Interesting malpractice verdict

[Rcola23]

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If anyone would find it interesting, I would be willing to post some more claims examples and the outcomes? I can do general ones, or specialty specific. Just let me know!

 

[San Marzano]

If anyone would find it interesting, I would be willing to post some more claims examples and the outcomes? I can do general ones, or specialty specific. Just let me know!

Please do! I’m assuming these are public record so no HIPAA issues right?

 

[Rcola23]

Please do! I’m assuming these are public record so no HIPAA issues right?

Correct - there are no HIPAA issues. They come from one of the medical malpractice companies that my business represents. They do internal reviews of claims that arise to help raise awareness and, hopefully, help prevent future claims.

 

[Rcola23]

In this Malpractice Claim Review:
A breakdown in communication among the health care team leads to a patient injury and documentation deficiencies hamper the defense of the claim.


SPECIALTY
Anesthesia, Surgery and Nursing
ALLEGATION
Improper Performance of Procedure and Failure to Provide Timely Treatment
RISK MANAGEMENT FOCUS
Communication Among Health Care Team
Documentation


Facts of Case
A 71-year-old woman with a history of dysphagia and tracheostomy from radiation therapy for laryngeal cancer presented to the hospital for an esophageal dilatation. The surgeon planned to do the procedure under conscious sedation and did not obtain an anesthesia consult.

Approximately 10 minutes into the procedure, the patient indicated she was uncomfortable. The surgeon called for anesthesia to deliver more sedation.

A CRNA arrived and after verifying what medications the patient had been given, he administered Diprivan 30 milligrams IV push. The patient’s oxygen saturation level immediately dropped and the CRNA lifted her chin. The patient’s oxygen saturation level continued to decrease so the CRNA gave Narcan IV push and bagged the patient by mask. The patient’s oxygen saturation level continued to decline and the patient went into respiratory and cardiac arrest. The surgeon began chest compressions and ordered Lidocaine 100 milligrams given IV push. The surgeon then advised the CRNA that the patient had a tracheostomy. The endoscopy nurse went to the next room to get a tracheostomy tube and the CRNA intubated the patient through the tracheostomy. The patient’s heart rhythm returned and an EKG showed sinus rhythm, first degree AV block, nonspecific intraventricular conduction delay and abnormalities consistent with ischemia. The surgeon transferred the patient to the intensive care unit where the patient was unresponsive to verbal and pain stimuli. At the request of the family, the surgeon ordered the patient transferred to a tertiary facility with a diagnosis of hypoxic encephalopathy.

The patient’s family filed a malpractice claim on behalf of the patient against the surgeon and the hospital alleging improper performance of a procedure and failure to provide timely treatment. They claimed current medical expenses, future medical expenses, permanent disability, physical pain and mental suffering on a permanent basis, and emotional and psychological injuries because of the negligent care and treatment.



Disposition of Case
The case settled for more than $130,000 against the hospital.



Patient Safety and Risk Management Perspective
The experts who reviewed this case were concerned with the amount of time it took to ventilate the patient through her tracheostomy. The experts opined that when the surgeon called the CRNA in to administer additional medications, he should have immediately informed the CRNA of the tracheostomy; and his failure to do so led to the prolonged period of hypoxia. The endoscopy nurse testified that she did not know the patient had a tracheostomy prior to the event. The experts were critical of the surgeon and nurse for failing to be prepared for an emergent complication.

The reviewers were also concerned with the documentation of the event. They reported it was difficult to tell from the records who gave what medications when and that according to the nurse’s notes it appeared to take six to seven minutes to successfully intubated through the tracheostomy; however, the monitor recording of the event showed that the patient was without any oxygen for approximately 10 minutes.

The nurse testified that she did not write down nursing notes at the time of the event but reconstructed her notes following the event as she was assisting in providing care to the patient.



Risk Management Tips

• Communication – Communication failure between members of the health care team is a frequent root cause of patient injuries. Because health care often involves rushed interactions among the health care team, a standardized approach to communication is needed to ensure that patient information is effectively communicated.
• Documentation – Experts estimate that problems with medical record documentation jeopardize the defense of 35-40 percent of all medical malpractice claims. Avoid hinting that a patient's current condition is harder to manage because of another physician's treatment.

