HUGE Malpractice Claim in PA

Discussion in 'Anesthesiology' started by 2ndyear, May 27, 2008.

  1. 2ndyear

    2ndyear Senior Member
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  2. dfk

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    serves 'em right for waiting near 2 hours to call for help.
    i'm sure the award will be lessened by judge.
     
  3. Noyac

    Noyac ASA Member
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    What a horrible position to be in.
     
  4. Taurus

    Taurus Paul Revere of Medicine
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    The jury found yesterday that Glunk and his nurse anesthetist, Edward DeStefano, were negligent. It awarded $5.5 million in compensatory damages. The liability is split 75 percent for Glunk and 25 percent for DeStefano. Glunk is on the hook for an additional $15 million in punitive damages.​

    I'm glad to see that the CRNA didn't get away, but as usual the doc gets hit the hardest. I hope that changes if the CRNA's get their "doctorate".
     
  5. sevo85288

    sevo85288 Junior Member
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    I feel bad for the family. Goes to show that the CRNA is a tool. I would kick the surgeon in the balls if he got in the way of patient care. That is the difference b/t M.D and Nurse. Nurse will follow orders from Surgeon b/c of traditional role.
     
  6. SleepIsGood

    SleepIsGood Support the ASA !
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    This is reason again why an Anesthesiologist should be present during ALL surgeries.

    Atleast we're trained to pick up on these things. Fat emoblism is quote esoteric as the surgeon claims. Esoteric things are why we as anesthesiologists go through four years of medical school, do an internship year, and then 3 years of anesthesia. We know more because it's repetition in all those years of training.

    NURSES just fly through a community school then do a few years and walla are 'certified'.

    As physicians we look at the 'whole' picture not just the immediate intraop and post op situation. I hope the Pennsylvannia Society of Anesthesiologists use this case to really show their case of why nurse anesthesists should never practice solo or under the guidance of a non-anesthesiologist.

    Nevertheless, this is a tragic outcome. My hopes and prayers to everyone involved. Unfortunately there are risks to every surgery that can not be mentioned to every patient.
     
  7. bluewater

    bluewater Cardiac Anesthesiologist
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    I feel for everyone involved.

    However, this could not have happened in a better state- PA.
    When is the last time a Plastic Surgeon or CRNA has diagnosed a PE?
    This will definitely color the political scene in PA.
     
  8. Taurus

    Taurus Paul Revere of Medicine
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    Since the CRNA's are pushing for autonomy again in PA, we should forward this story to the PSA.
     
  9. coprolalia

    coprolalia Bored Certified
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    I'm certain that the upper eschelons of the PSA are already well aware of it. Certain. ;)

    -copro
     
  10. Stitch

    Stitch Jedi Ninja Wizard
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    What kind of family gets their healthy, athletic 18 year old daughter liposuction anyway? How idiotic. I know it happens, but goes to show that no surgery has 'zero risk,' and what kind of family you're dealing with.
     
  11. A-non-y-mous

    A-non-y-mous Junior Member
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    She's 18. She's an adult. If she wanted the surgery, she doesn't need her parents consent. So pointing the finger at the family is unfair. And who cares what kind of surgery it was for? The surgeon was negligent.
     
  12. Jeff05

    Jeff05 Senior Member
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    letter sent to governor's (PA) office:

    Mr. Rendell,

    I am an anesthesiology resident currently living in new york city. You may be aware of a recent large settlement made against a plastic surgeon who had a healthy 18 year old patient die under his care.

    It may interest you to know that the person providing the anesthesia was a CRNA (nurse) who did not pick up on the manifestations of a fat embolism. This was a healthy patient with a single abnormality. In today's world anesthesiologists are taking care of a very complicated population with a multitude of health problems, undergoing very complicated surgeries. This requires the expertise of a physician, not the superficial knowledge of a nurse.

    Anyone can inject medications into a patient. It takes a physician to DIAGNOSE and TREAT. This girl did not have the benefit of either diagnosis or treatment.

    You must re-examine your proposals to give CRNAs independent practice in Pennsylvania. People's lives are at stake.

    Regards,

    Jeff, M.D.
     
  13. nutmegs

    nutmegs ASA Member
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    I'm doubting an 18 year old has the means to pay for cosmetic surgery, and the article says her mom took her to the doc. I think it's a great example of why anyone should think twice about getting a completely optional surgery. Her death could have happened to the greatest surgeon on earth, end of story.
     
  14. Jeff05

    Jeff05 Senior Member
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    fat embolism has a 10-20% mortality. in most cases, if recognized and managed appropriately (example: http://www.chestjournal.org/cgi/reprint/93/6/1294.pdf ) the patient does well.


    if they had a BC anesthesiologist there, she would have had a fighting chance. period.
     
