"Dallas anesthesiologist convicted of $10M healthcare fraud"

[Carbocation1]

http://crimeblog.dallasnews.com/201...-guilty-in-10-million-health-care-fraud.html/

"A Dallas anesthesiologist who submitted bogus payment claims — including one when he was actually under anesthesia for surgery himself — has been found guilty of bilking millions from the U. S. government ."

http://www.beckershospitalreview.co...of-10m-healthcare-fraud-5-things-to-know.html

"In one case, a nurse anesthetist couldn't reach Dr. Toussaint because he was "asleep in bed," and as a result she was "forced to do a difficult and dangerous central line through the central artery in a patient's neck without needed assistance."'

---

Members don't see this ad.

 

[gasp]

"In one case, a nurse anesthetist couldn't reach Dr. Toussaint because he was "asleep in bed," and as a result she was "forced to do a difficult and dangerous central line through the central artery in a patient's neck without needed assistance."'

lol. Very entertaining. Thanks..

 

[pgg]

"In one case, a nurse anesthetist couldn't reach Dr. Toussaint because he was "asleep in bed," and as a result she was "forced to do a difficult and dangerous central line through the central artery in a patient's neck without needed assistance."'

Interesting technique!

 

[criticalelement]

"t she was "forced to do a difficult and dangerous central line through the central artery in a patient's neck without needed assistance."'
.

Forced by whom?

 

[Doctor4Life1769]

Lol through the central artery.

 

[Chloroform4Life]

I don't understand, was that a typo or did she inadvertently catheterized an artery while trying to do a central line?

 

[criticalelement]

She basically put the line in the carotid artery and the patient stroked out most likely. How is the blame on the physician who is in bed?

We couldnt find the surgeon so the nurse did the bowel resection and the patient died.. The nurse was forced to do it.

 

[pgg]

She basically put the line in the carotid artery and the patient stroked out most likely. How is the blame on the physician who is in bed?

We couldnt find the surgeon so the nurse did the bowel resection and the patient died.. The nurse was forced to do it.

I don't think that's much of a defense. If you're a physician on call to provide emergency services and the hospital can't find you (you're asleep, pager batteries are dead, drunk, 200 miles away, etc) then there's a non-dismissible argument that the physician has some liability.

I used to know a locums who'd overlap his call shifts at two hospitals (no reason other than greed). All fun & games until he started at hospital B with several hours left on his hospital A shift, and then A called him for an emergency. He was fired on the spot and someone from group A scrambled in to do the case, but you can't tell me that clown shouldn't have been liable for a bad outcome if the partner hadn't happened to be available.

Doesn't excuse the nurse going solo, but that's a separate issue.

 

[WholeLottaGame7]

I don't understand, was that a typo or did she inadvertently catheterized an artery while trying to do a central line?

Could have been a complication, or it could have just been a very layman's explanation of a central line. Who knows.

 

[criticalelement]

I don't think that's much of a defense. If you're a physician on call to provide emergency services and the hospital can't find you (you're asleep, pager batteries are dead, drunk, 200 miles away, etc) then there's a non-dismissible argument that the physician has some liability.
.

You would have to prove that in a court of law. Phones, pagers, etc malfunction all of the time. If a nurse is trying to call me and my phone is not going off(for whatever reason) how is that on the physician. If there is a bad outcome it would be difficutl to pin it on the physician. Sure you can fire him but thats about it.

 

[urge]

You would have to prove that in a court of law. Phones, pagers, etc malfunction all of the time. If a nurse is trying to call me and my phone is not going off(for whatever reason) how is that on the physician. If there is a bad outcome it would be difficutl to pin it on the physician. Sure you can fire him but thats about it.

So if you turn your pager off, then you are not liable for anything?

Good to know.

 

[Planktonmd]

A central line through the "central artery" could indeed be very dangerous especially when the poor anesthesia nurse is forced to do it, but... wait... aren't they supposed to be as good or better than physicians???
Why would they need a greedy physician to hold their hand while doing a procedure well within the scope of their training?

 

[criticalelement]

So if you turn your pager off, then you are not liable for anything?

Good to know.

Not sure.

But i know if i called you for an emergency and for some reason your phone was not functioning properly (for whatever reason) are you responsible for a 25 million dollar lawsuit?

 

[urge]

Not sure.

But i know if i called you for an emergency and for some reason your phone was not functioning properly (for whatever reason) are you responsible for a 25 million dollar lawsuit?

Is AT&T then responsible for the 25 million?

 

[leaverus]

So if you turn your pager off, then you are not liable for anything?

Good to know.

is deliberately turning off your pager a malfunction? I think the point was that it would be difficult to prove there wasn't a true technological malfunction. I'm not a lawyer but I would think if there was an honest good faith effort to contact the physician and they truly didn't receive said attempts for reasons out of their control then they shouldn't be liable; of course that would be unusual since most people these days have several different ways of being contacted.

 

[Ignatius J]

There is much more to the story here.

Google "Forest Park Medical Center".