 

[NightNight]

In this Malpractice Claim Review:
A breakdown in communication among the health care team leads to a patient injury and documentation deficiencies hamper the defense of the claim.


SPECIALTY
Anesthesia, Surgery and Nursing
ALLEGATION
Improper Performance of Procedure and Failure to Provide Timely Treatment
RISK MANAGEMENT FOCUS
Communication Among Health Care Team
Documentation


Facts of Case
A 71-year-old woman with a history of dysphagia and tracheostomy from radiation therapy for laryngeal cancer presented to the hospital for an esophageal dilatation. The surgeon planned to do the procedure under conscious sedation and did not obtain an anesthesia consult.

Approximately 10 minutes into the procedure, the patient indicated she was uncomfortable. The surgeon called for anesthesia to deliver more sedation.

A CRNA arrived and after verifying what medications the patient had been given, he administered Diprivan 30 milligrams IV push. The patient’s oxygen saturation level immediately dropped and the CRNA lifted her chin. The patient’s oxygen saturation level continued to decrease so the CRNA gave Narcan IV push and bagged the patient by mask. The patient’s oxygen saturation level continued to decline and the patient went into respiratory and cardiac arrest. The surgeon began chest compressions and ordered Lidocaine 100 milligrams given IV push. The surgeon then advised the CRNA that the patient had a tracheostomy. The endoscopy nurse went to the next room to get a tracheostomy tube and the CRNA intubated the patient through the tracheostomy. The patient’s heart rhythm returned and an EKG showed sinus rhythm, first degree AV block, nonspecific intraventricular conduction delay and abnormalities consistent with ischemia. The surgeon transferred the patient to the intensive care unit where the patient was unresponsive to verbal and pain stimuli. At the request of the family, the surgeon ordered the patient transferred to a tertiary facility with a diagnosis of hypoxic encephalopathy.

The patient’s family filed a malpractice claim on behalf of the patient against the surgeon and the hospital alleging improper performance of a procedure and failure to provide timely treatment. They claimed current medical expenses, future medical expenses, permanent disability, physical pain and mental suffering on a permanent basis, and emotional and psychological injuries because of the negligent care and treatment.



Disposition of Case
The case settled for more than $130,000 against the hospital.



Patient Safety and Risk Management Perspective
The experts who reviewed this case were concerned with the amount of time it took to ventilate the patient through her tracheostomy. The experts opined that when the surgeon called the CRNA in to administer additional medications, he should have immediately informed the CRNA of the tracheostomy; and his failure to do so led to the prolonged period of hypoxia. The endoscopy nurse testified that she did not know the patient had a tracheostomy prior to the event. The experts were critical of the surgeon and nurse for failing to be prepared for an emergent complication.

The reviewers were also concerned with the documentation of the event. They reported it was difficult to tell from the records who gave what medications when and that according to the nurse’s notes it appeared to take six to seven minutes to successfully intubated through the tracheostomy; however, the monitor recording of the event showed that the patient was without any oxygen for approximately 10 minutes.

The nurse testified that she did not write down nursing notes at the time of the event but reconstructed her notes following the event as she was assisting in providing care to the patient.



Risk Management Tips

• Communication – Communication failure between members of the health care team is a frequent root cause of patient injuries. Because health care often involves rushed interactions among the health care team, a standardized approach to communication is needed to ensure that patient information is effectively communicated.
• Documentation – Experts estimate that problems with medical record documentation jeopardize the defense of 35-40 percent of all medical malpractice claims. Avoid hinting that a patient's current condition is harder to manage because of another physician's treatment.

This is why we don’t let anybody “call us into help” in the middle of any endoscopy procedure. You either want our help on the front end or you reschedule the procedure.

Can’t believe the CRNA was not named in the claim, they ****ed up on many levels as well.

 

[caligas]

Please do! I’m assuming these are public record so no HIPAA issues right?

Yes, interesting and educational. Maybe even start a new thread?

 

[Rcola23]

This is why we don’t let anybody “call us into help” in the middle of any endoscopy procedure. You either want our help on the front end or you reschedule the procedure.

Can’t believe the CRNA was not named in the claim, they ****ed up on many levels as well.

