Cosmetic Surgery Leaves Thornton Teen Brain Damaged

[AdmiralChz]

Heart of a nurse!

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[deleted500612]

This is strange, because typically (as someone who admittedly has gotten plastic surgery), the patient pays for the anesthesia and certainly one can ask for an anesthesiologist - they tried this switch and bait on me. I specifically asked for an anesthesiologist, was told yep. then on day of procedure the anesthesiologist comes and tells me "Ms so and so will be at the procedure." I was like ummm no. I specifically said and demand and anesthesiologist. He tells me - is there something I can tell you to change your mind? I was thinking - while he doesn't know I am a physician, I won't feel bad when so many of you are out of work as you are doing this to yourselves. I obviously said no - anesthesiologist or I go home. They surely got me an anesthesiologist within about 10 minutes.
So it's not to save money. The plastic surgeon does not eat the costs - the patient pays. Typically a lot of these procedures are an hour to a few hours long- so it typically increases the bill a few thousand which the patient pays.

A lot of cosmetic plastic surgery practices do office-based surgeries, not even utilizing a surgicenter. The cosmetic plastics guys I know have a procedural suite in their office and contract a CRNA to come in for their OR days. According to the article, this operation was done at the plastic surgery office, so they likely have a similar arrangement. One could not just request an anesthesiologist on the spot in such a circumstance as there isn't even one in the building or on call. Either way, using an anesthesiologist is going to result in a higher cost to the patient, which may drive away business to a different practice in town that uses cheaper CRNAs and thus would likely still lower the surgeon's profits indirectly. Almost all of these types of practices will typically contract CRNAs rather than anesthesiologists to lower the cost. Let's face it, a lot of patients do not really know the difference, or are susceptible to being easily reassured by the surgeon into thinking a CRNA will provide equivalent care.

 

[Piebaldi]

A lot of cosmetic plastic surgery practices do office-based surgeries, not even utilizing a surgicenter. The cosmetic plastics guys I know have a procedural suite in their office and contract a CRNA to come in for their OR days. According to the article, this operation was done at the plastic surgery office, so they likely have a similar arrangement. One could not just request an anesthesiologist on the spot in such a circumstance as there isn't even one in the building or on call. Either way, using an anesthesiologist is going to result in a higher cost to the patient, which may drive away business to a different practice in town that uses cheaper CRNAs and thus would likely still lower the surgeon's profits indirectly. Almost all of these types of practices will typically contract CRNAs rather than anesthesiologists to lower the cost. Let's face it, a lot of patients do not really know the difference, or are susceptible to being easily reassured by the surgeon into thinking a CRNA will provide equivalent care.

Yes I am aware of this as I've had both -in office and at surgicenter and no, typically the patient pays for anesthesia, not the cosmetic practice. Granted I can understand if this practice worked this way but it's not the typical thing. Also anesthegiolosits and CRNAs in this case typically get charged the same - for example in the example I gave I paid x amount, and initially they assigned me a CRNA but I had asked for an anesthesiologist which they later switched to.
For procedures that are office based, typically it is only local anesthesia, it's not general, so no anesthesiologist/CRNA is needed. A lot of procedures are done this way - lipos, face lifts, etc. So yes in this situation you can't get an anesthsia/CRNA provider, but one is not needed.
But I agree the scenario above sounds like a nightmare.
I agree with the lawsuit and those people shoulld lose their license - both the CRNA and potentially the surgeon. Complete negligence.

 

[Mikkel]

- Again ROSC is achieved, patient is sent to PACU "I'm sure she'll wake up eventually and be fine, lets just watch her for 5 hours and see what happens"

I don't think so, surgery center PACUs almost certainly don't have an anesthesia machine or ventilator. The patient was almost certainly kept in the operating room.

I bet that most of the staff there in pre-op and PACU had no idea anything truly horrific going on until closer to 911 call time.

 

[Mikkel]

Line 45 says he wasn’t present in the first 15 min she’s under GA. I take it as he induced and then left the room.

Line 52-53 says the nurse reenter the room 15 min later and found pt was blue. Then they start monitoring the pt

So..no one was in the room and no monitor the first 15 min she’s under GA

Airway, breakroom, coffee.

