Dr Death

[ethilo]

http://www.dmagazine.com/publications/d-magazine/2016/november/christopher-duntsch-dr-death/

Just wanted to ask the anesthesiology folks here about cases like these. It can be easy for us to identify a surgeon with poor outcomes, you can watch it all from a couple feet away.

But how does am anesthesiologist go about confronting issues like these? As patient safety advocates, are we able to be heard?

Also, how does anesthesia culpability work in a case with unexpected massive blood loss as caused by the surgeon's techniques? If you're trying the best you can to keep up with resuscitation but falling behind despite your best efforts, can you be found at fault of the person had a stroke like one of this guy's patients?

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[WholeLottaGame7]

http://www.dmagazine.com/publications/d-magazine/2016/november/christopher-duntsch-dr-death/

Just wanted to ask the anesthesiology folks here about cases like these. It can be easy for us to identify a surgeon with poor outcomes, you can watch it all from a couple feet away.

But how does am anesthesiologist go about confronting issues like these? As patient safety advocates, are we able to be heard?

Also, how does anesthesia culpability work in a case with unexpected massive blood loss as caused by the surgeon's techniques? If you're trying the best you can to keep up with resuscitation but falling behind despite your best efforts, can you be found at fault of the person had a stroke like one of this guy's patients?

Ha! Was going to post something very similar.

Here's the follow-up if anyone is interested: http://www.dmagazine.com/frontburne...the-fate-of-neurosurgeon-christopher-duntsch/

As to your last question, absolutely. Every physician in the chart will be named in the suit. The hope would be that they would be able to figure out who is primarily responsible.

Your first question is harder to answer. I think realistically from my position, if I had concerns about a surgeon, I would take it to my department chief and have him take it up with the surgical chief. +/- also going straight to the state medical board depending on how egregious it is.

I would also think radiologists would be in a unique position to comment on his surgical technique, since they get to see the sequelae post-operatively.

Also, can we talk a minute about how his "childhood friend" went and partied and did cocaine all night with this guy AND THEN LET THE GUY OPERATE ON HIM!?!?

 

[aneftp]

There are a lot of more details in the case and outside factors going on here. The news doesn't report it.

 

[teacher2md]

There are a lot of more details in the case and outside factors going on here. The news doesn't report it.

Ooooh.... Do tell!

 

[aneftp]

Ooooh.... Do tell!

Most people in Dallas area especially in north Dallas suburbs are familiar.

Surgeons aren't bad surgeons. No one makes it that far being a "bad surgeon". Hint: why do doctors do bad things?

"
But prosecutors argued that Duntsch had 17 years of extensive training and research behind him and knew exactly what he was doing with all the patients whose surgeries he botched.

That includes Efurd, who had surgical hardware misplaced inside her body that caused permanent damage.

"He chose not to get help," prosecutor Michelle Shughart said. "He chose to continue maiming and killing patients."

Read in between the lines and it's very obvious.

http://www.dallasnews.com/news/cour...rately-botch-surgeriesdallas-jury-deliberates

 

[Man o War]

The concept of a bad surgeon is interesting. I think a surgeon can be technically skilled but have terrible judgment. This can be disastrous even with talented hands. They can be technically sound but slow as s@@t.
2 kids/cohabitating with a stripper..... Clearly he had bad judgment in and outside the OR. Curious if he was like this before the drugs.

 

[aneftp]

He's already has his own Wikipedia webpage

"According to court documents, he was suspected of being under the influence of cocaine while operating during his fourth year of residency. He was sent to an impaired physicians program and then he was allowed to return to his residency program.[10]

https://en.m.wikipedia.org/wiki/Christopher_Duntsch

 

[Noyac]

To address the question of how anesthesiologists address these issues, I would only say that in my practices these issues were usually brought to the group's attention by surgeons. Also, as a partner, you see how your other partners pts do when rounding post-op and in PACU. If issues arise that are addressible then we try to remedy them. This is difficult because we all think we are doing our best. So outcomes start to matter. If someone's outcomes are not up to par then that needs to be addressed. This usually, also comes from medical staff since some poor outcomes will go to a Peer Oversight committee. If a physician has more cases in this committee than the usual, then this is addressed. The bottom line is that there are many avenues of physician oversight. None are to be overlooked.

 

[mikey014]

Curious what kind of outcomes are we looking at ... Aside from turnover time, poor nursing communication/professionalism, icu admissions, and major postop complications (reintubations, post op stroke, post op mi's).. . I can't think of many other issues that would be brought up to a peer oversight committee.