This is total speculation and opinion, but my guess is whatever PI Attorney they consulted figured that the Surgeon &/or Hospital had a much larger Malpractice policy to go after.

 

[anbuitachi]

Wow only 130k ! That's nothing these days for a screw up like that. But yea totally agree, it's either with us or without us, no in between.

 

[Rcola23]

Yes, interesting and educational. Maybe even start a new thread?

I'd be happy to. I'll start one under the Anesthesiology section and I will try and keep things geared towards the specialty.

 

[Ronin786]

In this Malpractice Claim Review:
A breakdown in communication among the health care team leads to a patient injury and documentation deficiencies hamper the defense of the claim.


SPECIALTY
Anesthesia, Surgery and Nursing
ALLEGATION
Improper Performance of Procedure and Failure to Provide Timely Treatment
RISK MANAGEMENT FOCUS
Communication Among Health Care Team
Documentation


Facts of Case
A 71-year-old woman with a history of dysphagia and tracheostomy from radiation therapy for laryngeal cancer presented to the hospital for an esophageal dilatation. The surgeon planned to do the procedure under conscious sedation and did not obtain an anesthesia consult.

Approximately 10 minutes into the procedure, the patient indicated she was uncomfortable. The surgeon called for anesthesia to deliver more sedation.

A CRNA arrived and after verifying what medications the patient had been given, he administered Diprivan 30 milligrams IV push. The patient’s oxygen saturation level immediately dropped and the CRNA lifted her chin. The patient’s oxygen saturation level continued to decrease so the CRNA gave Narcan IV push and bagged the patient by mask. The patient’s oxygen saturation level continued to decline and the patient went into respiratory and cardiac arrest. The surgeon began chest compressions and ordered Lidocaine 100 milligrams given IV push. The surgeon then advised the CRNA that the patient had a tracheostomy. The endoscopy nurse went to the next room to get a tracheostomy tube and the CRNA intubated the patient through the tracheostomy. The patient’s heart rhythm returned and an EKG showed sinus rhythm, first degree AV block, nonspecific intraventricular conduction delay and abnormalities consistent with ischemia. The surgeon transferred the patient to the intensive care unit where the patient was unresponsive to verbal and pain stimuli. At the request of the family, the surgeon ordered the patient transferred to a tertiary facility with a diagnosis of hypoxic encephalopathy.

The patient’s family filed a malpractice claim on behalf of the patient against the surgeon and the hospital alleging improper performance of a procedure and failure to provide timely treatment. They claimed current medical expenses, future medical expenses, permanent disability, physical pain and mental suffering on a permanent basis, and emotional and psychological injuries because of the negligent care and treatment.



Disposition of Case
The case settled for more than $130,000 against the hospital.



Patient Safety and Risk Management Perspective
The experts who reviewed this case were concerned with the amount of time it took to ventilate the patient through her tracheostomy. The experts opined that when the surgeon called the CRNA in to administer additional medications, he should have immediately informed the CRNA of the tracheostomy; and his failure to do so led to the prolonged period of hypoxia. The endoscopy nurse testified that she did not know the patient had a tracheostomy prior to the event. The experts were critical of the surgeon and nurse for failing to be prepared for an emergent complication.

The reviewers were also concerned with the documentation of the event. They reported it was difficult to tell from the records who gave what medications when and that according to the nurse’s notes it appeared to take six to seven minutes to successfully intubated through the tracheostomy; however, the monitor recording of the event showed that the patient was without any oxygen for approximately 10 minutes.

The nurse testified that she did not write down nursing notes at the time of the event but reconstructed her notes following the event as she was assisting in providing care to the patient.



Risk Management Tips

• Communication – Communication failure between members of the health care team is a frequent root cause of patient injuries. Because health care often involves rushed interactions among the health care team, a standardized approach to communication is needed to ensure that patient information is effectively communicated.
• Documentation – Experts estimate that problems with medical record documentation jeopardize the defense of 35-40 percent of all medical malpractice claims. Avoid hinting that a patient's current condition is harder to manage because of another physician's treatment.

Naloxone after propofol.

 

[caligas]

Naloxone after propofol.

I assume this was to reverse narcotic given earlier by sedation nurse.