Lips and face blue, spreading to periphery.

Anaphylaxis (didn't mention antibiotics or paralytics)? Latex dust?

Inhalational overdose? EtSevo% of 8%?

Undiagnosed cardiac abnormality? No coroner report available.

Desflurane used in a desiccated absorber and carbon monoxide poisoning? Wouldn't she still be pink?

Esophageal intubation? Unlikely, no mention of reintubation. Cause of ROSC was tied to chest compressions, not airway manipulation.

Documented start of 2:00pm and return of staff at 2:15pm. A little too precise, nothing runs on time like that. Probably inaccurate paper charting, anoxia and hypotension could have been a lot longer.

Hypoxic mixture? Maybe low quality maintenance. Anesthesia machine safety checks not followed. No O2 sensor functional.



In the end it doesn't matter because there was obvious patient abandonment.

 

[Shimmy8]

This makes me physically angry. Like anger seeping through my body reading that text.

 

[Mikkel]

Very often these self pay plastic surgery cases are lump sum packaged deal which includes the surgery and the anesthesia. There is definitely an incentive for the surgeon to try to skimp and save money at the patients peril. We learn from day 1 that off site anesthesia is potentially the most dangerous place to be.

A young healthy patient! A vegetable. This malpractice case is worth a hundred million dollars.

This CRNA deserves more than a slap on the wrist for such egregious deviation from the standard of care. Should lose license permanently. Should be made to pay with his bank account and house. Criminal charges should be seriously considered.

Manslaughter

Fraudulent misrepresentation


I don't know if patient abandonment counts for criminal penalty.

 

[emergentmd]

My 4 yr old had caps placed in the dentists office under moderate sedation. Thank God it was an anesthesiologist. My kid closed down, hard to bag, Sats dropped down to the 50's.

He was difficult to intubate but he did get it, and my kid did well. I was getting close to getting up and trying it myself.

If it was a CRNA, would they freak out and kill my kid?
If it was a NP, how the hell would they know to even intubate? The dentist surely would have no clue.

Atleast I would be able to intubate my kid. what if the NP/CRNA couldn't secure his airway and the parents would just be sitting there watching all this mess? The dentist surly was freaking out, told me this has never happened before in his 10+ yrs practice.

All it takes is one time.

 

[ShockIndex]

Honestly, I’d consider going after the entire practice for false imprisonment if I were the DA and see what shakes loose.

It goes like this - a reasonable person would want to be taken to the hospital after a cardiac arrest event. Holding her in the office for 5 hours in an attempt to cover their tracks can be reasonably assumed to be against her consent and likely resulted in further injury.

Colorado "false imprisonment" laws |18-3-303 C.R.S.

 

[Mikkel]

Remember some people here used to say ASA 1 patients could theoretically be handled by CRNAs independently?

TBH I think the colorado Board of nursing and AANA should also be sued here. They talk big about independent practice CRNAs. Well here you go. This is what happens. Horrible judgement leads to horrible outcome.

Class action would be better fit for this, at the national level, against the AANA. Get all the patients ever injured in the care of a nurse anesthetist. Sue the AANA for false advertising, misrepresentation.

 

[XRanger]

Really wondering what they’re thinking/doing for the 5 hours that she’s just lying on the OR table. And the fact that they’re trying to hide it from the family makes it even worse.

 

[DrOwnage]

The first problem was trusting someone named Rex.

I laughed way too hard at this (combined with your profile picture), the neurosurgeons turned around over the drapes.

 

[coffeebythelake]

 

[AMEHigh]

Similar story.

Chula Vista Cosmetic Surgeon Sued Over Patient's Death

It was supposed to be a routine breast augmentation surgery, but it went horribly wrong and left a 35-year-old wife dead and her two young children motherless.

www.google.com

How sad. What’s with these cases and not calling 911 right away?

 

[AMEHigh]

And I know everyone gets mad about malpractice and how much the payouts are sometimes, but unfortunately there are some truly horrific things that happen in our profession and patients pay the price.

 

[Crabbygas]

Doubt it's possible but I would be totally on board with suing the nursing board as individuals on this. At the very least I hope some reporter asks the Governor on camera what he thinks of the boards work.

