Man falls off surgical table; St. Joseph's Hospital sued

[interleukin2]

To what degree is the patient accountable? I mean 300Lb, if he was properly secured then where is the negligence? I am curious as to what thoughts you guys may have since it seems that as the population gets more obese and risks increase due to complicating factors of this, when complications occur the patient has zero responsibility and its all on us.

Man falls off surgical table; St. Joseph's Hospital sued
,
Max DeVries was sedated and awaiting a routine surgery when he rolled off the operating table and hit his head, where doctors had earlier removed part of his skull because of brain swelling following a stroke.
The 61-year-old St. Paul man later died and the family contends St. Joseph's Hospital of St. Paul didn't use proper procedures and equipment to safeguard DeVries, who was 5- feet-5 and weighed about 300 pounds. According to a lawsuit filed Thursday in Ramsey County District Court, "The fall from the operating table was a direct cause of, or contributed to, the death of Max DeVries."
"It's a tragedy and it could have been avoided," said Shawn DeVries. His father suffered a stroke Feb. 7 and on March 8 was scheduled for a routine procedure to have a lumbar drain replaced. He was expected to leave the hospital in three days for rehabilitation.
"It was another routine procedure," Shawn DeVries said. "It was the fourth [drain] they had to replace. He was making slow and
steady progress -- until the fall."
Robert Hajek, the family's attorney, said the table's three Velcro straps couldn't hold DeVries.
The lawsuit contends that the hospital lacked "appropriate facilities and equipment, including wide enough tables and adequate restraints to perform an operation on Max DeVries." The suit argues that DeVries' weight "is not an unusual or abnormal weight for patients that experience stroke."
With growing obesity and about 30 percent of American obese, having adequate equipment for very heavy people has become an issue for hospitals and skilled nursing facilities.
In some cases, hospitals have bolted surgical tables to the floor to prevent heavy patients from tipping them over. How to care for overweight surgical patients has generated new operating-room products as well as medical journal articles and books in recent years.
Officials at the St. Paul hospital declined to comment about the lawsuit, citing patient privacy laws.
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"St. Joseph's Hospital and HealthEast Care System take this situation and this family's concerns very seriously. We extend sincere sympathy to the family of Max DeVries," hospital officials said in a written statement.
"St. Joseph's Hospital and HealthEast Care System have a strong commitment to patient safety and have been nationally recognized f or providing the highest quality patient care. When there are patient safety concerns, we always conduct a thorough internal investigation to ensure that our processes meet rigorous standards for safety and implement improvements that we believe will advance safety."
Hajek said the hospital, as required, filed a report on the incident with the Minnesota Department of Health's Office of Health Facilities Complaints but isn't sure when the state will complete its review. State officials won't say whether there is an investigation until the report is complete.
Shawn DeVries said his father's fall could have been prevented if the hospital had used bigger straps or maybe rails. "Realistically, 330 pounds isn't that much," he said. "I'm 220 pounds. There are a lot of people who are this size."
Doctors had expected to mend Max DeVries' skull once the swelling was gone, his son said. In the meantime, he said, doctors were waiting for stitches to heal before outfitting Max DeVries for a helmet.
Shawn DeVries spent about four hours with his father before the surgery on March 8. "It was one of his best days I had with him [since the stroke]," he said. Because of a tracheotomy, his father had spent most of his time communicating by "head nods and scribbles."
He was paralyzed on his left side after the stroke but his family expected him to regain some movement in time. "It was going to be an uphill battle but possible," Shawn DeVries said.
The operating room fall caused "substantial additional injuries," the lawsuit contends. Additional surgeries were performed to save DeVries' life, the suit states.
Shawn DeVries said his father barely, if at all, opened his eyes after the fall. "He would nod or shake his head yes or no. ... But three days later, he was unresponsive. "We were holding out hope. We waited for things to change. But nothing did."
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Max DeVries later suffered a massive stroke, Hajek said. He died on April 13.
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[Dejavu]

"To what degree is the patient accountable? I mean 300Lb, if he was properly secured then where is the negligence? I am curious as to what thoughts you guys may have since it seems that as the population gets more obese and risks increase due to complicating factors of this, when complications occur the patient has zero responsibility and its all on us."


