Joan Rivers' Malpractice Settlement 8 figures

[BLADEMDA]

We are in the developed world. Why not buy the sux, have an agreement with a hospital that once used if mh occurs you can have dantrolene brought to facility or medevac. Her death was a facility driven death versus individual provider malpractice. Shame on the medical director of the facility.

At least put the sux in the code cart. I don't understand the rationale for avoiding sux entirely when the incidence of MH is so very low in these emergency situations. Perhaps, the Joan Rivers case will help rectify this problem for future patients.

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[deleted171991]

At least put the sux in the code cart. I don't understand the rationale for avoiding sux entirely when the incidence of MH is so very low in these emergency situations. Perhaps, the Joan Rivers case will help rectify this problem for future patients.

Probably some JCAHO or stupid bureaucratic requirement saying that the ASC cannot stock sux without dantrolene.

 

[Robotic Wis-Hipple]

So, I hope to never have to cut the neck but I sure as hell try before I let a patient die. But if no sharp available? Why not just needle cric, 3cc syringe with ETT circuit connector in the barrel then O2 flush as a poor man's jet ventilator. I will Macgyver the hell out of it if I need to.

 

[deansrv72]

Guess how much money Melissa Rivers would have gotten if the same thing happened in Florida: $0.00 Florida has strict laws on the books regarding malpractice lawsuits if an elderly person dies in a hospital, ASC or GI center. Melissa Rivers would not likely have any grounds to initiate the lawsuit. Typically, only young adults or the affected spouse of the supposed "wrongful death" has any legal standing to initiate a lawsuit in my State.

Perhaps that's why so many AAs and anesthesiologists are in Fla, when seconds count?


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[BLADEMDA]

Perhaps that's why so many AAs and anesthesiologists are in Fla, when seconds count?


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By many measures, Florida – which has long attracted snowbirds and retirees – is one of the nation’s grayest states. Overall, 19.1% of the Sunshine State’s population is 65 and older, the highest percentage in the nation.

So, every time grandma kicks the bucket in a hospital post procedure the children who are usually middle age and live out of state would seek to initiate a lawsuit. After all, why not sue the physicians and hospitals especially if you do no t even reside in that State. Florida already has a bad malpractice problem and without that state law limiting lawsuits for wrongful death the number of claims would likely double.

 

[dannyboy1]

The whole case is strange. Did they not have Roc available. RSI roc works alot faster then someones attempt at a cric, and joan rivers does not look like a difficult airway. Also the business about the ENT having already left the building dosent make a whole lot of sense. If she left after her procedure was over and the laryngospasm occured while the EGD was going on, why is she responsible ? (I find it hard to believe that the left as the patient was crashing from an acute airway issue.)

 

[BobBarker]

Don't paramedics use sux all the time? I don't think they have dantrolene on the ambulance?

 

[Chloroform4Life]

Probably some JCAHO or stupid bureaucratic requirement saying that the ASC cannot stock sux without dantrolene.

You can thank our own society for that.

http://www.asahq.org/quality-and-practice-management/standards-and-guidelines

According to the guidelines for office based anesthesia, the facility should have medications, equipment, and protocol available to treat MH when triggering agents are in use.

 

[deleted171991]

"Should" is different than "must". Should is common sense. Must is what happened here, I guess, because sux is cheap, dantrolene is not.

 

[Chloroform4Life]

"Should" is different than "must". Should is common sense. Must is what happened here, I guess, because sux is cheap, dantrolene is not.

True, but to the plaintiff lawyer and the jury, should will be interpreted as must.

 

[deleted171991]

True, but to the plaintiff lawyer and the jury, should will be interpreted as must.

In a laryngospasm, there is a 1 in 100,000 chance that there will be a plaintiff's lawyer with sux, and a 1 in 4 without. I'd take my chances.

 

[aneftp]

It's pretty simple what happened. We can all play Monday morning quarterback. Some of us can beat and pound our chests and say "we would do it, we would they that". We all know the situation.

The simple facts is that there was an adverse event (desat, spasm whatever). This is what anesthesiologist get paid the big bucks.

I don't know when the anesthesiologist last Intubated someone? I remember doing GI anesthesia almost exclusively for 3 years back around 2008. They were paying me close to 500k for 40 hours of work (I still had hospital privileges and went back once every 2-3 months just to maintain my skills and we were doing huge cases at the level 1 center often times MD only). And I would feel a little "rusty" doing an open thoractomy or open AAA case especially if I were my first day back after doing GI for months.


I can certainly imagine the panic that may have set in with Joan Rivers case. Not saying people panic. But there are some people tend to panic more.

We have 1 anesthesiologist in my 11 MD group currently who tend to bring the glide scope 80% of the time "just as stand by". Another anesthesiologist brings it in about 50% of the time. They rarely use the glide scope but it becomes a "security blanket". Some people do see it as a sign of weakness.

Me personally when I am solo at night on call and if it's even a questionable airway I will have the glide scope immediately in the room. Since I don't want to rely on the staff to have to run to the anesthesia work room to find the glide scope.