 

[nimbus]

How sad. What’s with these cases and not calling 911 right away?

My best guess is that there is cognitive dissonance and wishful thinking that the neurologic insult is not as bad as it actually is. That leads to watchful waiting and hoping that the patient wakes up intact. Tragically that strategy also leads to a delay in optimal post-arrest management (temp, BP, oxygenation, seizure prophylaxis, glucose) that could improve the outcome.

 

[Choo]

All that we know is what the lawyer filed; they make it sound as bad as possible. For all we know the anesthesia given could have been IV fluids; or oxygen; or just the anesthesia start time on the paper chart.

 

[Mikkel]

All that we know is what the lawyer filed; they make it sound as bad as possible. For all we know the anesthesia given could have been IV fluids; or oxygen; or just the anesthesia start time on the paper chart.

Very true. Bad documentation could give a terrible picture, even an incorrect one.

But I think they deposed enough staff to determine that neither the surgeon nor CRNA were in the room. Unless she circulating nurse wasn't documenting well enough too.



Bad documentation can screw you over.

Good documentation ain't gonna change a thing in a healthy ASA 1 braindead patient permanently crippled through whatever negligence you committed.

 

[emergentmd]

All that we know is what the lawyer filed; they make it sound as bad as possible. For all we know the anesthesia given could have been IV fluids; or oxygen; or just the anesthesia start time on the paper chart.

I am sure there is 2 sides for every story as these health professionals can not be that incompetent. But Waiting 5 hrs Post arrest hoping she wakes up CAN NOT be explained.

Literature is very clear about post arrest care and how it can improve outcome esp in the young/healthy. Who knows what was going on with her body for 4-5 hrs while they prayed she wake up and then sweep the whole incident under the rug.

 

[Ho0v-man]

I think the scariest part of all of this is the question of how many times have they effed up epically like this and gotten away with it somehow.

 

[rightonn_dude]

Unreal.

 

[Ronin786]

I wonder if they forgot to turn on the ventilator. That or unrecognized esophageal.

No excuse for leaving the room.

 

[dabears505]

Could it have been some sort of block in a bay with vascular injection or a big pneumo and after the block, everyone left and then came back when it was time to go to OR to find her blue?

 

[Mikkel]

Could it have been some sort of block in a bay with vascular injection or a big pneumo and after the block, everyone left and then came back when it was time to go to OR to find her blue?

Local anesthetic toxicity definitely possible. Right location for it. And she's probably low weight and easy to overdose. I doubt they'd do it in pre-op, it would have been done in the OR under general anesthesia.

Tension pneumothorax possible, but no mention of therapies done to address it, unlikely to fix itself.

 

[Mikkel]

How about this:

CRNA has more than one patient asleep at a time. (Billing rules "don't matter" when everything is cash upfront.) CRNA, circulating nurse, scrub nurse, and surgeon are all absent from the second room... because they have another case to finish up in a different room.

Once one case is done, surgeon, nurse, and scrub move to next case while CRNA wakes up the previous patient.


It would be a hell of a way to run a "jump room" with just one set of room staff. It could work logistically, but not ethically, safely, or honestly. When $$$ is on the line, maybe those lines got crossed?

 

[dabears505]

Local anesthetic toxicity definitely possible. Right location for it. And she's probably low weight and easy to overdose. I doubt they'd do it in pre-op, it would have been done in the OR under general anesthesia.

Tension pneumothorax possible, but no mention of therapies done to address it, unlikely to fix itself.

Im wondering like paravertebrals in a preop bay. That seems most logical. Like why would everyone just leave the or? If they were all gonna take a break, why induce?

 

[Mikkel]

 

[sevo00]

Remember some people here used to say ASA 1 patients could theoretically be handled by CRNAs independently?


Class action would be better fit for this, at the national level, against the AANA. Get all the patients ever injured in the care of a nurse anesthetist. Sue the AANA for false advertising, misrepresentation.

i am totally onboard with this idea. A class action lawsuit should be filed against the AANA for false advertising and risking patient lives. What is the next step in beginning this process?