  15. Stitch

    Stitch Jedi Ninja Wizard
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    Exactly my point. :thumbup:
     
  16. A-non-y-mous

    A-non-y-mous Junior Member
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    So she gets a summer job, saves up, and gets herself the surgery....big difference how?


    Would the greatest surgeon on earth wait X number of hours to call 911?
     
  17. dfk

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    who knows.
    this doctor did, and i'm sure he is/was the greatest to somebody out there.
     
  18. polyposis

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    Not to sound cold or anything, but what kind of time do you have with a fat embolus? The article doesn't really describe where it was. Would she have survived the ambulance ride to the hospital?
     
  19. Stitch

    Stitch Jedi Ninja Wizard
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    That's the other thing I wondered. I'm not in anesthsia, so how would it be handled in a main/real OR? I know with clot PEs you can have the vascular surgeons go in and get it or clot bust it, but what do you all do for fat emboli?

    And the detail we don't have is how long the surgeon did wait. What was the sequence of events? Just because a jury was convinced doens't mean anything.
     
  20. dfk

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    supportive/symptomatic.
    O2/pressors/fluids/ACLS...etc
     
  21. Noyac

    Noyac ASA Member
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    I have had a fat embolism pt and it ain't pretty. My case was a long bone fx in a ESRD pt and a slow surgeon just out of hand fellowship trying to rod the femur.
    Basically you are doing ACLS.

    In the liposuction pts it can take some time to present and the clinical picture can be confusing (possibly why they waited to call the ambulance). But it must be on your differential dx list.
     
  22. toughlife

    toughlife Resident
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    That's the key. Your eyes won't see what your mind doesn't know and this applies to all CRNAs who are clearly not up to par with physicians in clinical diagnosis and treatment. They just don't have the knowledge base or training.

    As we can see with this tragic case, there's no such as a thing as an easy anesthetic, as any case can turn into a major complication when least expected. Since CRNAs don't know medicine, they will fail to provide medical care when it is badly needed. In other words, they need to be supervised by a medical doctor who is trained in anesthesiology. ALWAYS.
     
  23. dfk

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    is it beyond the 'scope' of CRNAs to formulate a differential dx list??
     
  24. powermd

    Physician Lifetime Donor Classifieds Approved 15+ Year Member

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    Forming an appropriately narrowed differential diagnosis based on the patient and the procedure is precisely what anesthesiologists are trained to do, in addition to their training in tailoring an anesthetic to the same. Anyone with a brain can memorize a by-the-book differential for any given problem. It takes a physician to narrow that differential, rank the choices in some way, and quickly rule out the wrong ones, while initiating treatments that are likely to catch the right one.

    CRNAs are supposed to be able to troubleshoot basic problems that commonly occur during the course of an anesthetic. The vast majority of anesthetics, like the vast majority of airline flights, are totally uneventful. You really only need the basic training of a CRNA/AA to do it successfully. It's when things don't go as planned that the average CRNA gets in over his or her head. The very best CRNAs are probably about as good as the average anesthesiologist at handling unexpected intraoperative events, but most CRNAs are not.

    CRNAs can not be expected to diagnose and treat as a physician does, which is why they should not, as a group, be given independent practice rights.
     
  25. SleepIsGood

    SleepIsGood Support the ASA !
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    Formulating a correct dx is out of their scope. Case and point above case.

    As Tough stated above. The eye can not see what the mind does not know.:cool:
     
  26. cfdavid

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    Sounds like one of the biggest mistakes is that the doc stated "zero risk", if in fact he actually did say that. But, how would the parents know for sure?
    The girl could have been told of the risks, but to gain approval from her parents, she could easily have lied about the circumstances. We'll never know.

    Regardless, an unfortunate situation.

    It seems that surgical centers would be a more risky place to do surgery from the simple aspect of reluctance to actually call a damn ambulance if something goes awry and hospital facilities/expertise are required.

    In other words, if a problem arises in a hospital OR, it seems that the surgeon and anesthesia team would be more apt to acknowledge the situation (rather than crossing fingers hoping it'll go away so they don't have to totally upset the day by calling in a crisis and having that potential negative publicity or whatever).

    What do you guys think? In an ideal world, the above dynamic wouldn't occur, but....
     
  27. amyl

    amyl ASA Member
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    everytime one of the nurses would offer her opinion to one of the surgeons I worked with he would say: you are a nurse, you are not paid to think, you are paid to follow orders....the doctor's orders.
     
  28. nutmegs

    nutmegs ASA Member
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    In NC, the CRNAs say they aren't practicing medicine because they are assisting the surgeon in curing the patient, not diagnosing and treating the patient. You can't have it both ways, that I can see.
     
  29. TaiShan

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    The scary part is that, even in states having caps, the courts are striking down these caps one by one. I guess lawyers do help lawyers.
     

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