Med mal

[Man o War]

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Sad.

$2 Million in Punitive Damages Assessed Against Hospital in $5.5 Million Medical Malpractice Wrongful Death Jury Verdict

 

[Psai]

During the trial, there was also testimony that the CRNA who had mis-intubated the patient was told that the breathing tube was not placed properly but nonetheless disregarded these warnings and left the room, thereby abandoning the patient and leaving him to suffocate to death.

 

[chocomorsel]

I don’t buy the the CRNA “left the room and let the patient suffocate to death”. Sure he or she may have left the room, but where was the patient’s nurse? Where was RT? And where was the code team? This story is obviously incomplete and one sided.

And the money received was 5+million dollars for a disabled 78 year old? Come on. It’s lotto time in America.

 

[sethco]

I thought WV had a 500k cap on non-economic damages? From the article, it sounded like 3.5 million in non-economic damages and 2 million in punitive damages, but nothing in economic damages because he was a disabled 78 year old. Maybe I'm missing something?

 

[pgg]

And the money received was 5+million dollars for a disabled 78 year old? Come on. It’s lotto time in America.

The bulk of the award ($3.5M) was pain and suffering and for the family's loss.

I don't know if I buy the pain and suffering bit; an esophageal intubation and anoxic brain injury is actually a pretty humane way to get killed. It beats most alternatives.

Anyway -

"The jury did not award any economic damages because the plaintiff did not present any evidence of special damages in that the decedent was 78 years old and disabled."

and

"Evidence was also presented during the trial that Weirton Medical Center fraudulently changed the patient’s medical records after his death to conceal the length of time that the patient’s breathing tube was left in his esophagus. Weirton Medical Center also failed to complete a mandatory Incident Report which plaintiff alleged was done to conceal the malpractice and the length of time the patient was without proper oxygen."

They got off easy with only $2M in punitive damages if that's true.

 

[drmwvr]

West Virginia jury assessed $1.5 Million in compensatory damages for the conscious pain and suffering endured by the plaintiff’s decedent prior to his death and $2.0 Million for the family’s sorrow, mental anguish, and loss of society, companionship, guidance, advice, and services of the decadent.

Decadent indeed...tax free too...

The jury did not award any economic damages because the plaintiff did not present any evidence of special damages in that the decedent was 78 years old and disabled.

 

[AdmiralChz]

Decadent indeed...tax free too...

The “tax” will go to the attorney. Likely > 50%.

 

[chocomorsel]

@pgg, 3.5 mil for a 78 year old disabled man is still too much. I don’t condone what happened, however he was old and disabled. I can see a healthy 50 year old but an 80 year old?

 

[dannyboy1]

as an aside. This is why I use a videoscope (glide, McGrath) for every floor intubation, no matter how easy the airway looks. I just don’t trust those portable CO2 detectors and you can reliably see that you are in much easier with videolarygoscopy.

 

[pgg]

@pgg, 3.5 mil for a 78 year old disabled man is still too much. I don’t condone what happened, however he was old and disabled. I can see a healthy 50 year old but an 80 year old?

I agree it's excessive.

My major criticism is that pain and suffering should've been $0 (instead of $1.5M). Presumably this guy got an induction dose of something and then 8 minutes later he was brain dead. There's no pain or suffering there. Terminal people pay good money for that kind of exit in those few civilized countries that allow it.

$0 economic damages is absolutely correct (duh, 78 yo disabled guy)

The $2M to cover "the family’s sorrow, mental anguish, and loss of society, companionship, guidance, advice, and services of the decadent" ... seems excessive. The word "disabled" doesn't necessarily mean low-functioning; all of us ought to be well steeped in the cynicism of what passes for "disabled" in some quarters. So maybe he had lots of good years left. I don't know where to set a fair price on the family's loss. More than $0. Less than $2M.

The $2M of punitive damages, give the falsification of medical records, is a blessing. Honestly, there ought to be criminal charges associated with that.


Overall, my outrage meter over the verdict is vigorously pegged at "meh" for this jury verdict.

These days juries are giving out $BILLION verdicts for assault cases, so ...

 

[deleted59964]

as an aside. This is why I use a videoscope (glide, McGrath) for every floor intubation, no matter how easy the airway looks. I just don’t trust those portable CO2 detectors and you can reliably see that you are in much easier with videolarygoscopy.

As an old hand your reply pains me ... the grumpy old man in me says this is feeble
The pragmatist in me says if it doesn’t delay things then it’s probably smart, and I think it’s only a matter of time till all intubations are with video laryngoscopy

 

[Arch Guillotti]

as an aside. This is why I use a videoscope (glide, McGrath) for every floor intubation, no matter how easy the airway looks. I just don’t trust those portable CO2 detectors and you can reliably see that you are in much easier with videolarygoscopy.