 

[Mikkel]

Im wondering like paravertebrals in a preop bay. That seems most logical. Like why would everyone just leave the or? If they were all gonna take a break, why induce?

The office of Colorado Aesthetic & Plastic Surgery includes comfortable waiting areas and procedure rooms that are warm and inviting. In addition, there is an on-site surgical suite and a recovery center.

Most procedures are performed in Dr. Kim's office which means that you are comfortable, relaxed and home before you know it. Here, a dedicated team of professionals work diligently to give you their undivided attention. This is a personal experience, from your first phone call to your follow up visits!

Dr. Kim has built his exclusive office based on his extensive experience. You will always know who will be taking care of you – a professional team which includes Dr. Kim’s own Anesthesia Personnel, a Registered Nurse for your recovery, a Certified Surgical Technologist, and a Medical Assistant not to mention the friendly faces at the Front Desk.





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Not really well equipped or well staffed at all.

Scary.

 

[Mad Jack]

The first problem was trusting someone named Rex.

I exclusively allow myself to be operated on people named Rex whose last names evoke gun manufacturers

 

[dpmd]

I would just like to add that on my general surgery rotation one of the general surgeons was in a room down the hall in clinic doing cosmetic cases including breast augmentations under local only, or if the patient paid extra then with "sedation" but no anesthesia provider at all. I made sure to stay the hell away. The **** these cosmetic folks pull is amazingly shady.

 

[deleted59964]

... a surgeon who can perform adequate intercostal blocks, and a combination of midaz/prop/ketamine (note: no opiates).

no details here, only conjecture - but that certainly opens up a wider differential for cause of arrest

 

[pgg]

i am totally onboard with this idea. A class action lawsuit should be filed against the AANA for false advertising and risking patient lives. What is the next step in beginning this process?

Wait for the next victim to be the child of a person with eight figures of disposable cash to throw at lawyers.

 

[pgg]

you seriously think someone would do paravertebrals for office based anesthesia?

A while back I did some 4:1 PRN work at a surgicenter where one of the CRNAs got bent because he wanted to do the interscalenes for the day and I said no, I'll do them. He talked a good game about his experience but then just said he took a "course" to learn ultrasound guided blocks. Toxic place. I quit after a few days.

I totally believe he's got a clownish twin out there doing paravertebrals in plastic surgery offices after some YouTube how-to browsing.

 

[Mikkel]

Wait for the next victim to be the child of a person with eight figures of disposable cash to throw at lawyers.

Fortunately, they would have the resources and intellect to realize an anesthesiologist would be the safer and better option compared to a solo CRNA in some dingy plastic surgery "office".

 

[linkin06]

“Every second every beat that I’m not on break”

 

[ambiturner]

professional team which includes Dr. Kim’s own Anesthesia Personnel, a Registered Nurse for your recovery, a Certified Surgical Technologist, and a Medical Assistant

They list the state board credentials of everyone there, except the ‘anesthesia personnel’. That tells you all you need to know.

 

[dpmd]

Fortunately, they would have the resources and intellect to realize an anesthesiologist would be the safer and better option compared to a solo CRNA in some dingy plastic surgery "office".

Not necessarily, but they wouldn't be choosing a surgeon based on cost and therefore would likely find one who isn't trying to do things the cheapest possible way.

 

[Noyac]

In a previous gig of mine the crnas had a nasty habit of turning off all the alarms. They said it bothered the surgeons. I was on call late one night and had a morbidly obese chic with dead bowel and a piece of ****e IV. My plan was to get her off to sleep and quickly place something more substantial. So I induced her, intubated, gave a couple breaths and went into IV access mode. I forgot to flip the ventilator on. Luckily i got an IV quickly and looked up at the monitors. Her Sats were 60’s. That took maybe 2min. I quickly realized what had happened and bagged her back up. My point is, maybe the monitor alarms were off and Rex forgot to turn on the vent before he stepped out of the room for 15 min. Nobody in the room was aware because there were no alarms going off to notify them. Therefore, no need to reintubate but too late to recover from the event.
This is all speculation of course and we won’t know the details for a long while or maybe never.
BTW, I immediately notified the group President the next day of what happened and made sure the nurses never turned off the alarms again.

