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Family suing American Airlines over death of 25-year-old woman

Discussion in 'Anesthesiology' started by anbuitachi, Apr 26, 2018.

  1. anbuitachi

    anbuitachi ASA Member

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    An American Airlines passenger died after a flight during which a doctor allegedly asked crew for an emergency landing three times

    I think most of us have heard of how bad the medical equipments are on planes... most of the time it end up being ok, but it looks like AA is going to have to pay this time...

    I wonder if the doctor on the round will have any responsibility? Passing out and defecating on yourself is not normal, and without vitals i wonder how that ground doctor came to the conclusion of no emergent landing needed
     
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  3. sb247

    sb247 Doer of things

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    Th link didn’t mention a doc on ground overruling the passenger doc....did I miss that?
     
  4. anbuitachi

    anbuitachi ASA Member

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    Oops, I read a couple articles, didn't realize this one didn't address it

    One of the articles from fox mentioned "
    The doctor then spoke with the pilot about Oswell’s symptoms, but after consulting with another doctor on the ground, the pilot decided to continue on to their destination of Dallas-Forth Worth, which was still about 90 minutes away, the lawsuit claims."
     
  5. chocomorsel

    chocomorsel Senior Member
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    They gonna write a big fat paycheck!
    Filled with at least six zeros.
    Captain was an idiot for not listening to the doc on board.
    Poor lady. Good chance probably would have still died, but they didn’t offer her a chance. Guess they didn’t want to ruin their on-time quotas.
     
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  6. DocVapor

    DocVapor Big Schwartz
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    I was under the impression that ground doctors are the only ones with the authority to divert a plane for medical emergencies on board. Theoretically even Dr Oz couldn't demand the pilot land.
     
  7. sb247

    sb247 Doer of things

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    I'm completely dumbfounded a doc on the ground would dare contradict a doc literally laying hands on the patient about the need to land the plane.....that's all risk with almost no reward
     
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  8. sb247

    sb247 Doer of things

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    I don't think at all that the passenger (doc) can order the plane down.....but once a doctor is there saying you need to land, it's a cartoonish liability to be the guy overruling a doctor
     
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  9. DocVapor

    DocVapor Big Schwartz
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    Oh definitely.
     
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  10. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Diverting a flight is insanely expensive. Not saying this as a defense, but if they can settle for less than it would have cost to divert the plan then I can see the bean counters' logic.

    Doesn't make it right, but that's possible what happened here.
     
  11. anbuitachi

    anbuitachi ASA Member

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    I can't imagine them being able to settle for less than the cost of diverting a plane..
     
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  12. chocomorsel

    chocomorsel Senior Member
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    I mean, we can all figure that much out. Money talks. Capitalism at its finest.
     
  13. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    The genius on the plane who attributed slurring of speech and loss of consciousness to a panic attack is VERY lucky not to be named in the lawsuit.
     
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  14. anbuitachi

    anbuitachi ASA Member

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    I dont think they can be sued anyway. good samaritan right. otherwise itd be a huge liability to volunteer to help on a plane when you have like barely any equipments/meds. that's even more true for doctors who probably aren't familiar with this type of stuff like pathologists etc
     
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  15. eikenhein

    eikenhein my cat is awesome, his name is bandit
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    So no equipment or way to even check a blood pressure or pulse ox? Can only think this was due to hypoperfusion. That's ****ed up.
     
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  17. Man o War

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    I’m really curious what type of doctor this was on the plane. Panic attack???
    Derm maybe? Pathology? DNP??
     
  18. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    Good samaritan laws usually don't cover egregious malpractice.

    The law that applies in flight is the Aviation Medical Assistance Act of 1998.

    And bingo:
     
    #16 FFP, Apr 26, 2018
    Last edited: Apr 26, 2018
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  19. WholeLottaGame7

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    I dunno, hard to judge without being there. I've seen/heard of some weird symptoms from panic attacks. Had a lady just yesterday in ECT say how she would have one arm go numb during a panic attack.

    Passenger could have been back to baseline after the first episode and was saying "I'm fine, really, just keep going" for all we know.

    But you're correct, doesn't mean they couldn't be named in the lawsuit.
     
  20. anbuitachi

    anbuitachi ASA Member

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    wait arm going numb is not a weird symptom for panic attack. its very common
     
  21. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    Theoretically one could argue that hyperventilation can also lead to slurring of speech and loss of consciousness, but still... Unless the person had a history of similar panic attacks, I would have been suspicious, especially after 6 hours of flight.
     
  22. Mad Jack

    Mad Jack Critically Caring
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    Diverting a flight costs tens of thousands. A lawsuit like this will cost millions.
     
  23. WholeLottaGame7

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    I'm saying it's not unheard of for a panic attack to present with symptoms mimicking a neurological event.

    But agree with @FFP, I'd be pretty wary of calling it that without a history of similar events. Again, though, we don't know what exactly the story was on the plane.
     
