Mom given emergency C-section without anesthesia, lawsuit claims - Fox News Mom given emergency C-section without anesthesia, lawsuit claims — Fox News
Was the anesthesiologist on the hook?
Was the anesthesiologist on the hook?
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Interesting Case
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Despite the picture the clickbait article tries to paint here and the patient's quotes, it will be very difficult for this patient to win anything in this case, even if the OB anesthesiologist is in-house 24/7 at this facility (which I doubt is the case). Given the context of the emergent conditions and the patient's hemodynamic instability, the MDs will be able to defend their actions somehow, someway. The plaintiff will have to prove that they deviated from the standard of care and I doubt they will be able to do that. One very underrated aspect about CA is that the malpractice laws/rules here are very favorable for physicians and easily the best of any state in the country IMO. Very difficult for a pt to win a case unless it's just clear-cut, obvious wrongdoing
The unresponding anesthesiologist will likely be disciplined by the CA medical board and may have licensure action. It is indeed below the standard of care to have a c-section without regional or general anesthesia and pain=suffering. It can be argued an anesthesiologist unresponsive to emergency pager calls is culpable for substandard care, therefore it is likely the anesthesiologist will be named. The lawsuit will be successful and there will be in-house call for anesthesia or a CRNA from now on since the hospital cannot withstand the bad PR about the patient perceived abandonment in the middle of an anesthetic. The community perception will be that if you come to that hospital, you better bring their own bullet to bite on during c-sections since they operate on you without anesthesia. This event could also potentially affect the patient choice of hospitals in the area for elective surgery and inpatient admission for non-surgical care, thereby damaging the hospital's bottom line. It also could result in anesthesia group replacement if the hospital needs but a small weight to tip the scales.
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You seem very confident of what's gonna happen for someone who doesn't know all the facts. All that based on a Fox News article lmao. No attention to detail. My 2 cents based on knowing people in that anesthesia group is that the doc will be fine.
My 2 cents are worth at least as much as your 2 cents. Having testified many times in court as an expert witness and been deposed many times over the past 30 years, what I outlined is the usual course of events. Of course there may be extenuating circumstances, such as the contact number on file with the hospital medical staff and operator may not have been the correct number called by OB. But that would be just about the only situation that would be exculpatory for the anesthesiologist. I stand by my statements that there will be changes in the hospital staffing, and there will be in-house coverage beginning long before the trial.
It's so sensationalized. Everyone gets strapped down before surgery so they don't fall off the bed.
If the anesthesiologist really was paged several times and did not respond then he is screwed.
But it seems that the wait time between the decision and going to the OR was only 9 minutes so unless the anesthesiologist was supposed to be in-house this is not realistic.
But it seems that the wait time between the decision and going to the OR was only 9 minutes so unless the anesthesiologist was supposed to be in-house this is not realistic.
The patient was hypotensive with an epidural infusion or bolus that was causing numbness, that could have ostensibly caused hypotension. Once an epidural catheter is dosed, the patient is then co-managed by OB and the anesthesiologist. Complications such as the reported hypotension are not uncommon, and if it becomes severe, then indeed C-section may result. That is why the anesthesiologist must remain available (in-house) or have a CRNA available in-house to go to C-section any time there is an epidural being dosed by PCA, nurse bolus, anesthesiologist bolus, or infusion. If the anesthesiologist was in house and was unreachable because of an issue that was avoidable (within the control of the anesthesiologist), then he is screwed. If he was not in house and did not have a CRNA present for the C-section, he is still screwed.
From the lawsuit:
11:06 PM - epidural placed
11:20 PM - pitocin started
12:39 AM - hypotension, pitocin stopped
5:21 AM - FHR tracing became unreadable
5:24 AM - emergency c-section called
time not specified - anesthesiologist "paged multiple times"
5:33 AM - patient arrives in operating room
time not specified - start of surgery
patient was screaming and demanding they stop
time not specified - healthy kid born
time not specified - anesthesiologist arrives
It seems to me, as a non lawyer (damn their oily hides), the patient has a pretty good case vs the surgeon for battery. She clearly didn't consent to the surgery. And indeed, the 4th cause of action is a claim of battery.
Assuming the first page occurred at 5:24 AM, the patient was in the OR nine minutes later. The lawsuit doesn't say what time incision was, but it implies it happened pretty quick. A couple minutes to get her on the table and prep and drape? So start time possibly less than 15 minutes from the decision to cut?
What's the standard for time to incision for an emergency c-section?
