Interesting Case

[Psai]

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Re: sleeping through a page.

I do 24 hour shifts in a busy level 2 trauma and stroke center. I have an OR phone and the OR also has my cell phone they know to call.

Do you all not give the OR staff your cell number as well? No pagers for us.

Only the good looking ones

 

[chocomorsel]

MD only hospital with in house anesthesia.

Thank you. Why does everyone assume it’s all about the CRNAs anyway? Some people don’t work with them.

And for the love of our hard earned titles, could we please stop calling ourselves providers? Why do doctors do this? I am looking at you @narcusprince.

@algosdoc, do you testify on the side of doctors or against them? And since expert witnesses don’t offer their services for free, don’t you think that you may be a bit biased in your assessments?

 

[chocomorsel]

Let's clear something up: the baby could be dying, and the mother can still refuse surgery.

And then the surgeon gets sued for a dead baby. Or a brain damaged baby. I mean it’s easier to say this from the other side of the ether drape, but being an OB sucks. You got two lives you are responsible for unlike us. I think as much as many of us hate OB, we gotta be a little more understanding of their situation. Of course no one put a gun to their head and told them to deliver babies.
But I do also wonder about lack of local by Dr. Lopez.

 

[chocomorsel]

The more I think about this anesthesiologist, the more I wonder if he slept through a call. We’ve all been there (at least I have). You’re on a 24 hour call getting destroyed and you don’t see the call room for the first time until 4am. An hour later the phone rings and you either sleep through it or you are so tired and delirious that you ignore it. Sometimes it takes a couple calls to bring you back to some level of lucidity. Not all 24 hour call is created equal, but I find it more and more difficult with each passing year. I’m curious to know what happened with the anesthesiologist here.

This is why I don’t do 24 hour calls. Inhumane and cruel.
I don’t need the money that badly. In residency I split mine in two whenever I could.

 

[chocomorsel]

This stuff happens. Lets add a twist. Nurses take mom to OR for c section. No epidural, IV gets pulled in transit. No iv no epidural, prolonged deceleration, surgeon wants to cut now. Whos fault if the c section is under local with additional pain and suffering?

Had this same exact scenario happen once. Except it was an IVDU who rolled into the ED bleeding and pregnant. Someone was able to get an IV that got accidentally pulled on the transfer to the OR bed. In this situation we masked her with Sevo and Nitrous, didn’t have to tell the OB to get local as she was already on it, told her to cut as soon as the local went in. But yes, we instructed the nurses to hold her down. It wasn’t pretty, but she was strung out, belligerent and bleeding.

And no, she didn’t aspirate. I was eventually able to get an IV in her thumb as soon as I could but the surgery had commenced. We then paralyzed and tubed I think.

I gave a talk about it on Grand Rounds. Was proud about what we did and didn’t care about criticism because we did what he had to do. Asked if I had to do it over again would I and I said, ideally no, but realistically yes.

 

[Aether2000]

I have testified on both sides, and yes, sometimes doctors screw up so badly that they indeed deserve to be whacked when their conduct is so far out of anyone's standard of care that you do what you can to prevent them from continuing operating recklessly. However, my analysis here is based on what I have seen over and over in the method of attack used by plaintiff's lawyers and prosecutors in a multipronged approach. There are usually multiple causes for action in any given case, but the state has its own rules about what may be alleged, and at what point in the legal process these allegations may be entered or modified.

There is also another process that will be used in this case (I guarantee it)- it is called peer review. Peer review from a hospital credentials or disciplinary committee, may act more rapidly than the legal system and can have long term effects on the physician's practice, especially when it reflects poorly on the hospital in the press, and is not defensible in the public sphere. These committees have the power to recommend revocation of privileges or restriction of privileges- items that are reportable to the NPDB, and are accessible by the public. In this case, the hospital must act quickly to engage damage control, even if it means a physician or two will be sacrificed in the process.

 

[deleted171991]

And then the surgeon gets sued for a dead baby. Or a brain damaged baby. I mean it’s easier to say this from the other side of the ether drape, but being an OB sucks. You got two lives you are responsible for unlike us. I think as much as many of us hate OB, we gotta be a little more understanding of their situation. Of course no one put a gun to their head and told them to deliver babies.
But I do also wonder about lack of local by Dr. Lopez.

I AM trying to be understanding, but still one can't just torture a human being to save another. We are not talking about holding down an incompetent patient to get her civilized treatment. This was cruel. I wouldn't be surprised if that baby is a walking PTSD for the mother.