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  24. pgg

    pgg Laugh at me, will they?
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    I don't get the impression the doctor on board ever talked to the doctor on the ground.

    I suspect the airline policy is for the pilot to do what the doctor on the ground says, as that is a person hired and vetted by the airline, as opposed to some random "doctor" on the plane.

    And who knows what the doctor on the ground was told?
     
  25. chocomorsel

    chocomorsel Senior Member
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    F that noise. That is why I will not be volunteering for any kind of assistance. Usually I am drunk and sleep on the long hauls anyway. Not fit to dx and treat for sure.

    It’s really sad that you just can’t help without the possibility of liability. I mean, we all make mistakes.
     
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  26. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    Agree. That's why I appreciate the family being grateful instead of looking for a scapegoat. I'm sure he will have PTSD for life.

    Although this should be a lesson for all of us: err on the side of defensive medicine.
     
    #24 FFP, Apr 26, 2018
    Last edited: Apr 26, 2018
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  27. Urzuz

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    I'm not a lawyer, but I am fairly certain that "mistake" and "gross negligence" are very different things in legal jargon. I believe it is very difficult to prove gross negligence unless you are doing something way outside the standard of care (not to say the patient's family's lawyer won't try arguing otherwise!). That being said, I don't think I could have it on my conscience if someone actually suffered from something preventable, and I was sitting a few rows down just watching it all unfold.

    I've helped out on a plane before and they did have a BP cuff, but it was a manual one. They also handed me a stethoscope akin to what you would give a three year old who wanted to play doctor. The POS stethoscope combined with the massive amount of noise while in the air made it impossible to hear the Korotkoff sounds for an accurate reading...getting a systolic by palpation was good enough though since the guy was awake and talking.
     
  28. FFP

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  29. anbuitachi

    anbuitachi ASA Member

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    True but it may not be as difficult when considering that not every doctor is trained in emergency airplane medicine. The question becomes should those ppl even volunteer? Obviously if theres someone whos more trained in these stuff like EM doc, hand it over to them instead of the dermatologist but what if there are no other doctors but the dermatologist?

    Wow you found it real quick
     
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  30. jwk

    jwk CAA, ASA-PAC Contributor

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    Correct - airlines have very specific policies and procedures for in-flight medical emergencies, and they generally contract with a company for exactly that purpose, and they're the ones who make the call. Remember - jet aircraft at cruising altitude take time to land. Even the Southwest flight that lost an engine a couple weeks ago took more than 20 minutes to land, and that was with an extreme dive necessitated by explosive decompression in the cabin. They're not going to make that kind of landing for a medical emergency - it will be far more controlled, and take longer. Honestly, if you have a cardiac arrest in flight, unless you can be defibrillated immediately, your survival chances are approaching nil. And let's not forget - there's no telling who is going to show up when the call goes out for "Is there a doctor on the flight?". Maybe an online DNP will turn up.
     
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  31. FFP

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    It's absolutely unacceptable that flights are not equipped with proper BLS & ACLS gear and meds. The necessary space and weight would be negligible (code bag).

    I hope AA loses big time.
     
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  32. drmwvr

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    Odd...well, can't really blame the ground physician of a major US airline carrier for not being suspicious. A DVT on a flight from Hawaii to the Mainland is pretty much unheard of....
     
    #30 drmwvr, Apr 26, 2018
    Last edited: Apr 26, 2018
  33. facted

    facted ASA Member

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    So you thinking in 10 hours, the patient develops a DVT and it dislodges? I've heard of plenty of patients getting DVTs from long flights. Never heard of one getting a PE from it while in flight.

    With that being said, given the patients state (passing out, vomitting, etc...) They clearly should have landed the plane early.
     
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  34. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Depending on the flight, can cost upwards of half a million. If the airline settles for 250k...
     
  35. coroner

    coroner Peace Sells...but who's buying?
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    Speaking as a pathologist who has less pt. contact than any other specialty i.e. zero, situations like this make me hesitant to assist even with the good Samaritan law. Because, once you are labeled with the title of "doctor", the majority of the public, family members, etc. does not make much of a distinction whether you're an ER doc vs a pathologist even though there's a world of difference in terms of training and capability. I would help if there's no one around who had a clue, but if they made an overhead announcement if there's any medical personnel on board to assist, I would absolutely defer to every other specialty out there and even a P.A. or nurse.

    Having said all that, even though I haven't seen a living patient in about 10 yrs, even I remember enough from med school and internship this isn't a panic attack...:confused:
     
  36. jwk

    jwk CAA, ASA-PAC Contributor

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    One of my first codes as a young EMT was a girl in her early 20s, smoker, on BCPs, just going about her normal daily routine. Still conscious but severe SOB when we arrived, coded loading her into our rig. Five minute transport to the hospital, coded her for two hours. Post was done on-site a few hours later. Huge saddle embolus. Not common, but it can happen.
     
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  37. chocomorsel

    chocomorsel Senior Member
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    If that was your family, would you accept 250k? Really?
    I wouldn’t. They were thinking about money and the inconvenience of an unscheduled landing instead of thinking of the possibility that someone could die.