While it is more difficult to deal with a larger pt, I submit that the single safety belt placed on a 65 kg pt isn't sufficient security for a 150kg man, but that is usually what is done. More securing techniques seem to be in order for larger pts.

An argument by analogy (admittedly faulty sometimes), but, while driving a car, when you hit someone from the rear, you always are tagged for following too close, no matter what the conditions. If it is icy, you need to allow for that. Same with a larger pt. You need to allow for the need for more sturdy securing devices.

I agree with the argument that the pt got obese on his own and this does complicate things by their actions, but I bet I know what the jury is going to rule.

 

[Bertelman]

The standard of care in this country is that no one should fall off an operating room table, or any other bed for that matter, particularly while anesthetized/sedated. I think that's pretty realistic.

If you expect the patient to bear some burden of responsibility, they should maybe get their choice of beds to lay on, and devices to secure them. That's not an option at my hospital. We tell them how they will move to the bed, we tell them when, we dictate the choice of bed and we assure them they will not fall. The trade-off of all those decisions we have made for the patient is that we assure them everything will be OK.

I'm not at all surprised someone is being sued for a patient falling off an OR table. What does upset me is that this hospital has taken great care of this man for over a month, been a large part of why he has even survived an often fatal event, and the family has chosen this moment to extract money. They have basically ignored all the postive work and professional standards for one momentary lapse.

I agree that falling off an OR table is unacceptable, but I am saddened that they think their best recourse is litigation for financial reward.

 

[Gern Blansten]

The standard of care in this country is that no one should fall off an operating room table, or any other bed for that matter, particularly while anesthetized/sedated. I think that's pretty realistic.

If you expect the patient to bear some burden of responsibility, they should maybe get their choice of beds to lay on, and devices to secure them. That's not an option at my hospital. We tell them how they will move to the bed, we tell them when, we dictate the choice of bed and we assure them they will not fall. The trade-off of all those decisions we have made for the patient is that we assure them everything will be OK.

I'm not at all surprised someone is being sued for a patient falling off an OR table. What does upset me is that this hospital has taken great care of this man for over a month, been a large part of why he has even survived an often fatal event, and the family has chosen this moment to extract money. They have basically ignored all the postive work and professional standards for one momentary lapse.

I agree that falling off an OR table is unacceptable, but I am saddened that they think their best recourse is litigation for financial reward.

I understand your point...but the one momentary lapse led to the patient's ultimate demise. Pretty big lapse. I would be surprised if the family did not sue. I suspect 99.9% of families would. I agree with the above statement that standard of care would be to NOT have the patient fall off the table. I think standard of care was not upheld here. And 300 lbs is not large where I come from; it would be considered a bit above average weight.

 

[All4MyDaughter]

What does upset me is that this hospital has taken great care of this man for over a month, been a large part of why he has even survived an often fatal event, and the family has chosen this moment to extract money. They have basically ignored all the postive work and professional standards for one momentary lapse.

I agree that falling off an OR table is unacceptable, but I am saddened that they think their best recourse is litigation for financial reward.

What do you think would be better recourse for this family? What other recourse do they have?

And I agree with Gern. 300 lb = somewhat svelte at my hospital. Certainly not abnormally large as we have patients who are MUCH MUCH larger than that.

 

[pgg]

To what degree is the patient accountable? I mean 300Lb, if he was properly secured then where is the negligence?

If he was properly secured he wouldn't have fallen off the table. Granted, the article looks like a press release from the plaintiff's attorney, and I generally hold such lawyers in contempt on principle ...

It's one thing if a patient comes into the ER drunk and combative and flails himself onto the floor. But a guy under anesthesia, disgusting fatbody or not, it really is our responsibility to not drop him on the floor.

 

[Idiopathic]

It would be interesting to see if this patient was SEDATED or ANESTHETIZED. I wager an anesthetized patient would not have fallen off the table, but a sedated patient (especially one mildly sedated) could easily fall, and also likely wouldnt be secured as well. it seems like a slam dunk to say that no patient should ever fall from an operating table, and i agree with this, but there is likely a mitigating factor here as well.

also, for arguments sake, if he was "properly secured" then he wouldnt have fallen. here, the negligence is in the outcome, rather than the preventive measures,

 

[Idiopathic]

i see pgg already touched on that

 

[Bertelman]

What do you think would be better recourse for this family? What other recourse do they have?