1982 the OB guideline was 15 minutes
In 1988 the 5th edition of the ACOG standards changed it to 30 minutes
AFAIK the standard has been 30 minutes ever since then
ASA guideline states "Availability of anesthesia and surgical personnel to permit the start of a cesarean delivery within 30 minutes of the decision to perform the procedure."
So, 30 minutes.
It sounds like we've got an OB who possibly could have waited longer before cutting, and who ignored a patient's withdrawal of consent. That's a lot more damning an accusation than the one made of an anesthesiologist who didn't arrive 15 minutes into the 30 minute window specified by both ACOG and the ASA.
Also. There exists such a thing as local anesthetic. The op report quoted in the lawsuit doesn't make any note of local. Again, this is on the OB.
11:06 PM - epidural placed
11:20 PM - pitocin started
12:39 AM - hypotension, pitocin stopped
5:21 AM - FHR tracing became unreadable
5:24 AM - emergency c-section called
time not specified - anesthesiologist "paged multiple times"
5:33 AM - patient arrives in operating room
time not specified - start of surgery
patient was screaming and demanding they stop
time not specified - healthy kid born
time not specified - anesthesiologist arrives
It seems to me, as a non lawyer (damn their oily hides), the patient has a pretty good case vs the surgeon for battery. She clearly didn't consent to the surgery. And indeed, the 4th cause of action is a claim of battery.
Assuming the first page occurred at 5:24 AM, the patient was in the OR nine minutes later. The lawsuit doesn't say what time incision was, but it implies it happened pretty quick. A couple minutes to get her on the table and prep and drape? So start time possibly less than 15 minutes from the decision to cut?
What's the standard for time to incision for an emergency c-section?
1982 the OB guideline was 15 minutes
In 1988 the 5th edition of the ACOG standards changed it to 30 minutes
AFAIK the standard has been 30 minutes ever since then
ASA guideline states "Availability of anesthesia and surgical personnel to permit the start of a cesarean delivery within 30 minutes of the decision to perform the procedure."
So, 30 minutes.
It sounds like we've got an OB who possibly could have waited longer before cutting, and who ignored a patient's withdrawal of consent. That's a lot more damning an accusation than the one made of an anesthesiologist who didn't arrive 15 minutes into the 30 minute window specified by both ACOG and the ASA.
Also. There exists such a thing as local anesthetic. The op report quoted in the lawsuit doesn't make any note of local. Again, this is on the OB.
Maybe. The local standard of care in some places is for anesthesiologists to place epidurals and go home, within a 30 minute recall.
My personal opinion is that if you've got an epidural running, you should be in the hospital. At worst, at the Holiday Inn across the street.
you have GOT to keep a CRNA free to cover OB for exactly this reason, while its OK to have the doc 30 mins out, you have to have a reasonably competent CRNA available to bolus the epidural and get the section started while you are coming into the hospital. If hospitals are so small that they dont have an available CRNA covering OB (or could have a gap in coverage like this) then they should not be doing deliveries. thats what will happen here, either the hospital will get coverage or stop doing OB.
The 30 min buffer zone I define as the time that if a surgeon decides to cut medicolegaly its their decision to make. If we respond sooner then as soon as we gain control of the patient we assume liability. I would like to know if FHR tones were attained prior to incision and were they normal. Also, was the anesthesia provider occupied in another location? What I do see as a problem is the anesthesiologist not answering their pages? Which could be a myriad of system related problems? Did the page go through the system?
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deleted162650
MD only hospital with in house anesthesia.
So....then it was a communication or lack of responsiveness issue. The calls made will be examined, the person making the calls, the equipment used, and any other reasons for no response will be thoroughly examined by the lawyers to determine who was culpable.
This right here. Anesthesiologist could've been involved in an emergency airway, and if so, dear God I hope he/she documented that. Also agree on the FHR. We all know we get "OB OR stat" pages all the time where people are scrambling back to the OR, only to have the FHR recover. From the nursing side, that's something that needed to be well documented as well as actual incision time
I know there are a handful of "place the block and leave" places but an article like this, even if sensationalized, will probably make them change their mind. A big problem is that pain in subjective and juries are sympathetic to plaintiffs. You can easily have a patient with an excellent block who just "feels stuff" and freaks out so you give them sedative to calm down, and the story will be "I had pain and I passed out" when in reality you put her to sleep. I'm not saying that's what happened here. Here, she probably was experiencing pain if no one bolused the block (and even if the OB used local it probably wasn't enough) and the anesthesiologist probably walking in and put her to sleep. I'm willing to bet that's what actually happened, but the anesthesiologist will need to explained no be able to be contacted for 9 mins. At the very least you have to respond and say where you are.