He essentially opened up the initial one in Dallas. It was physician-owned. Expanded to other big Texas cities based on him selling a bill of goods. The one in San Antonio never got off the ground and declared bankruptcy. Not sure if the one in Austin even had enough money to complete. Lot of doctors have lost money based on taking the hook here.

Oh, and of course he billed fraudently in Dallas too. Guy seems like a true piece of work.

 

[Spinach Dip]

it could have just been a very layman's explanation of a central line.

This.

Who really thinks the American media knows the differnce between an artery and a vein? Or cares? When there is a story about greedy doctors stealing millions, little details (like anatomy and terminology) get brushed to the side.

 

[Random Anesthesiologist]

nurse-anesthetist.org running usual lip service about "SEE!! We are SO much better than MDs!!"

Yet fail to see the irony in the CRNA funk up. Oh, typical.


Sent from my iPad using SDN mobile

 

[Doctor4Life1769]

How did the CRNA not know how to place the central line?
What does this mean for the CRNAs in opt-out states? Don't have surgery there.

 

[pgg]

How did the CRNA not know how to place the central line?
What does this mean for the CRNAs in opt-out states? Don't have surgery there.

The central line problem is a minor issue in practice. If the surgeon knows the CRNA can't do it, and the surgeon thinks one might be needed, the surgeon just pre-emptively places one before scrubbing for the case. I saw this happen a number of times at my old opt-out-state moonlighting job.

Also ... the value of a central line for an emergency is overblown. A couple of 16-18 g peripheral IVs are adequate for transfusion and volume resuscitation in the vast majority of cases, and actually superior to central lines that don't have lumens measured in French. PIVs can be used (with care) to give vasopressors and other drugs that we might prefer to give via the central circulation. CVP monitoring is practically useless. It's a rare patient that really needs a neck line.


The real problem in this vein of procedure competence, is that a majority of CRNAs are not facile with regional anesthesia other than spinals and sometimes epidurals. That's not something the surgeon can step in to do. There are times when patients clearly would benefit from regional techniques. In those cases, the patients just get general anesthesia, oh well! One can argue that there is scant evidence that regional is ever provably superior to GA ... but I think most of us would agree that a patient who gets GA instead of regional, when regional is indicated but the provider lacks the skill, is getting a disservice.

 

[aneftp]

The guy was already loaded. Worth millions. Married into a lot of money. We aren't talking 2-3 million here. He was probably worth 20-25 million.

Just greed.

 

[Doctor4Life1769]

The central line problem is a minor issue in practice. If the surgeon knows the CRNA can't do it, and the surgeon thinks one might be needed, the surgeon just pre-emptively places one before scrubbing for the case. I saw this happen a number of times at my old opt-out-state moonlighting job.

Also ... the value of a central line for an emergency is overblown. A couple of 16-18 g peripheral IVs are adequate for transfusion and volume resuscitation in the vast majority of cases, and actually superior to central lines that don't have lumens measured in French. PIVs can be used (with care) to give vasopressors and other drugs that we might prefer to give via the central circulation. CVP monitoring is practically useless. It's a rare patient that really needs a neck line.


The real problem in this vein of procedure competence, is that a majority of CRNAs are not facile with regional anesthesia other than spinals and sometimes epidurals. That's not something the surgeon can step in to do. There are times when patients clearly would benefit from regional techniques. In those cases, the patients just get general anesthesia, oh well! One can argue that there is scant evidence that regional is ever provably superior to GA ... but I think most of us would agree that a patient who gets GA instead of regional, when regional is indicated but the provider lacks the skill, is getting a disservice.

I agree that central lines aren't something that is needed emergently. 16-18g PIVs are better. However, perhaps they couldn't get one in. You're also right in that surgeons can do the central lines. However, it is well within their (CRNA) scope to perform a central line and if they can't then that's an issue.

 

[Vandalia]

I don't understand, was that a typo or did she inadvertently catheterized an artery while trying to do a central line?

Most likely a direct quote from the prosecutor in opening/closing arguments attempting to explain things to the jury.

 

[IlDestriero]

A central line through the "central artery" could indeed be very dangerous especially when the poor anesthesia nurse is forced to do it, but... wait... aren't they supposed to be as good or better than physicians???
Why would they need a greedy physician to hold their hand while doing a procedure well within the scope of their training?

That's a good defense. Hire a couple ultra militant CRNAs to testify as CRNA expert witnesses.


--
Il Destriero

 

[bigeyedfish]

The guy was already loaded. Worth millions. Married into a lot of money. We aren't talking 2-3 million here. He was probably worth 20-25 million.

Just greed.

Multiples of that. I've heard estimates in the 100's of millions as the amount he extracted from the Forrest park fiasco. A lot of investors lost a lot of money. And yet he still felt the need to commit billing fraud.

 

[deleted171991]

Multiples of that. I've heard estimates in the 100's of millions as the amount he extracted from the Forrest park fiasco. A lot of investors lost a lot of money. And yet he still felt the need to commit billing fraud.

Old habits die hard?

 

[Doctor4Life1769]

Old habits die hard?

I'm sure it can be addicting. There's an element of rush behind these actions.