And I agree with Gern. 300 lb = somewhat svelte at my hospital. Certainly not abnormally large as we have patients who are MUCH MUCH larger than that.

I don't know what recourse they have, it just doesn't sit right with me that this pt. presumably got pretty good stroke care for a long period, and it ended with a lawsuit. Call me naive, but what exactly will be the basis for the award judgment? Will they be reimbursed for the "lost wages" of a man that would live his life in a facility as a hemiplegic? I guess my opinion just stems from my misunderstanding of what these judgments are used for.

I have a grandfather who has been between the hospital and rehab for the better part of a year now. Massive stroke, permanent disability, feeding tube, aphasic, etc. If something were to happen to him, even if it were blatant medical error, I'm not really sure what a lawsuit would accomplish. It's not helping my grandfather, that I know. I also know that 30-40% of the settlement goes to the lawyer. Not that there's a conflict of interest. 🙄 I would expect a hospital investigation, change of policy, etc. I am not convinced a settlement would motivate any of the participants to do anything greater.

And I absolutely agree that 330 lb is pretty standard these days. Having said that, 330 lb on a 5'5" frame is more like 400 lb., with most of it concentrated in the abdomen. I can imagine that can roll off an OR table during lateral or prone positioning pretty easily.

 

[Gern Blansten]

Unfortunately, I don't think this occurrence is as rare as we would like it to be. Just in the past few years, I have heard of several of these occurrences. Usually a "word of mouth" report and usually without a bad outcome. But there have been a couple of higher profile ones that got some press because they led to a patient death.

I heard from a med student that it occurred at a place while they were doing an away rotation. I know that I have personally seen a couple of close calls and it is something that I try to be very vigilant about. Surgeons also often request steep trendelenburg or steep "airplane" positioning that really gets me nervous.

 

[Jay K]

I don't know what recourse they have, it just doesn't sit right with me that this pt. presumably got pretty good stroke care for a long period, and it ended with a lawsuit. Call me naive, but what exactly will be the basis for the award judgment? Will they be reimbursed for the "lost wages" of a man that would live his life in a facility as a hemiplegic? I guess my opinion just stems from my misunderstanding of what these judgments are used for.

I have a grandfather who has been between the hospital and rehab for the better part of a year now. Massive stroke, permanent disability, feeding tube, aphasic, etc. If something were to happen to him, even if it were blatant medical error, I'm not really sure what a lawsuit would accomplish. It's not helping my grandfather, that I know. I also know that 30-40% of the settlement goes to the lawyer. Not that there's a conflict of interest. 🙄 I would expect a hospital investigation, change of policy, etc. I am not convinced a settlement would motivate any of the participants to do anything greater.

👍 Numerous good points. This should be an impetus for re-evaluation of patient safety protocols at that hospital as well as the necessary implementation of such procedures and/or equipment, but I also question the idea of substantial monetary rewards. Logical and appropriate financial restitution amounts, not emotionally "upcharged" by a jury in a tort-reform-less state may be in order.

 

[All4MyDaughter]

I don't know what recourse they have, it just doesn't sit right with me that this pt. presumably got pretty good stroke care for a long period, and it ended with a lawsuit. Call me naive, but what exactly will be the basis for the award judgment? Will they be reimbursed for the "lost wages" of a man that would live his life in a facility as a hemiplegic? I guess my opinion just stems from my misunderstanding of what these judgments are used for.

What they can recover for depends on state law. In my state, survivors can recover for lost wages or future earnings, (as determined by an objective party), pain and suffering (of the deceased), and relevant medical costs relating to the incident. Parents can recover for loss of consortia from the time their child died to the child's 18th birthday. Children can recover similarly if a parent is lost. These are all examples of compensatory damages. Punitive damages are separate.

I have no idea what (if anything) might apply to this case b/c I don't think the article gives enough info to make a determination. What I've listed above are just possibilities.

I have a grandfather who has been between the hospital and rehab for the better part of a year now. Massive stroke, permanent disability, feeding tube, aphasic, etc. If something were to happen to him, even if it were blatant medical error, I'm not really sure what a lawsuit would accomplish. It's not helping my grandfather, that I know. I also know that 30-40% of the settlement goes to the lawyer. Not that there's a conflict of interest. 🙄 I would expect a hospital investigation, change of policy, etc. I am not convinced a settlement would motivate any of the participants to do anything greater.