I also argue this is a part of OB anesthesia where the nursing floor needs to know how to give local anesthetic via the epidural, at the very least the most senior, experienced charge nurse. As I said, if you're in house dealing with a difficult airway or other procedure and a stat C-section happens, the nurses need to know what the anesthesiologists means when he said, "give 10 cc of 2% lidocaine and i'll be there in five minutes". I understand the nurses don't want to be involved like that but this is the situation that results.
I also argue this is a part of OB anesthesia where the nursing floor needs to know how to give local anesthetic via the epidural, at the very least the most senior, experienced charge nurse. As I said, if you're in house dealing with a difficult airway or other procedure and a stat C-section happens, the nurses need to know what the anesthesiologists means when he said, "give 10 cc of 2% lidocaine and i'll be there in five minutes". I understand the nurses don't want to be involved like that but this is the situation that results.
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deleted643396
The anesthesiologist did show up as she was cutting uterus (running into the room). Was he tied up doing something else? This is on the OB for not waiting another minute...especially since the patient was screaming to stop. I did not see anything about the anesthesiologist inducing general anesthesia upon arrival, so I wonder about that.
There are some allegations about “injury to her nervous, digestive, and reproductive system and illness” in addition to the emotional disturbance. What are those injuries? I mean I know most OBs are hacks, but was this OB just slicing and dicing? I also wonder about some of the sensationalization...the vast majority of patients are “strapped down” while awake for a c-section. Also, did she really not have any anesthesia from the epidural that was placed?
I will use this as an opportunity to vent about the OB floor. I hate the fetal heart monitor. How many times is a nurse unable to get tones, she overreacts, the OB floor hysterics ramp up, and another nurse walks in and moves the probe and the tones are fine? The typical OB floor hysterics predisposes patients to being anxious and unnerved...even if everything is fine. If there is ever a unit that needs to heed the Fat Man’s advice of “check your own pulse,” it’s OB.
There are some allegations about “injury to her nervous, digestive, and reproductive system and illness” in addition to the emotional disturbance. What are those injuries? I mean I know most OBs are hacks, but was this OB just slicing and dicing? I also wonder about some of the sensationalization...the vast majority of patients are “strapped down” while awake for a c-section. Also, did she really not have any anesthesia from the epidural that was placed?
I will use this as an opportunity to vent about the OB floor. I hate the fetal heart monitor. How many times is a nurse unable to get tones, she overreacts, the OB floor hysterics ramp up, and another nurse walks in and moves the probe and the tones are fine? The typical OB floor hysterics predisposes patients to being anxious and unnerved...even if everything is fine. If there is ever a unit that needs to heed the Fat Man’s advice of “check your own pulse,” it’s OB.
Oh... then that's really a problem for the anesthesiologist.
But that 9 minutes from decision to incision is still pretty intriguing to say the least.
It's for this very reason I don't strap arms during sections. I tell them they can put their arms wherever, but don't touch the stomach. You can put your arms behind your heads like you're lying on the beach, just anything that makes you more comfortable.
100%. Not only check your own pulse, but a good amount of times the best thing you can do for a patient is to "do nothing".
Most definitely. That means that OB ran the patient into the room, threw on betadine, and was ready to slice. If that were the case I may not even load an epidural. It's sleepy time.
At 530 am, if anesthesiologist is in-house, I can only guess he/she was in deep sleep, or in the shower, etc. We can speculate all day.
But I will say this is why my OB sleeps are always "nervous sleeps". I'm never REALLY asleep because I know the call is coming.
And here's a group wanting to have VBAC be offered at hospitals without an anesthesiologist or CRNA in house because obstetricians can just use local.
"Hospitals offering VBAC are required to have 24/7 anesthesia" is false - VBAC Facts
"Hospitals offering VBAC are required to have 24/7 anesthesia" is false - VBAC Facts
My takeaway from that article is how society has started to treat pregnancy and labor/delivery as this benign concept. In my opinion, pregnancy in itself is high risk. But I also see the other side. It’s hard enough to get anesthesiologist to be within 30 min of a hospital in BFE let alone pay one to stay in house. This is where the discussion of ‘penny pinching hospitals’ come into play.
Perhaps the hospital involved in this incident will invest in Vocera badges (hands free) now? That way it doesn't matter what the doctor is doing- they can communicate with others in the hospital while they are intubating or running a code.
Yeah. Even if I’m doing something else in the hospital, I try to remember to let the nurses where I am know they should call OB to let them know where I am in case of emergency
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deleted171991
I would suspend the OB's medical license IMMEDIATELY. This was extremely poor judgment.
I think the only reason the patient did not file a criminal complaint was that the baby was healthy.