To address the question of how anesthesiologists address these issues, I would only say that in my practices these issues were usually brought to the group's attention by surgeons. Also, as a partner, you see how your other partners pts do when rounding post-op and in PACU. If issues arise that are addressible then we try to remedy them. This is difficult because we all think we are doing our best. So outcomes start to matter. If someone's outcomes are not up to par then that needs to be addressed. This usually, also comes from medical staff since some poor outcomes will go to a Peer Oversight committee. If a physician has more cases in this committee than the usual, then this is addressed. The bottom line is that there are many avenues of physician oversight. None are to be overlooked.

 

[Noyac]

Curious what kind of outcomes are we looking at ... Aside from turnover time, poor nursing communication/professionalism, icu admissions, and major postop complications (reintubations, post op stroke, post op mi's).. . I can't think of many other issues that would be brought up to a peer oversight committee.

Some of those things are handled by the group and some by Peer Review.
The best way to put it is, if it effects pt outcomes to a serious degree then it goes to peer review.

 

[aneftp]

We all know the spine business is big money. Hospitals will turn a blind eye. They want the revenue. Heck. My buddy in Dallas told me last week how much he COLLECTS OUT OF NETWORK for anesthesia services. 50 plus units per case (they all due creative billing routine ultrasounds for A line, surgeon requested hypotension to pad the billing units, no AMC). Like 24-25 units just to start the case. They collect more than double what the "efficient AMC" can collect out of network. Texas is just crazy like that. Just need 1-2 of those spine cases out of network a month 15k per case (anesthesia collection alone out of network).

So just imagine what type of revenue the hospital collects from that spine surgeon. And that's why they just ignore his history.

 

[nimbus]

We all know the spine business is big money. Hospitals will turn a blind eye. They want the revenue. Heck. My buddy in Dallas told me last week how much he COLLECTS OUT OF NETWORK for anesthesia services. 50 plus units per case (they all due creative billing routine ultrasounds for A line, surgeon requested hypotension to pad the billing units, no AMC). Like 24-25 units just to start the case. They collect more than double what the "efficient AMC" can collect out of network. Texas is just crazy like that. Just need 1-2 of those spine cases out of network a month 15k per case (anesthesia collection alone out of network).

So just imagine what type of revenue the hospital collects from that spine surgeon. And that's why they just ignore his history.

In my area insurers won't pay for ultrasound for Alines. Guess you can try to bill whatever you want out of network. Texas is TEXAS

Even so, its hard to ignore disastrous outcomes in your first couple cases at a new place.

 

[Gas you down]

wow just read it. seems like $ makes some overlook a lot or just not look at all.

 

[Pooh & Annie]

wow just read it. seems like $ makes some overlook a lot or just not look at all.

Plus people don't expect someone who seems to have done extremely well up to now to be a nut job. There must've been a lot of disbelief and confusion about why everything this guy was doing was so catastrophically stupid.

 

[Southpaw]

We all know the spine business is big money. Hospitals will turn a blind eye. They want the revenue. Heck. My buddy in Dallas told me last week how much he COLLECTS OUT OF NETWORK for anesthesia services. 50 plus units per case (they all due creative billing routine ultrasounds for A line, surgeon requested hypotension to pad the billing units, no AMC). Like 24-25 units just to start the case. They collect more than double what the "efficient AMC" can collect out of network. Texas is just crazy like that. Just need 1-2 of those spine cases out of network a month 15k per case (anesthesia collection alone out of network).

So just imagine what type of revenue the hospital collects from that spine surgeon. And that's why they just ignore his history.

I'm just going to point this out, since this is a public forum, read potentially by you know, the public, along with trainees, but if the day comes where I can't pay my bills and save for retirement without doing everything you mentioned, I'll just go do something else. After all, I do try and sleep each night with my conscience intact.

However, I do agree with your statement that spine surgery is big money, for the hospital and for instrument companies more than anyone. And I guess for the surgeon and anesthesiologist if they're purposefully staying out of network.

And I agree that people tend to look the other way with regard to 'what's best for the patient' when big money comes into play.

I'm no saint, and I've seen some doctors without the highest moral standard in my time in private practice, but I want no part of any type of practice you describe. Which shouldn't be a problem I guess as I'll never work in Texas.

FYI I don't know of a spine surgery with 24-25 start units. Unless you're including all the nonsensical crap that your buddy is including to pad the bill, which insurers rightfully chuckle at and don't pay for in my area. But perhaps your buddy has no problem passing that 'not covered by insurance' part of the bill along to the patient.

Please don't take my rant as an insult to you personally. I just get extremely annoyed when doctors make the choice to practice medicine without a moral compass.

And I do see the irony of my post in a thread in which a doctor was found guilty of purposefully harming patients.

 

[Dr. Death]

Keep my name outchyo mouth

 

[leaverus]

After all, I do try and sleep each night with my conscious intact.