    Bet if that someone was famous they would have landed. F that ****.
     
  38. chocomorsel

    chocomorsel Senior Member
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    I don’t know if you are being serious or joking. As fat and sedentary as people are these days, the possibility of a PE on a long haul flight can happen. Who knows how active this person was before she got on the plane. Could have had the DVT for days already and ignored it or didn’t know it. Could have already had small PEs already. Then the “Big one” like Sanford says.

    Oh yeah and like JWK said, chance of her being on OCPs, given her age, and if fat or smoking, well there you have it.

    Like I said, chance of her making it anyway would have been low. However what’s the price of human life? They should be at least more humane and tried to land and given her a better chance. LA to Dallas is at least a 2 hour flight.

    They need to pay.
     
    #36 chocomorsel, Apr 27, 2018
    Last edited: Apr 27, 2018
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  39. facted

    facted ASA Member

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    Not doubting at all she could have a PE and die quickly from it. My point though its not common for a patient to develop a DVT on a plane and on the same flight for it to dislodge and get a PE?! Not sure it matters, though. If a patient is having SOB and then starts vomitting, passing out etc... That's a medical emergency that requires landing.
     
  40. drmwvr

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    Well, she had to get to Hawaii in the first place, and she didn't walk.
     
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  41. drmwvr

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    Sarcasm doesn't come over these forums very well. I'll use an emoji next time.:laugh:
     
  42. chocomorsel

    chocomorsel Senior Member
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    I thought you were being funny. Yes, you gotta use faces.
     
  43. facted

    facted ASA Member

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    Sure. How many PEs have you heard of on an airplane?

    This study found an incidence of 5/1,000,000 for passengers traveling more than 6000 miles (required medical care in Paris upon arrival at airport). That's not exactly common.

    NEJM - Error
     
  44. drmwvr

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    Who cares where it happens? That doesn't change being suspicious for one. DVT's on long haul flights are very well described. What percentage of PEs are embolized DVT's?
     
  45. skankhunt42

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    There was a good NEJM article on in flight emerbgencies that discussed medicolegal stuff, epidemology etc.... NEJM - Error

    Things I took away:

    Good sumaritan should cover you- but remember, for this to be best it is important to deny all payments from the patient/ family. Don't even let them give you a bottle of wine.

    IF YOU HAVE HAD ONE DRINK DO NOT EVERY VOLUNTEER ON A FLIGHT. Practicing medicine having consumed alcohol even in an emergency will cause you to loose your license (if reported).
     
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  46. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    They were 6 hours into the flight. PE/stroke (with PFO) should have been on any doctor's mind.
     
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  47. facted

    facted ASA Member

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    Of course DVTs related to travel are well described. And of course PEs come from DVTs for the most part. However, that almost always happens after getting off the plane. PE on a plane is not common.

    5/1,000,000 passengers is not the top of the differential.

    Should you think about it in the differential? Sure. Should they have landed the plane? Absolutely.
     
  48. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    I doubt that's true. The risk of death and it's consequences is part of their calculations.
     
  49. chocomorsel

    chocomorsel Senior Member
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    Then why ignore a doctor on Board who’s evaluated the patient and is saying the plane needs to be diverted?
     
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  50. jwk

    jwk CAA, ASA-PAC Contributor

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    Because they're not the one who gets to make that decision. Again - every airline has a policy to deal with this exact issue, and is in contact with someone on the ground whose paid responsibility is to make that decision. The doc on board talked to the pilot, and there was a conversation with their ground-based medical director. Maybe they should have landed, maybe not. But that decision was not in the hands of the doctor on the plane, nor should it be. S/he sees one thing - a patient in distress. They have no idea where they are. They have no idea how long it will take to land. They have no idea how the weather is between the plane and the airport. Y'all make this sound like a no-brainer decision. It's not. Sure, a cardiac arrest is a medical emergency. But given the fact that with extremely limited resources and likely a minimum 30 minute descent and land time, survivability is virtually nil.
     
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  51. turkeyjerky

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    And you have to consider the odds of the Doctor on the flight over calling it, and recommending diversion for something nonemergent or merely urgent. The truth is, most people with PEs or MIs are not going to decompensate in 90 minutes. If 8-9/10 called for diversion from a volunteer are unnecessary (would you doubt that from the responses here--I mean we're trained and conditioned to practice overly definsive) then the cost/benefit analysis looks different. AA won't get a major stain on their reputation from this, and the medical control doc isn't going to get a mark on his/her NPDB profile for this. It's all about the $$$
     
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  52. chocomorsel

    chocomorsel Senior Member
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    It’s good they have a policy in place. However, if they aren’t going to listen to the doc on board, who’s actually laid hands on the patient, then they need to have the doc on the ground do a video evaluation or something. Why do they ask “is there doctor on board?” to assist if they aren’t going to take their evals and recommendations seriously?
     
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