There is no excuse for operating on a conscious patient without anesthesia, unless she consents AND MAINTAINS THE CONSENT. Even saving the mother's life (against her wishes) would not be a legal reason.
Btw, this is another example while I can't be paid enough to do OB ever again.
I think the only reason the patient did not file a criminal complaint was that the baby was healthy.
There is no excuse for operating on a conscious patient without anesthesia, unless she consents AND MAINTAINS THE CONSENT. Even saving the mother's life (against her wishes) would not be a legal reason.
Btw, this is another example while I can't be paid enough to do OB ever again.
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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?
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deleted171991
Let's clear something up: the baby could be dying, and the mother can still refuse surgery.
If patient difficult IV and this is truly cut right away situation and not the usual OB bs, then lots of local plus IM ketamine +/- versed. Meanwhile get an IO or work on the IV
Can anyone really be blamed in a situation like this? The circumstances suck.
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OB waits for me to place an IV while another nurse looks on the other side. First one who gets the IV wins. Induce general if it’s that bad an emergency. At VERY worst, mask induction
A lot of them aren't even good surgeons, you thinknthry are good at putting in local?
Local only c sections when extremis are still appropriate. However if that patient says stop medicolegaly the obstetrician is committing assault and battery. Real kobayashi maru. Ob stops baby comes out apgars of 1,2 with brain injury. Ob continues under local while your still trying to find an IV. Induce as soon as you have access. Im sure you and the obstetrician are liable. Your damned if you do and damned if you dont. Too many situations in OB like that. I used to love OB early in my career now I realize too many things can go wrong that you can be blamed for without it a actually being your fault.
This one is pretty easy, the surgeon either starts under local (yeah right) or waits for you to put in an IV and put the patient to sleep. If the airway looks difficult, the surgeon waits for a spinal, or an AFOI.
An alternative, possibly, if the right patient is in front of you, might be IM ketamine and some sevoflurane while the OB cuts and a nurse gets an IV.
I think we all know how panicked and hysterical OB nurses can get, and sometimes OB surgeons too, but of course the textbook, real life, and courtroom answer is always that the woman's life is primary and the baby's life is secondary.
Let's not forget that in this case, the speedy anxious battering OB pulled out a healthy crying baby.
Where I trained I'd hypothetically tell a nurse to go get the ultrasound while I was rolling the patient in. Grab a 2" 16g and syringe. 3 second chloraprep to the neck. Thread off 16g in IJ and go to town.
I think the idea in my mind is moms safety is priority. Get access and safely induce GA( accouting for difficult airway precautions). Local only opens up the pain and diuress problem again not the anesthesiologist problem especially if its under 30 minutes. IM ketamine sevo, I can get an IV faster then that stuff works. Key thing too is after something like this happens you need to examine the process and see if the IV access is a system failure.
I don't really agree.
One, these situations are rare - in my career I can probably count on just my fingers the number of true, no kidding, emergency sections I've done in patients with real barriers to fast surgical anesthesia (airway concern, difficult IV access, +/- super morbid obesity). Stressful but it's what we're trained to handle.
Two, our approach is always pretty straightforward. OB disasters are one of the most discussed, debated, and drilled scenarios in all of anesthesiology. There isn't often a case where a good plan is hard to find. Sometimes a challenge to fend off an eager surgeon while you execute that plan ...
The scenario of a woman showing up to triage, no history, no prenatal care, no IV, and being called to emergency section happens isn't any better or worse than the laboring patient with a lost IV ... and it's really not a mystery how to handle it. Someone puts in an IV, you ask about allergies and major medical history, and you put her to sleep.
A bad baby can appear any time, any patient, any delivery. Any of us can be sued at any time, for any reason. Do the right thing and leave the rest to your liability insurance lawyers. 🙂
I like where your head is and this will get you access pretty quick but:
1) How fast can the OB nurses get you an U/S? Honestly, in my hospital the C/S would be over by the time they get it
2) I’m not sure about sticking a neck in a hysterical OB patient. If this were my plan, I’d prob get some N2O/Sevo in her lungs first and then do this. At least I can have some bit of MAC if the OB needs to start.
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deleted643396
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.
I'm interested in the definition of assault and battery in a civil court vs a criminal court. What kind of evidence does the plaintiff have to meet to prove assault and battery in a civil court? Assault and battery charge scares me since malpractice insurance doesn't cover it and the damages are huge! Also, possibly going to jail and losing one's license.
Based upon this case, do you guys consent your spinal/epidural+sedation cases the real possibility of waking up in the middle of the case with pain and recall? What if that patient said to stop the surgery because of pain and you then induced a general anesthetic?