I try to do most things with my conscious intact. Except sleep.

 

[deleted126335]

Dr. Death got life in prison.

http://www.foxnews.com/health/2017/...gets-life-in-prison-over-botched-surgery.html

 

[Psai]

Keep my name outchyo mouth

Put some respek on it

 

[aneftp]

The hospital credentialing and vetting process failed here as well.

Wonder those who credentialed him will get off easily?

Someone who "recommended" him for privilege could and should be sued as well. It happened in the South a few years ago with MD who recommend a colleague. Knowing full well colleague had drug issue. We all don't want to talk bad about a fellow colleague. But cannot endanger patients lives.

So becareful when u are listed as a reference.

My friend hospital (hospital employee position). Brand New hospital was about to hire an anesthesiologst . Contract signed etc. but references were honest and said this doc panic under stressful situations. Cannot be the lead MD etc. so they axed her credentialing process.

 

[anbuitachi]

From what i hear, one big spinal fusion case is about 100k.

 

[Mman]

all I can say to those suggesting the hospitals make a killing on the spine cases...not necessarily. Our hospital ran off several spine surgeons because they were losing money (on average) for every fusion they did. Why? Because the hospital is the one buying all the hardware the surgeon is putting in. I mean sure they can generate lots of billing from it, but what they collect depends on who is paying the bill (private insurer vs CMS) and profit margin depends on how much they spent on everything. For plenty of procedures the hospital is only collecting a flat fee and when those patients end up in patient for several days to a week afterwards it generates additional costs that don't get reimbursed at all. I saw the numbers myself. Now don't get me wrong, we still have spine surgeons, just not as many as before and the ones we still have operate in a little bit more of a financially conservative fashion from the hospital point of view.

Spine surgery is most profitable for the spine surgeon. From an anesthesia standpoint we also do pretty well for the most part. Hospital is far more hit or miss since they are the ones eating the cost of everything.

 

[Timeoutofmind]

all I can say to those suggesting the hospitals make a killing on the spine cases...not necessarily. Our hospital ran off several spine surgeons because they were losing money (on average) for every fusion they did. Why? Because the hospital is the one buying all the hardware the surgeon is putting in. I mean sure they can generate lots of billing from it, but what they collect depends on who is paying the bill (private insurer vs CMS) and profit margin depends on how much they spent on everything. For plenty of procedures the hospital is only collecting a flat fee and when those patients end up in patient for several days to a week afterwards it generates additional costs that don't get reimbursed at all. I saw the numbers myself. Now don't get me wrong, we still have spine surgeons, just not as many as before and the ones we still have operate in a little bit more of a financially conservative fashion from the hospital point of view.

Spine surgery is most profitable for the spine surgeon. From an anesthesia standpoint we also do pretty well for the most part. Hospital is far more hit or miss since they are the ones eating the cost of everything.

EXACTLY
A lot of hospitals lose a lot of money on all sorts of surgeries where the pt has crappy insurance.
I am involved with this in detail a little at my own employment currently and was shocked

 

[Man o War]

all I can say to those suggesting the hospitals make a killing on the spine cases...not necessarily. Our hospital ran off several spine surgeons because they were losing money (on average) for every fusion they did. Why? Because the hospital is the one buying all the hardware the surgeon is putting in. I mean sure they can generate lots of billing from it, but what they collect depends on who is paying the bill (private insurer vs CMS) and profit margin depends on how much they spent on everything. For plenty of procedures the hospital is only collecting a flat fee and when those patients end up in patient for several days to a week afterwards it generates additional costs that don't get reimbursed at all. I saw the numbers myself. Now don't get me wrong, we still have spine surgeons, just not as many as before and the ones we still have operate in a little bit more of a financially conservative fashion from the hospital point of view.

Spine surgery is most profitable for the spine surgeon. From an anesthesia standpoint we also do pretty well for the most part. Hospital is far more hit or miss since they are the ones eating the cost of everything.

Yep. Vascular has been a huge money suck at every place I've worked too.

 

[Mman]

Yep. Vascular has been a huge money suck at every place I've worked too.

the problem for a hospital with some surgeries is how much money the stuff costs. All those rods and screws spine surgeons put in aren't the same as the ones you buy at Home Depot, they can cost $10-20K or much more per surgery.

If you want a hospital turning a big profit on surgeries, find one with a good payor mix doing lots of bread and butter cases on patients that go home and don't end up in the ICU afterwards.

 

[nimbus]

If you want a hospital turning a big profit on surgeries, find one with a good payor mix doing lots of bread and butter cases on patients that go home and don't end up in the ICU afterwards.

I believe that's called a surgicenter.