 

[deleted59964]

"A CRNA arrived and after verifying what medications the patient had been given, he administered Diprivan 30 milligrams IV push. The patient’s oxygen saturation level immediately dropped and the CRNA lifted her chin. The patient’s oxygen saturation level continued to decrease so the CRNA gave Narcan IV push and bagged the patient by mask. The patient’s oxygen saturation level continued to decline and the patient went into respiratory and cardiac arrest. The surgeon began chest compressions and ordered Lidocaine 100 milligrams given IV push. The surgeon then advised the CRNA that the patient had a tracheostomy."

... W.T.A.F

 

[Vandalia]

I will provide no details but I know of a similar case where the surgeon defamed the anesthesiologist both to the patient’s family and the OR staff. The anesthesiologist sued and on recommendation of his lawyer the surgeon eventually settled. I don’t know the dollar figure of the settlement but I know it wasn’t small potatoes.

I disagree strongly with your sentiment that an opinion can never be defamatory.

The fact that an opinion can in no circumstances be defamation is Law 101. However, it is true to say that simply because someone calls something an opinion, it is not necessarily so. It also is not defamation if something is said with hyperbole, sarcasm, humor. "Rank speculation or surmise" also cannot be defamation. As a rule of thumb, a defamatory statement must be something that can be proven false. If reasonable people can disagree as to whether a statement is false, it is not defamation.

In the case above, there are at least two problems. First, for defamation, you have to prove that the speaker knew the statement was false. (It is slightly more complicated, but those aspects really don't come into play here.) Second, based on what was presented, the surgeon disclosed the facts he used to come up with his opinion, and/or they were already known by the recipient.

There was a case vaguely similar to this in 2014 that addresses many of these issues. (Except it was a patient saying that her surgeon was negligent in an online forum.) Another service provider loses a libel lawsuit against a client

The highlights from the court's opinion:

[A]ll of Ms. Nazari’s statements concerning the allegedly poor results of her surgery are protected opinion, because they do not imply the existence of undisclosed facts. Basically, she says she had the surgery, and she has the unfortunate conditions described. Also, in her opinion, they are the result of the surgery, which — also in her opinion — involved negligence on the part of Dr. Loftus. These are all the facts she adduces; she does not imply the existence of any undisclosed facts. The reader of the postings may decide for himself or herself whether the opinions should be accepted, or are an example of the logical fallacy known as post hoc ergo propter hoc.

Dr. Loftus’s proffer of medical experts rebutting Ms. Nazari’s assertions is irrelevant; her statements are still protected opinion.

 

[Southpaw]

The fact that an opinion can in no circumstances be defamation is Law 101. However, it is true to say that simply because someone calls something an opinion, it is not necessarily so. It also is not defamation if something is said with hyperbole, sarcasm, humor. "Rank speculation or surmise" also cannot be defamation. As a rule of thumb, a defamatory statement must be something that can be proven false. If reasonable people can disagree as to whether a statement is false, it is not defamation.

You care about this more than I do. You also must be a lawyer. Or at minimum - what you say sounds very lawyeresque (completely subjective) and therefore makes little to no sense to a dumb ole doc like me.

I will only say I know of at least one lawsuit, and I suspect there are others, where a surgeon blabbed at the mouth to family and OR staff about the care provided by the anesthesiologist only to lose big time. I am only pointing out that what you say regarding an opinion and/or defamation isn’t really clear and in my personal experience it hasn’t held water. I think it’s smart, both for self-preservation and just being a good person, to watch what you say and who you say it to, while at work.

 

[deleted87051]

A false opinion is very different than a false statement of fact. For example, stating “the anesthesiologist mishandled the airway” ( an opinion) is vastly different than falsely stating “the anesthesiologist initially intubated the esophagus.”

 

[Arch Guillotti]

I will only say I know of at least one lawsuit, and I suspect there are others, where a surgeon blabbed at the mouth to family and OR staff about the care provided by the anesthesiologist only to lose big time. I am only pointing out that what you say regarding an opinion and/or defamation isn’t really clear and in my personal experience it hasn’t held water. I think it’s smart, both for self-preservation and just being a good person, to watch what you say and who you say it to, while at work.

Something about euthanasia was mentioned if I am not mistaken.