 

[Mikkel]

In a previous gig of mine the crnas had a nasty habit of turning off all the alarms. They said it bothered the surgeons. I was on call late one night and had a morbidly obese chic with dead bowel and a piece of ****e IV. My plan was to get her off to sleep and quickly place something more substantial. So I induced her, intubated, gave a couple breaths and went into IV access mode. I forgot to flip the ventilator on. Luckily i got an IV quickly and looked up at the monitors. Her Sats were 60’s. That took maybe 2min. I quickly realized what had happened and bagged her back up. My point is, maybe the monitor alarms were off and Rex forgot to turn on the vent before he stepped out of the room for 15 min. Nobody in the room was aware because there were no alarms going off to notify them. Therefore, no need to reintubate but too late to recover from the event.
This is all speculation of course and we won’t know the details for a long while or maybe never.
BTW, I immediately notified the group President the next day of what happened and made sure the nurses never turned off the alarms again.

45. Defendant Meeker did not remain present in the operating room for the first fifteen minutes
that Ms. Nguyen was under general anesthesia.
46. Employees of Defendant Kim/CAPS, including Defendant Hubert, did not remain present
in the operating room for the first fifteen minutes that Ms. Nguyen was under general anesthesia.
47. Defendant Kim was not present in the operating room for the first fifteen minutes that Ms.
Nguyen was under general anesthesia.
48. After the start of anesthesia, Ms. Nguyen was left unobserved in the operating room.
49. Defendant Meeker failed to properly observe and monitor Ms. Nguyen while she was under
general anesthesia.
50. Employees of Defendant Kim/CAPS also failed to properly observe and monitor Ms.
Nguyen while she was under general anesthesia.
51. Defendant Kim failed to properly observe and monitor Ms. Nguyen while she was under
general anesthesia.
52. At approximately 2:15 p.m., fifteen minutes after the start of anesthesia, employees of
Defendant Kim/CAPS re-entered the operating room.
53. At approximately 2:15 p.m., employees of Defendant Kim/CAPS discovered that Ms.
Nguyen’s lips and face were blue and that cyanosis was quickly spreading to her upper extremities
and torso.
54. Upon discovering Plaintiff in a cyanotic state, Defendant Meeker and employees of
Defendant Kim/CAPS began vital sign monitoring and discovered that Ms. Nguyen was
bradycardiac and was in asystole/cardiac arrest.
55. Defendant Meeker and employees of Defendant Kim/CAPS, including Defendant Hubert,
did not immediately attempt to resuscitate Ms. Nguyen.
56. Defendant Kim entered the operating room and began cardiopulmonary resuscitation with
chest compressions.

----------

There were no alarms because the monitors were never on / never placed.

54. Upon discovering Plaintiff in a cyanotic state, Defendant Meeker and employees of
Defendant Kim/CAPS began vital sign monitoring and discovered that Ms. Nguyen was bradycardiac and was in asystole/cardiac arrest.


"She's young and healthy, she'll be fine."

 

[dpmd]

I wonder if it was truly general anesthesia with no one in the room, or if it was that she got some versed premedication and then after she got on the table everyone stepped out to grab stuff thinking someone else would stay (not that that would be good, but at least it would not be criminal to my mind)

 

[ProRealDoc]

Assuming the details are even remotely correct, this is the kind of case malpractice attorneys salivate over.

I should have been an attorney

 

[ProRealDoc]

tube in the goose?

 

[Man o War]

This story has now made national headlines...and as I peruse the comments, I see the “anesthesiologist” and “physicians” who were there being blamed. And the articles clearly state this individual was a nurse anesthetist.
HELLO ASA. We need a sweeping public information campaign that nurses are administering anesthesia without a qualified doctor present to supervise, and that they are nurses, not doctors. They are maiming and killing healthy people with their lesser training and the law allows it.
Stop wasting time and money on this physician anesthesiologist BS and just lay it out there. I’d gladly donate generously to the ASA for such a campaign, and I’m positive many of my colleagues would as well.

 

[IlDestriero]

And I doubt he'd leave the room for 15 minutes with an unsecured airway. Nobody is that stupid.

And the article makes no mention of airway problems.