 

[Ignatius J]

"The main anesthesiologist, Dr. Bankulla, concerned that she would be blamed in the death, wrote out five pages of notes on the day of the procedure detailing what she saw and heard. Lawyers for the Rivers family said they were greatly aided in their case by Dr. Bankulla’s notes"

Do you guys try document details of what happen after an adverse event? Seems like it may have backfired.

Biggest dogma in medicine IMO. I document what is necessary and nothing else.

I get really peeved when I look through an old anesthesia record and I have to read the "Grapes of Wrath" in Latin to figure out if the patient had issues with anesthesia.

Why document "Routine ASA monitors"? You check the monitor box on the side. "Patient extubated, moving good air, and in stabile condition headed to PACU"? Do you really need to clarify that?

 

[deleted171991]

It's pretty simple what happened. We can all play Monday morning quarterback. Some of us can beat and pound our chests and say "we would do it, we would they that". We all know the situation.

The simple facts is that there was an adverse event (desat, spasm whatever). This is what anesthesiologist get paid the big bucks.

I don't know when the anesthesiologist last Intubated someone? I remember doing GI anesthesia almost exclusively for 3 years back around 2008. They were paying me close to 500k for 40 hours of work (I still had hospital privileges and went back once every 2-3 months just to maintain my skills and we were doing huge cases at the level 1 center often times MD only). And I would feel a little "rusty" doing an open thoractomy or open AAA case especially if I were my first day back after doing GI for months.


I can certainly imagine the panic that may have set in with Joan Rivers case. Not saying people panic. But there are some people tend to panic more.

We have 1 anesthesiologist in my 11 MD group currently who tend to bring the glide scope 80% of the time "just as stand by". Another anesthesiologist brings it in about 50% of the time. They rarely use the glide scope but it becomes a "security blanket". Some people do see it as a sign of weakness.

Me personally when I am solo at night on call and if it's even a questionable airway I will have the glide scope immediately in the room. Since I don't want to rely on the staff to have to run to the anesthesia work room to find the glide scope.

I actually tend to respect people who use videolaryngoscopy all the time. It's like people who use ultrasound all the time, versus people who rely on their conventional physical exam. Guess which patient does better.

I have seen so many beginners intubate successfully with video, while everybody else was watching the screen, that it's a no-brainer, if available. Actually, because it requires slightly different skills, it's also a must, at least from time to time (same for DL). It also allows for a gentler intubation in the right hands, IMO. And shows everybody how good I am (at playing video games), which is also important. When they watch somebody with worse video skills, they can see the difference, reality TV-style.

 

[jwk]

Biggest dogma in medicine IMO. I document what is necessary and nothing else.

I get really peeved when I look through an old anesthesia record and I have to read the "Grapes of Wrath" in Latin to figure out if the patient had issues with anesthesia.

Why document "Routine ASA monitors"? You check the monitor box on the side. "Patient extubated, moving good air, and in stabile condition headed to PACU"? Do you really need to clarify that?

There's a difference between documenting something on an anesthesia record, and a progress note that's part of the medical record, and a personal "refresh my memory" note that is not part of the medical record. I agree that "excessive charting" is usually redundant and pointless.

Remember at this point that the public doesn't know anything about this settlement except that is was "substantial". Any speculation regarding amounts and how much each party paid is just that - speculation. For all we know, the anesthesiologist might have had the lowest payout simply because she kept good notes of what happened and why. I can tell you in a lawsuit many years ago in our group, the scrupulously detailed note written by the anesthetist involved prevented any financial liability on the part of the group. I know I've had a few cases over my career where I wrote down some notes for myself and saved them for years, just in case.

 

[Arch Guillotti]

I actually tend to respect people who use videolaryngoscopy all the time.

I don't.

 

[deleted171991]

I don't.

This reminds me of the attitudes about ultrasound use for central line (or better, a-line) placement.

I always try to use the best tool available, while also trying to keep as many of my skills active as possible (just because you never know...). But why reinvent the rifle, just to feel like a hip shooter, when one can use that nice laser sight coupled with the even nicer telephoto lens?

 

[Ignatius J]

There's a difference between documenting something on an anesthesia record, and a progress note that's part of the medical record, and a personal "refresh my memory" note that is not part of the medical record. I agree that "excessive charting" is usually redundant and pointless.

Remember at this point that the public doesn't know anything about this settlement except that is was "substantial". Any speculation regarding amounts and how much each party paid is just that - speculation. For all we know, the anesthesiologist might have had the lowest payout simply because she kept good notes of what happened and why. I can tell you in a lawsuit many years ago in our group, the scrupulously detailed note written by the anesthetist involved prevented any financial liability on the part of the group. I know I've had a few cases over my career where I wrote down some notes for myself and saved them for years, just in case.

Like I said, write down what is necessary. No I don't think "smooth IV induction" will save anyone. I still don't even know what that means- does it refer to changes in BP? The patient drifting off peacefully? I don't know.

If something happens, I write down an objective, concise, and logical sequence of events. Never had any issues.

I just see way too much OCD out there.

