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lma lawsuit

Discussion in 'Anesthesiology' started by militarymd, Apr 21, 2007.

  1. militarymd

    militarymd SDN Angel

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    4/18/2007 2:00 PM
    By Marilyn Tennissen

    LMA device for administering anesthesia
    A wrongful death lawsuit filed recently in Orange County is not only calling into question the actions of two anesthesiologists, but the constitutionality of the state's civil remedies code as well.

    Joann Brown, on behalf of her deceased mother Shirley Brown, filed a lawsuit April 12 against anesthesiologist Dr. Frank Kuang-She Che and nurse anesthetist Michael Ieyoub.

    According to the plaintiff's original petition, Shirley Brown, 59, underwent an outpatient gynecological procedure at Memorial Hermann Baptist Hospital in Orange on April 28, 2005.

    Che and Ieyoub administered the general anesthesia for the surgery to remove endometrial polyps.

    "The surgery itself was uneventful, but at the end of the procedure the patient developed respiratory distress, laryngospasm and hypoxia," the petition states. "Oxygen saturation dropped to as low as 40 percent. A code was called and the patient was intubated with an endotracheal tube and oxygen saturation returned to 100 percent."

    Medical records indicate that Brown aspirated stomach contents into her lungs during the procedure and died May 11, 2005, of aspiration pneumonia.

    "While under the care and control of the defendants, Shirley Brown continously suffered gross abuse, extensive neglect and undue pain. Mrs. Brown's basic needs were ignored and her dignity was disregarded," the petition states.

    The plaintiff alleges that Chen and Ieyoub were negligent because of the way they administered the anesthesia, which was done through a laryngeal mask airway, a device placed into the throat.

    In a statement attached to the original petition, Dr. Mark Winik, a board certified anesthesiologist licensed in Maryland and New York, said Brown had several risk factors that should have prompted the anesthesiologists to use a different course of action and administer additional medications.

    Winik said Brown's medical records indicate that she was obese, hypertensive and had ischemic heart disease, or a restriction in blood supply to the heart.

    Accoring to Winik's statement as an expert for the plaintiff, an obese patient with ischemic heart disease was at an increased risk of aspiration of stomach contents.

    "The standard of care … would require the anesthesiologist to administer anesthesia via endotracheal tube as opposed to LMA," Winik stated. "The LMA rests above the vocal cords and provides no protection against aspiration."

    The lawsuit also alleges that Chen and Ieyoub were negligent because they failed to administer prophylactic drugs that would have lessened the acidity and volume of gastric secretions in the patient's stomach, such as Alka-Seltzer, Bicitra, Reglan or Pepcid.

    "The afformentioned acts and ommissions of defendants constituted negligence per se and such actions were in violation of the legislative statutes passed for protection of the elderly, under the Texas Health and Safety Code," the petition states. The code says that the elderly may not be physically or mentally abused or exploited, must be treated with respect and dignity and may not be denied care based on sex, age or handicap.


    "The harm that befell Shirley Brown while under the care of the defendants was the type of harm these statutes were designed to prevent," the plaintiff alleges.

    The suit also alleges that the defendants committed a felony by having removed, destroyed or concealed writings.

    In addition, "plaintiffs maintain and contend that the Civil Practice and Remedies Code pertaining to medical malpractice is itself unconstitutional" because it limits damage amounts.

    The plaintiff says in particular, the limit on recovery of damages based on the number of plaintiffs and violates due process by "creating uneven or disportionate remedies for families because of the number of family members."

    Joann Brown is only child of Shirley Brown.

    She is seeking damages for medical expenses, mental anguish, impairment, funeral expenses and loss of companionship.

    The wrongful death suit also alleges that defendants acted with malice and conscious indifference and therefore the plaintiff is also seeking exemplary and punitive damages.

    She is requesting a trial by jury.

    Mike Jacobellis is representing Joann Brown.

    The case has been assigned to the 128th District Court in Orange County.

    Case No. A07015-C
     
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  3. zippy2u

    zippy2u Senior Member

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    LOL, now if the case had been done by a solo CRNA, this kind of misfortune would not have happened. Those 'ologists always tend to muck up these simple cases. Dammit, she got one of those rocket scientist gas docs rather than that run o' the mill CRNAs. Mise well settle and call it a day. Regards, ---Zip
     
  4. BlackScorpion

    BlackScorpion Member

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    This is cleary a blow to the ATC model. Had the CRNA been allowed to practice independently without the interference of an anesthesiologist, this kind of stuff would have never happened. Common sense dictates that one provider is superior to two providers, let alone a supervising anesthesiologist with all those unnecessary training. Let's forward this case the AANA.