Weak

 

[Ronin786]

As an old hand your reply pains me ... the grumpy old man in me says this is feeble
The pragmatist in me says if it doesn’t delay things then it’s probably smart, and I think it’s only a matter of time till all intubations are with video laryngoscopy

Maybe. But the number of bloody or aspirate airways that I've seen are a 10-fold higher on the floor than in the OR. DL >VL in those cases, and I don't want to be stuck with just a glide scope.

I've actually started noticing a trend that if an airway is unattainable with glide scope on first attempt, people don't think about switching to DL, simply assuming superiority of a VL. Sometimes the glide scope doesn't get it done but a DL and bougie will.

 

[sethco]

as an aside. This is why I use a videoscope (glide, McGrath) for every floor intubation, no matter how easy the airway looks. I just don’t trust those portable CO2 detectors and you can reliably see that you are in much easier with videolarygoscopy.

 

[Psai]

as an aside. This is why I use a videoscope (glide, McGrath) for every floor intubation, no matter how easy the airway looks. I just don’t trust those portable CO2 detectors and you can reliably see that you are in much easier with videolarygoscopy.

I can reliably see that I am in with a Mac 3 by watching the plastic tube go through the cords

 

[Robotic Wis-Hipple]

I can reliably see that I am in with a Mac 3 by watching the plastic tube go through the cords

I think we overuse VL’s, I think we are doing a disservice to trainees jumping straight to them in people that aren’t clearly at risk of or documented as difficult and because of that none of us new Anesthesiologists will ever be as good as many of the older wizards. And that pains me a bit.

With that said, I’m ok with this for floor codes or “airway team/intubation teams” if the VL is part of the condition response kit. If nothing else, it allows additional participants/witnesses to see ETT traverse cords and removes the “what if it’s not in” second guessing when things aren’t going as well as we’d like. Plus, as mentioned, I think in the not too distant future, it’ll be considered standard of care, especially in codes.

I think an anesthesiologist should be an expert in placing central lines by landmark in crash scenarios and wielding cold steel like a Jedi, but I also think there are tools that make these things easier, and it’s probably a little stubborn to not use them. I’m not sure how I reconcile these two things honestly.

 

[chocomorsel]

@pgg, that is insane. 1 Billion for rape? Guess that security company is bankrupt.
As a woman, even I find that a little... no a HELL of a lot of money to be fined.
10 milion, OK.

Wow, can't fathom that. She better take her share (if she gets even a fraction of it, I am sure there is gonna be a drawn out appeal) and hide. She gonna end up with all kinda relatives and friends begging.

 

[deleted59964]

Maybe. But the number of bloody or aspirate airways that I've seen are a 10-fold higher on the floor than in the OR. DL >VL in those cases, and I don't want to be stuck with just a glide scope.

I've actually started noticing a trend that if an airway is unattainable with glide scope on first attempt, people don't think about switching to DL, simply assuming superiority of a VL. Sometimes the glide scope doesn't get it done but a DL and bougie will.

Hence the superiority of cmac over glidescope - comes with Mac 3 or 4 blade if that’s what you want. First look is DL, then look up at screen.

 

[chocomorsel]

as an aside. This is why I use a videoscope (glide, McGrath) for every floor intubation, no matter how easy the airway looks. I just don’t trust those portable CO2 detectors and you can reliably see that you are in much easier with videolarygoscopy.

You don't always have access to those at each and every hospital. Unless you are carrying your own.

 

[dannyboy1]

Whatever. Call it weak if you want, I don’t care. I definitely have extra peace of mind using VL (usually McGrath) on the floor. The patients are often not positioned optimally and it is difficult to near impossible to get the ICU/floor staff to help you. Frequently the patient is having significant arrhythmias or profoundly hypoperfused which will interfere with the reliability of pulse oximetry. I try to leave my ego at the door and do what is best for the patient (and by extension myself) until someone starts paying me extra for direct laryngoscopy I will continue this way....

 

[deleted875186]

Whatever. Call it weak if you want, I don’t care. I definitely have extra peace of mind using VL (usually McGrath) on the floor. The patients are often not positioned optimally and it is difficult to near impossible to get the ICU/floor staff to help you. Frequently the patient is having significant arrhythmias or profoundly hypoperfused which will interfere with the reliability of pulse oximetry. I try to leave my ego at the door and do what is best for the patient (and by extension myself) until someone starts paying me extra for direct laryngoscopy I will continue this way....

I agree, I tend to use videoscope on the floor unless I think the patient is easy and has a little bit of reserve. I would feel uncomfortable with a DL that wasn’t at least a grade two and I tried to pass a tube or bougie without seeing definitely where it’s going. I might feel comfortable if the ICU routinely had capnography set up.