Someone is that stupid apparently.

 

[Bryan O’Blivion]

This story has now made national headlines...and as I peruse the comments, I see the “anesthesiologist” and “physicians” who were there being blamed. And the articles clearly state this individual was a nurse anesthetist.
HELLO ASA. We need a sweeping public information campaign that nurses are administering anesthesia without a qualified doctor present to supervise, and that they are nurses, not doctors. They are maiming and killing healthy people with their lesser training and the law allows it.
Stop wasting time and money on this physician anesthesiologist BS and just lay it out there. I’d gladly donate generously to the ASA for such a campaign, and I’m positive many of my colleagues would as well.

Indeed. A good rejoinder to the AANA “We are the answer” campaign. They are definitely the answer to the question of “What the heck happened here?”

 

[Man o War]

Indeed. A good rejoinder to the AANA “We are the answer” campaign. They are definitely the answer to the question of “What the heck happened here?”

I would also like to ask them if they are going to make sure and run to the defense of this plastic surgeon since they claim the “captain of the ship”is bogus when it comes to med mal. By that line of thinking this surgeon should be free and clear since the anesthesia and related complications are all on the CRNA?

 

[Vandalia]

I would also like to ask them if they are going to make sure and run to the defense of this plastic surgeon since they claim the “captain of the ship”is bogus when it comes to med mal. By that line of thinking this surgeon should be free and clear since the anesthesia and related complications are all on the CRNA?

This would almost certainly be considered res ipsa loquitur and not defensible. That was why the nurse was included in the suit.

If it was a debate over - throwing something out here - the use of zofran and QT prolongation, he could argue that it was exclusively the purview of the CRNA, but likely not this scenario. Assuming what is provided in the complaint is true, and everyone reading this should know that is not always the case.

 

[PieOHmy]

45. Defendant Meeker did not remain present in the operating room for the first fifteen minutes
that Ms. Nguyen was under general anesthesia.
46. Employees of Defendant Kim/CAPS, including Defendant Hubert, did not remain present
in the operating room for the first fifteen minutes that Ms. Nguyen was under general anesthesia.
47. Defendant Kim was not present in the operating room for the first fifteen minutes that Ms.
Nguyen was under general anesthesia.
48. After the start of anesthesia, Ms. Nguyen was left unobserved in the operating room.
49. Defendant Meeker failed to properly observe and monitor Ms. Nguyen while she was under
general anesthesia.
50. Employees of Defendant Kim/CAPS also failed to properly observe and monitor Ms.
Nguyen while she was under general anesthesia.
51. Defendant Kim failed to properly observe and monitor Ms. Nguyen while she was under
general anesthesia.
52. At approximately 2:15 p.m., fifteen minutes after the start of anesthesia, employees of
Defendant Kim/CAPS re-entered the operating room.
53. At approximately 2:15 p.m., employees of Defendant Kim/CAPS discovered that Ms.
Nguyen’s lips and face were blue and that cyanosis was quickly spreading to her upper extremities
and torso.
54. Upon discovering Plaintiff in a cyanotic state, Defendant Meeker and employees of
Defendant Kim/CAPS began vital sign monitoring and discovered that Ms. Nguyen was
bradycardiac and was in asystole/cardiac arrest.
55. Defendant Meeker and employees of Defendant Kim/CAPS, including Defendant Hubert,
did not immediately attempt to resuscitate Ms. Nguyen.
56. Defendant Kim entered the operating room and began cardiopulmonary resuscitation with
chest compressions.

----------

There were no alarms because the monitors were never on / never placed.

54. Upon discovering Plaintiff in a cyanotic state, Defendant Meeker and employees of
Defendant Kim/CAPS began vital sign monitoring and discovered that Ms. Nguyen was bradycardiac and was in asystole/cardiac arrest.


"She's young and healthy, she'll be fine."

Typically once you deliver Oxygen to a Hypoxic cardiac arrest, the situation miraculously improves.. THis story is sooo bizarre. Does not add up. IT's possible Meeker wasnt even there and they are scapegoating him. Even the most incompetent person could prevent something like this. Unless this guy's practice was soooo substandard that this would eventually happen.