    All kidding aside, I do feel for the family.
     
  5. urgewrx

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    Bend over. Nothing else to do.
     
  6. zippy2u

    zippy2u Senior Member

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    Notice how the plaintiff's expert witness is rarely from the state in which the incident occurs. Big money in being an expert witness, but I'd never do it. ---Zip
     
  7. Bertelman

    Bertelman Maverick!

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    Don't they get like $5k per case, plus incidentals?
     
  8. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved

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    This case is not about CRNA's or Physicians, it's about trial lawyers trying to make money, it also demonstrates what an expert witness would do for a few dollars.
    This guy has the nerves to claim CAD and hypertension to be risk factors for aspiration.
    These "experts" are out there and they will say anything for the right amount of money.
    Without these "experts" The lawyers are helpless.
     
  9. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved

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    It seems also they are after the tort reform of Texas.
     
  10. nurburgring

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    Just a student here, but I read this and was curious. I browsed through Morgan and Mikhail, and no where could I find CAD and HTN as risk factors for aspiration. I also saw no contraindication to the use of an LMA with those said risk factors. What gives? A prostitute of an expert witness?
     
  11. zippy2u

    zippy2u Senior Member

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    Try obesity as a risk factor for the aspiration. --Zip
     
  12. urgewrx

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    I guess there were too many "captains" in that ship!
    :laugh:
     
  13. Noyac

    Noyac ASA Member
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    Not always, not 100%. Many obese pts never have reflux.
     
  14. poster

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    Looks to me that the Physician took the fall for the CRNA's mistake. Why else would they even have pointed out the CRNA.
     
  15. Monty Python

    Monty Python Blissfully retired

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    Take the shotgun approach, sue everyone in the OR, let the settlement offers begin to fly, last man standing pays through the nose.
     
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  17. johankriek

    johankriek Banned
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    a good lesson to be learned here. many people believe, hey I will put an LMA in and its safer.. That is NOT the case.. ETT is always the safest thing..... many times i put in an ETT for a D and C at 11 weeks... Just my thing.. I am not gonna mask or LMA a pregnant chick.... I dont know the details of the case.. but i will agree..
    ETT may have prevented her aspiration.. I would never say that in court though... and would never be an witness for the plaintiff.
     
  18. Broken Ankles

    Broken Ankles Junior Member

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    if the crna was going solo in the case, would the surgeon be responsible, or would it have been just the crna?
     
  19. urgewrx

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    How did you arrive to that conclusion from the original post? In my mind there are two options. The anesthesiologist supervising the CRNA told him to place an LMA, or the anesthesiologist was ok with the CRNA doing whatever he wanted. Either way the anesthesiologist was responsible for the patient.

    Broken Ankles, in California the surgeon, along with the CRNA, would have been responsible.
     
  20. The_Sensei

    The_Sensei Banned
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    Very disconcerting........if I had $5 for every obese hypertensive I put an LMA in, I'd be a millionaire. Thanks for posting this, Mil - should garner some interesting conversation until the inevitable arguing between you and Volatile.;)
     
  21. poster

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    You are correct, but with that thinking then you will never be able to call any study that involves the safety of CRNA's vs Anesthesiologists a valid study because those are always the said options, therefore the Doctor will always be the one at fault. But that does not take away the poor decision of the CRNA (if in fact that is how it happened) and therefore the doctor getting the blame. BTW I believe it is more than likely the Crna being told to do whatever.
     
  22. urgewrx

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    There are plenty of CRNA's practicing solo, as well as plenty of Anesthesiologist practicing solo. It cannot be that hard to compare the closed claims from both groups in ASA1 pts for similar procedures.

    You talk about "poor decision" regarding the LMA. I think you are suffering from outcome bias. It's an unfortunate event, that's all I dare to say. Being fat is not an absolute contraindication for an LMA.

    I don't understand why you keep blaming the CRNA and not the anesthesiologist. If he was supervising, he is responsible for the patient. It is his fault that the pt was not intubated. Either because he wanted an LMA or because he did not have the CRNA intubate the pt. The anesthesiologist is always responsible for whatever happens unless he specifically ordered the CRNA to do something but his order was not carried.
     
  23. Noyac

    Noyac ASA Member
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    Just like Sensei, I have put LMA's in many obese pts. ****, I practiced in Louisiana when I first got out of training and if I wouldn't put an LMA in an obese pt then, I may have totally forgotten how to place them altogether. But I suspect that this pt was in lithotomy position and I rarely put LMA's in obese pts when in lithotomy position. I will use one in a normal size pt in lithotomy, however.
     