Based upon this case, do you guys consent your spinal/epidural+sedation cases the real possibility of waking up in the middle of the case with pain and recall? What if that patient said to stop the surgery because of pain and you then induced a general anesthetic?
That’s my bet. I agree, the older I get, the closer these OB calls get to the Murtaugh list.
OB should have stopped if patient cried stop. Doesn't matter if baby is dying.
Hard to blame the anesthesiologist when you dont have all the facts. I can't tell you how many times I've gotten pages in residency from nurses, i call back within 30 seconds, no one picks up, and later i see the nurse document, MD paged, did not respond.
I imagine people were rolling to the OR, did they have someone stand next to the phone? Perhaps the anesthesiologist was tied up doing an airway? (if they also have them cover airways?). I've had disaster airways on the floor, and have gotten paged while i was inducing for 2nd emergency airway, and i was unable to answer right away cause i'm not going to drop and run to a phone to return a page in the middle of an induction/intubation.
I also had cases where i couldn't reach an inhouse attending via page/vocera and had to physically go get the attending. luckily it wasn't an emergency
Hard to blame the anesthesiologist when you dont have all the facts. I can't tell you how many times I've gotten pages in residency from nurses, i call back within 30 seconds, no one picks up, and later i see the nurse document, MD paged, did not respond.
I imagine people were rolling to the OR, did they have someone stand next to the phone? Perhaps the anesthesiologist was tied up doing an airway? (if they also have them cover airways?). I've had disaster airways on the floor, and have gotten paged while i was inducing for 2nd emergency airway, and i was unable to answer right away cause i'm not going to drop and run to a phone to return a page in the middle of an induction/intubation.
I also had cases where i couldn't reach an inhouse attending via page/vocera and had to physically go get the attending. luckily it wasn't an emergency
I think the difference is if someone is conscious vs “in and out” of conscious. Someone can be dissociative from drugs and say “oh stop” and you can just give them more drugs. (Fill in the blank any case under regional) If a patient is under no mind bending drugs and says “this hurts please stop” and you keep going, you’re going against wishes and could be technically assaulting the patient. The same be said with difficult IV insertion. If they patient says “stop” don’t keep sticking until you ask if it’s ok to try again.
Systems communication issue. Whats the communication between on call staff and on coming anesthesia provider? Handoff( baby in room 7 not doing well g blah blah bla) communication network where was the overhead page or rapid response code purple called? Paging is out of date vocera network or cell phone communication available? Where is the anesthesiologist call room? Proximity to L and D? We all have slept through pages before but the system should have redundencies. Does the obstetrician know what the anesthesia team covers during the night? Is their a backup policy? If you have pregnant ladies on the deck and your in the OR a backup system should be in place. A load of system related questions in this case.
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deleted171991
That's easy. Criminal court decisions are based on being convinced "beyond any reasonable doubt". Civil court decisions are based on "more likely than not". So the latter are much easier to prove, hence OJ Simpson was acquitted by the criminal court and found liable by the civil one.
I always consent any regional/neuraxial block about the possibility that it may not work, hence I always discuss backup plans. I find that the best malpractice prevention is a good preop discussion (setting the expectations). I also encourage my patients to be straightforward about any discomfort they are feeling during the procedure. I will stop the surgeon and do whatever is necessary to keep the patient safe and comfortable.
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deleted171991
If 16 year-olds can understand that "No means NO" anytime during a sexual act, why can't certain healthcare workers accept and respect the decisions of their competent patients, just because their own opinions differ? It's still about one's right to decide about one's own body; it's not rocket science.
If the patient says "Stop!", you stop and stand at attention. If a sedated patient complains about pain, it's still pain, even if the patient may not be competent.
We do 12 hour calls just for this reason. It is almost inhumane and may compromise patient safety to work 24 hours straight in a busy center.
That's why I qualified "where I trained." We were flush enough that there was a dedicated sonosite, belmont, RICs, and glidescope in the supply room across from the OB ORs. If she's hysterical enough that the line would be difficult awake then she's getting 120mg IM ketamine while I start on access and the ob starts infiltrating local. If OB is screaming cut now and the pt consents I don't really see an alternative to a mask down with sevo/nitrous.
Unfortunately we are only human and this happens. I slept through a page a couple months ago and caught a little heat. My solution was to set up a new protocol—if I don’t respond to page in 10 min page again...if I don’t respond to that follow up page right away I want a hospital security guard knocking on my call room door ASAP. Now the operators have this protocol in writing and there shouldn’t be any more issues.
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.
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.
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