In my personal experience, sometimes a lawsuit is the only way to get people to pay attention. In the year after my daughter was killed I wrote letters, made phone calls, talked with elected and appointed public officials, trying to figure out why such a dangerous criminal (a parolee, allegedly being supervised) was out on the street continuing to commit crimes that eventually escalated to killing two children. I got mostly form letters and blow offs for my efforts. So, a year after she died (and a year ago today, actually) we filed a lawsuit against the parole officer who we allege was negligent in supervising the man who killed Riley (you can't directly sue the state). You can bet that the wrongful death lawsuit has made the state pay attention, because although they aren't a direct party to the suit, they have to defend their crappy employee.

I don't know what the family in this case wants, but sometimes asking for money is the only way to get large organizations to pay attention and be accountable for their errors. I also don't doubt that there are people out there (plaintiffs) who are greedy. But I also tend to believe that people who lose someone they love due to someone else's negligence are genuinely hurting, and probably acting more from that pain than from a "get money" viewpoint. It's impossible to know...

This should be an impetus for re-evaluation of patient safety protocols at that hospital as well as the necessary implementation of such procedures and/or equipment, but I also question the idea of substantial monetary rewards. Logical and appropriate financial restitution amounts, not emotionally "upcharged" by a jury in a tort-reform-less state may be in order.

Yes, I think it's reasonable to expect appropriate compensation when an error is made that harms or kills a patient. Sometimes juries go crazy with the punitive damages, although that often gets reduced on appeal. And you'd hope that such an error would cause the hospital to re-evaulate protocols and procedures to make sure that the error isn't repeated, but without financial incentive to do so, would it really happen? I'm not sure...

 

[IceDoc]

There are some things you just can't defend in court, and falling off a table is one of them. People (juries) understand falling off a table, and they're going to assign the responsibility to the medical providers.
(Of course in residency we had someone CLAIM he fell off a table; extensive investigation revealed he didn't. He'll probably sue anyway.)


Another thing is fires. You can't defend them because juries understand fires and make the determination that fires shouldn't ever happen. You usually won't be able to pin all the blame on the surgeon because the juries usually consider fire prevention as a shared responsibility.
Check out http://ppmrrg.com/FileUploads/Issue26.pdf
It's definitely worth the 15min to read it.

 

[jwk]

It would be interesting to see if this patient was SEDATED or ANESTHETIZED. I wager an anesthetized patient would not have fallen off the table, but a sedated patient (especially one mildly sedated) could easily fall, and also likely wouldnt be secured as well. it seems like a slam dunk to say that no patient should ever fall from an operating table, and i agree with this, but there is likely a mitigating factor here as well.

also, for arguments sake, if he was "properly secured" then he wouldnt have fallen. here, the negligence is in the outcome, rather than the preventive measures,

Huh? Of course an anesthetized patient can fall off the table.

This is res ipsa loquitur personified. It shouldn't happen - ever - and it's indefensible when it does. It will never make it to a jury - easy money for even a fresh-out-of-school trial lawyer. And the idea that the patient "contributed" to the problem by being obese is idiotic.

A case almost identical to this happened at a hospital I trained at more than 30 years ago and was the subject of an M&M conference. The patient was anesthetized for a cerebral aneurysm clipping. They were turned on their side for placement of a lumbar CSF drain (sounding familiar?). No straps in place - several people were around the patient "holding" him. For some inexplicable reason, everyone turned away at the same time - the resident placing the drain, the nurses/techs holding him, everyone. The patient rolled off the table and hit the floor - fortunately his head didn't hit the floor, because it was suspended by a very well-taped ETT still attached to the black rubber breathing circuit. Amazingly, the patient had no sequelae from the fall, the surgery was completed another day, and the patient was discharged home neurologically and orthopedically intact.

These things happen FAR more frequently than you might imagine or will ever hear about. Steep T-berg, lateral tilt, steep reverse T-berg and that freakin beach chair position for lazy orthopods (the most dangerous unstable position that we do every day). All of them are accidents waiting to happen.