  24. Monty Python

    Monty Python Blissfully retired

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    "...The controlling factor in determining whether a surgeon is to be held accountable for a nurse anesthetist's actions is whether, based on the facts of the case, the surgeon actually exercised control or had the right to exercise control over the nurse anesthetist during the surgical procedure.

    If not, the surgeon is likely not to be held accountable for the actions of the nurse anesthetist or adverse patient outcomes resulting from the administration of anesthesia. Under this control or right to control test, the scope of practice of the nurse anesthetist under state law is less important.

    Whatever state law provides, if a hospital requires some level of physician oversight of anesthesia services, or if the surgeon intervenes in the administration of anesthesia, the surgeon may be found liable for a nurse anesthetist's actions." http://www.asahq.org/Newsletters/2000/12_00/semo.htm
     
  25. VolatileAgent

    VolatileAgent Livin' the dream

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    thanks. good lesson to learn here. let us know what the outcome eventually is.
     
  26. Mman

    Mman Senior Member

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    I'm not a fan of using LMA's in cases that will take > 2 hours or in patients with an abdomen that extends farther vertically than their chin when in the supine position. Not hard rules, but just more of a rule of thumb that I follow.
     
  27. BLADEMDA

    BLADEMDA ASA Member

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    If you are the attending then the buck (literally) stops with you. The choice is yours each and every case to make but you must deal with all the consequences.

    I have done these cases many times with an LMA. That said, I have seen more than a few aspirations from these types of patients. If I LMA an obese patient I give a lot of pre-meds and am prepared to alter course (intubate) quickly if required. An LMA is a poor excuse for an E.T. tube as this case illustrates.

    Once you become Board Certified the choice is yours as well as the consequences like defending yourserlf in court.
     
  28. VentdependenT

    VentdependenT You didnt build thaT
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    You proseal the bigguns if they go in lithotomy or just intubate them?

    Unrelated, my friggen firefox2 web browser is trying to correct every spelling error I make and its driving me downright batty.
     
  29. VentdependenT

    VentdependenT You didnt build thaT
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    why the 2 hour rule?
     
  30. Tenesma

    Tenesma Senior Member

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    the interesting thing is that in the U.K. my buddies do most c-sections with LMAs!!!!! and their maternal morbidity/mortality rate is pretty darn low...

    personally it freaks me out...

    i do some legal work and my charges are about average: 2,500 per half day and 5,000 per full day not including full coverage of travel/incidentals, etc... of course, so far i have only done defense for physicians - but i am getting sick and tired of it and the bull**** of the lawyers... You can't imagine how many times the lawyers hiring me have lied to me so as to spruce things up and then you get on the stand and they basically use you...

    i strongly encourage everybody to get involved w/ legal work because it puts things into a whole new perspective and has really changed my practice - i have learned a ton from other peoples mistakes or "omissions"...

    now if the defense gets a good lawyer to show that aspiration pneumonia can occur even with an ETT and that the patient lied about being NPO then you got a good defense...
     
  31. Mman

    Mman Senior Member

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    I figure at a teaching institution if the case is booked for 3 or 4 or 6 or whatever hours, I'm not quite sure what sort of blood loss they are going to get into and how much volume I'll be giving. Could do an LMA, but if it's a longer case I'd just as soon stick at ETT in. What's the downside? Can still let them breathe spontaneously with a little pressure support.
     
  32. cubs3canes

    cubs3canes Senior Member

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    I believe ETT still have an incidence of aspiration as well. I know it is lower than LMA's, but still there. I extremely doubt they would have done rapid sequence.

    They must PROVE that the provider acted outside the Standard of Care or showed negligence. Did they truely act outside the standard of care? This case is not as easy to win for the patient's family as it sounds.
     
  33. BLADEMDA

    BLADEMDA ASA Member

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    Cases like this are never easy to win. But, like John Edwards will tell you if you do win the verdict can be huge. My guess is that the insurance company will offer to settle the case. How much? I don't know but usually the limits of the policies involved suffice.

    Would I want to be the defendant in THIS case? No way. The odds are you will LOSE and tie up years of your life as well. I use pre-meds for morbidly obese patients and they do work. Reglan starts working in 3-5 minutes and reduces gastric volume. Antacids like Pepcid/Zantac are cheap and may help. Finally, how FAT is too fat for an LMA? There is no agreement on this and a former partner would LMA anybody (I mean anybody). Is this the standard of care?

    I have been there many times myself and understand "complications." Our system is OUTCOME Driven and whenever there is a poor outcome expect malpractice litigation to be considered every time.

    BladeMDA
     

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