I know time was of essence, but there are certain things a physician just can't do. This was one of them. Beyond using a lot of local, they could have had her breathe nitrous, at least; it's not rocket science to turn on that anesthesia machine and rotate the dial. Even paging the chief of anesthesia, or an ER doc in house, may have gotten them some suggestions (e.g. giving the mother ephedrine to treat the hypotension, bolusing the epidural with lidocaine,), if time was of essence. Still, there is no excuse if the mother said STOP. My guess is that her argument will be that the patient was altered and unable to consent, or to withdraw it, in an emergency.

I hope I will never have to make this kind of decision, but, still, there is stuff one just can't do.

 

[coffeebythelake]

it would be much easier medicolegally to defend: "mother said stop knowing that her baby might die"

 

[Twiggidy]

I AM trying to be understanding, but still one can't just torture a human being to save another. We are not talking about holding down an incompetent patient to get her civilized treatment. This was cruel. I wouldn't be surprised if that baby is a walking PTSD for the mother.

I know time was of essence, but there are certain things a physician just can't do. This was one of them. Beyond using a lot of local, they could have had her breathe nitrous, at least; it's not rocket science to turn on that anesthesia machine and rotate the dial. Even paging the chief of anesthesia, or an ER doc in house, may have gotten them some suggestions (e.g. giving the mother ephedrine to treat the hypotension, bolusing the epidural with lidocaine,), if time was of essence. Still, there is no excuse if the mother said STOP. My guess is that her argument will be that the patient was altered and unable to consent, or to withdraw it, in an emergency.

I hope I will never have to make this kind of decision, but, still, there is stuff one just can't do.

Exactly this. We live in a society of patient autonomy. It doesn’t matter if it’s a 30 min deceleration or a ruptured AAA, you can’t force a patient to the OR. I don’t feel bad for an OB. The OB simply has to explain the risks of not proceeding with surgery and have it well documented.

I imagine the patient agree for the c-section, the anesthesiologist was in the room, and the OB took it upon themselves to proceed. The local was inadequate and the patient said “stop”. If what I’m in the lawsuit is true. If they were dragging a patient to the OR screaming “no”, then that’s criminal but I also would imagine a nurse would have documented to situation as such.

 

[deleted171991]

I imagine the patient agree for the c-section, the anesthesiologist was in the room, and the OB took it upon themselves to proceed. The local was inadequate and the patient said “stop”. If what I’m in the lawsuit is true. If they were dragging a patient to the OR screaming “no”, then that’s criminal but I also would imagine a nurse would have documented to situation as such.

You'd be shocked what the famous "patient advocates", aka nurses, consider normal and legal to do to a patient, "in her own best interest".

Many of them have almost zero concept of patient autonomy, and are more "maternalistic" than the worst of third-world doctors. Remember all those incidents where they wanted to restrain a competent PACU patient who wanted to get out of bed, or change her position, or an ICU patient who pulled his own Foley (after being fed up with them not removing it when told so by the patient), or wanted to call security on a patient who just got fed up with them and told them to F* off etc.

 

[izzygoer]

So my understanding is epidural was placed, some hours later pt hypotension then csection with no anesthesiologist and subsequent events. The question is Did the nurse shut off the epidural with hypotension? And not turn it back on Which commonly happens where I work or was it patchy to start with?

It would also be interesting to see if the patient gets money for the anesthesiologist not being present, or because they felt pain as all the articles state pain and ptsd from the pain. the latter could have broader implications

I think most of us have been in situations where Pts start squirming a little with even the best epidurals in place, usually emergencies where the level isn’t quite there yet. Usually a little ketamine or versed does well but most still remember the pain.

If there is a big payout for pain I could easily see these bottom feeders start running ads did you feel pain during your c section, give us a call...

 

[IMGASMD]

If there is a big payout for pain I could easily see these bottom feeders start running ads did you feel pain during your c section, give us a call...

My brain always hurts when I watch OBs operate, can I get a big pay out?

Hopefully we will know the whole story, probably not, at some point. Other emergencies at hand, over slept, missed page? Our ob Anesthesiologists are always in House, and all nurses know where the call rooms are.

I never imagined that c-section can be done with local only. Also, bothered me that the patient didn’t get anything before they cut. But that whole thing about passing out from pain, somehow I didn’t really “feel” it from the reporting. Just from my reading of the article and parts of the summary of the suit, she did have some relieve from the epi, no?