 

[Bertelman]

What they can recover for depends on state law. In my state, survivors can recover for lost wages or future earnings, (as determined by an objective party), pain and suffering (of the deceased), and relevant medical costs relating to the incident. Parents can recover for loss of consortia from the time their child died to the child's 18th birthday. Children can recover similarly if a parent is lost. These are all examples of compensatory damages. Punitive damages are separate.

I think it would be perfectly reasonable to forgive all medical expenses of the hospitalization, and even to suspend litigation pending the proof that hospital policy has been enacted, and all parties have been trained in the new policy.

I understand that corporations often don't listen unless there is financial "motivation", but unfortunately in incidents such as this, the people in the OR remain relatively unscathed from the incident, save maybe the physicians present. The nurses, techs, etc. will never feel the pinch of the lawsuit.

 

[Gimlet]

The patient rolled off the table and hit the floor - fortunately his head didn't hit the floor, because it was suspended by a very well-taped ETT still attached to the black rubber breathing circuit.

😱 Damn, that is one well-secured tube!

These things happen FAR more frequently than you might imagine or will ever hear about. Steep T-berg, lateral tilt, steep reverse T-berg and that freakin beach chair position for lazy orthopods (the most dangerous unstable position that we do every day). All of them are accidents waiting to happen.

Lazy, as in the surgery can be accomlished in a safer position with a bit more effort from the surgeon's end? Any suggestions on how to deal with positioning requests that optimize surgical approaches at the potential expense of patient safety?

In my personal experience, sometimes a lawsuit is the only way to get people to pay attention. In the year after my daughter was killed I wrote letters, made phone calls, talked with elected and appointed public officials, trying to figure out why such a dangerous criminal (a parolee, allegedly being supervised) was out on the street continuing to commit crimes that eventually escalated to killing two children. I got mostly form letters and blow offs for my efforts. So, a year after she died (and a year ago today, actually) we filed a lawsuit against the parole officer who we allege was negligent in supervising the man who killed Riley (you can't directly sue the state). You can bet that the wrongful death lawsuit has made the state pay attention, because although they aren't a direct party to the suit, they have to defend their crappy employee.

I remember hearing about your daughter's tragedy...I hope you win the **** out of that lawsuit.

 

[SleepIsGood]

I understand that patients need to be secured on a table. However, take the following case.


It's 230AM and an emergency appy cmes into a small community hosp. The patient is 6'0 and 450lbs.

Case goes well. However, during extubation the patient is bucking, is not really awake but is squirming all over the place. You do not want to remove the tube yet, since it was a difficult intubation, having used FOI,etc. He's not responding to command. In addition to the OR straps around the patient, you have all the OR staff attempt to restrain the patient (remember there's its 230AM and it's an emergency case...all you have in the OR is an anesthesiologist, surgeon, circulator, and scrub tech and maybe even a maintenance guy). There are no additional techs/help.

Despite everyone's best efforts, the patient falls off the table and the sme outcome occurs, patient dies/is injured.

Who is at fault? Is their negligence? It seems the anesthesiologist was acting in the best interest of the patient by keeping him intubated given the fact he was a difficult a/w. The anesthesiologist did have multple people in the room for help.

 

[proman]

If you're concerned about the patient's safety and having a rocky emergence, you can always put them back under, regain control, and try again. The scenario above, I'd give a slug of propofol, transfer to the big boy bed, get restraints on, sit the patient up and let him emerge in a more controlled fashion.

Rarely happens because everyone's in a hurry and no one (OR staff etc) recognizes or cares that emergence is just as dangerous as induction.

 

[lord_jeebus]

I understand that patients need to be secured on a table. However, take the following case.


It's 230AM and an emergency appy cmes into a small community hosp. The patient is 6'0 and 450lbs.

Case goes well. However, during extubation the patient is bucking, is not really awake but is squirming all over the place. You do not want to remove the tube yet, since it was a difficult intubation, having used FOI,etc. He's not responding to command. In addition to the OR straps around the patient, you have all the OR staff attempt to restrain the patient (remember there's its 230AM and it's an emergency case...all you have in the OR is an anesthesiologist, surgeon, circulator, and scrub tech and maybe even a maintenance guy). There are no additional techs/help.

Despite everyone's best efforts, the patient falls off the table and the sme outcome occurs, patient dies/is injured.

Who is at fault? Is their negligence? It seems the anesthesiologist was acting in the best interest of the patient by keeping him intubated given the fact he was a difficult a/w. The anesthesiologist did have multple people in the room for help.