 

[caligas]

Like I said, write down what is necessary. No I don't think "smooth IV induction" will save anyone. I still don't even know what that means- does it refer to changes in BP? The patient drifting off peacefully? I don't know.

If something happens, I write down an objective, concise, and logical sequence of events. Never had any issues.

I just see way too much OCD out there.

EMR is taking care of this issue. You can write "smooth IVI" all you want but the blood pressure of 243/127 still gets recorded.

 

[Chloroform4Life]

EMR is taking care of this issue. You can write "smooth IVI" all you want but the blood pressure of 243/127 still gets recorded.

You can make a note that BP is falsely elevated due to fasiculation or nurse is dry humping the cuff.

 

[IlDestriero]

EMR is taking care of this issue. You can write "smooth IVI" all you want but the blood pressure of 243/127 still gets recorded.

I saw a lot of fantasy vitals charted in the .mil on paper records. The people most vocal about not changing to an anesthesia EMR tended to be the ones with a history of precharting vitals and having records that did not seem to match what I saw on the slave monitors in the anesthesia office.
I wonder if that's a coincidence?

Maybe fantasy vitals is too harsh, let's go with "based on a true story."

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Il Destriero

 

[Planktonmd]

I saw a lot of fantasy vitals charted in the .mil on paper records. The people most vocal about not changing to an anesthesia EMR tended to be the ones with a history of precharting vitals and having records that did not seem to match what I saw on the slave monitors in the anesthesia office.
I wonder if that's a coincidence?

Maybe fantasy vitals is too harsh, let's go with "based on a true story."

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Il Destriero

Fantasy vitals is a form of "buffing the chart", and as we all know chart buffing is essential to the modern practice of medicine.
Here is the definition of "buffing" from the House of God glossary:
BUFF: polish to make look good, as BUFF a car, BUFF a chart, BUFF a gomer; part of BUFF and TURF.

 

[Ignatius J]

EMR is taking care of this issue. You can write "smooth IVI" all you want but the blood pressure of 243/127 still gets recorded.

Haha. Good point.

 

[GravelRider]

Maybe fantasy vitals is too harsh, let's go with "based on a true story."

--
Il Destriero

Medicine is art. The chart is an artistic interpretation of reality.

I think it's probably more important to document your thought process on decisions that you make that are not so clear cut. Writing "smooth as butter IV induction" is not going to save you in court. However, documenting your induction plan and your reason why, may fend off some lawyers even if there is a bad outcome. Too many times the decisions we make in anesthesia are done in our heads, which is probably part of the reason anesthesia is often taken for granted. We make it look easy or routine even though we are often making fairly complex decisions. For example, if I am looking at an old anesthesia record, I would rather see some thought process on the overall plan rather than the usual "standard asa monitors, smooth as a baby's butt induction."

 

[urge]

Medicine is art. The chart is an artistic interpretation of reality.

Made me laugh.

 

[pgg]

Fantasy vitals is a form of "buffing the chart", and as we all know chart buffing is essential to the modern practice of medicine.
Here is the definition of "buffing" from the House of God glossary:
BUFF: polish to make look good, as BUFF a car, BUFF a chart, BUFF a gomer; part of BUFF and TURF.

The House Of God is full of great wisdom.

But as I recall (it's been a while) the BUFF is all about making the TURF happen. BUFFing is drawing attention to a problem that would be better managed by another service and doing it in such a way that they couldn't put up a WALL to stop the transfer.

I never got the impression that BUFFing was lying or fabricating data.

 

[fakin' the funk]

I believe in: documenting facts and events without commentary as to why. If something didn't happen, don't document that it did.

I also believe -- and mercifully haven't had the chance to try -- that someone shouldn't die from a lost airway without an attempt at an invasive airway (needle or scalpel cric). I mean...if the alternative is death...

 

[Planktonmd]

The House Of God is full of great wisdom.

But as I recall (it's been a while) the BUFF is all about making the TURF happen. BUFFing is drawing attention to a problem that would be better managed by another service and doing it in such a way that they couldn't put up a WALL to stop the transfer.

I never got the impression that BUFFing was lying or fabricating data.

Buffing means the chart does not reflect reality but rather reflects an alternate reality in which turfing to somewhere else would be easier.
Perfectly harmonious vitals reflect an alternate reality in which turfing to PACU would be straight forward!
I am not saying it's right but people do it all the time!

 

[anbuitachi]

How were they able to sue 2 other anesthesiologists and get money from them? They came in to help and they were sued and got the 2 to settle?

 

[Pharmado]

How were they able to sue 2 other anesthesiologists and get money from them? They came in to help and they were sued and got the 2 to settle?

If they were able to successfully sue 2 other providers who came in to assist, the laws in that state need changing ASAP. If suing the code team is a possibility then there won't be anyone coming to help for fear of liability.

RN: "Dr Smith, you're needed emergently in endo 3!"
Dr. Smith: "Not a chance. I don't know what's going on in there but I'm not taking liability for someone else's case. Go find the janitor, maybe the patient's family won't bother to sue him."