odds, etc.

Well, you are old.😉 Why have those new-fangled monitors become mandatory? Because people simply couldn't recognize goosed tubes quickly enough without them. Patients suffered. It's not saying that the current crop of anesthesiologists are weaker clinically (which is what you implied).

 

[hoyden]

Well, you are old.😉 Why have those new-fangled monitors become mandatory? Because people simply couldn't recognize goosed tubes quickly enough without them. Patients suffered. It's not saying that the current crop of anesthesiologists are weaker clinically (which is what you implied).

I do not think so. I think he simply can compare the situations ( as can I, though I have never seen the copper kettle or MOF )))) - you could get aspiration because of esophageal intubation if you have a full stomach very quickly - just with one or two squeezes of the bag in order to listen where you are ( the only way to confirm placement at that time and even later and even NOW - in other places on this planet). The case described was clearly a full stomach on a girl with a trauma. Why didn't she suction the stomach( or did she) before changing the nasotracheal tube to ETT is a bigger question than her racing form ( clearly she was reading one before the disaster occurred). It is also easy to apply the standards of modern life to the time which most of the involved in the discussion remember not by providing anesthesia 🙂 I have provided anesthesia not at that time but in the ORs where the only monitors were your stethoscope, your watch, your eyes and your fingertips. Plus and old fashioned BP cuff which you had to inflate yourself. Nothing else. If one had a single trace ECG it was considered a lot. You can not judge the way anesthesia is provided in such environment from nowadays point of view.

 

[omniatlas]

Wait, so you don't want to be blamed for a patient's death? Or you don't want to cause it? Either way, you're screwed, IMHO.

Definitely don't want to be in this guys shoes:

Old article --

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9D06E3DC1330F937A15753C1A960958260&fta=y

Anesthesiologist Found Negligent in Boy's Death