One of our attendings does a lot of work as an expert witness defending anesthesiologists in court, and has told me that this sort of thing is not uncommon. His opinion is that patients in this position should be aggressively restrained (eg. multiple OR straps plus 3-inch silk tape securing hands, wrists, forearms, arms) so that you are not dependent on other people to keep the patient on the table - because if you don't, some plaintiff's attorneys know to ask why you could have, but chose not to.

 

[Bertelman]

I understand that patients need to be secured on a table. However, take the following case.


It's 230AM and an emergency appy cmes into a small community hosp. The patient is 6'0 and 450lbs.

Where I'm chilling, that case doesn't happen at the small community hospital. 450 lb appy gets turfed down the road to the "academic center".

 

[SleepIsGood]

Where I'm chilling, that case doesn't happen at the small community hospital. 450 lb appy gets turfed down the road to the "academic center".

too bad where i'm at now, we are that 'academic center'

 

[Bertelman]

too bad where i'm at now, we are that 'academic center'

Me too. 😡

 

[basupran]

and that freakin beach chair position for lazy orthopods (the most dangerous unstable position that we do every day). All of them are accidents waiting to happen.

Interesting comment. Would you- an anesthesiology assistant who is also an expert in orthopedic surgery (enough to realize that we are all just lazy)- be so kind as to provide your input on how orthopaedic surgeons should perform shoulder surgery?

 

[jwk]

Interesting comment. Would you- an anesthesiology assistant who is also an expert in orthopedic surgery (enough to realize that we are all just lazy)- be so kind as to provide your input on how orthopaedic surgeons should perform shoulder surgery?

Never claimed to be an expert sport, although I've been doing this for 30 years so I'm hardly a newbie. But since you asked, I'll give you an anesthesia perspective.

I'd much rather see shoulder surgery done in a lateral decubitis position with the arm on the operative side suspended in traction as needed. Beach chair, IMHO, is the most dangerous position we use routinely, with significantly increased risks of air embolism, unrecognized cerebral hypoperfusion, and the topic du jour, falling off the table, as well as a lot of near-misses from poor positioning on any number of positioning devices required by the surgeon, and intra-operative manipulation by the surgeon. Maybe there are some procedures that mandate a beach-chair position, but pretty much everything I see on a day-to-day basis (shoulder scopes, RCR's, SAD's, etc.) can be done in a lateral position.

Most neurosurgeons have abandoned sitting-position posterior fossa surgery because of the inherent risks of that position, and have changed to a lateral "park bench" position. Again, some procedures may need an approach which can only be achieved in a sitting position, but by and large, it's been abandoned.

And all that being said, although pretty much everyone in the OR will get sued if somebody hits the floor, you can bet my anesthesia record will indicate that the patient was positioned under the direction of the surgeon. I insist that the surgeon personally participate and check the patient's position prior to the prep. BTW, as an FYI, we also no longer use deliberate hypotension for shoulder surgery (or spines).

 

[De68801]

One issue that hasn't been raised is the fact that the patient was having surgery that precluded use of a restraining strap across the waist - the best place to secure a patient.

I can see how, with a patient having lumbar drain surgery, the straps would have to be placed away from the surgical field - up on the chest and down by the thighs. I can envision an obese squirmy patient, especially in the lateral position, squirming his way out of the straps and falling pretty quickly. The kind of straps that lock onto the rails could be lifted up by the patient's motion.

It is still a tragedy, but let's not be so quick to place all blame on the OR people involved.

 

[jwk]

One issue that hasn't been raised is the fact that the patient was having surgery that precluded use of a restraining strap across the waist - the best place to secure a patient.

I can see how, with a patient having lumbar drain surgery, the straps would have to be placed away from the surgical field - up on the chest and down by the thighs. I can envision an obese squirmy patient, especially in the lateral position, squirming his way out of the straps and falling pretty quickly. The kind of straps that lock onto the rails could be lifted up by the patient's motion.

It is still a tragedy, but let's not be so quick to place all blame on the OR people involved.

It doesn't matter. You have a sedated/anesthetized patient, up on their side in a position you know might present a problem. Regardless of how or why it happened, you are in an indefensible position. And c'mon - who else are you going to blame? Really.