Ohio Mom dies after tummy tuck

[NPJR]

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https://www.aol.com/articles/ohio-mom-whose-tummy-tuck-100756944.html


It sounds like post-anesthesia gone bad if the husband was talking to her post surgery.

 

[Gern Blansten]

Terrible outcome. Seems it could have been a number of things. PE, opioid overdose, cardiac event, LAST?

 

[Lab Lover]

According to the video made by patient's husband, she received 150 mcg Fentanyl and 0.5mg Dilaudid at the same time in PACU.

 

[agammaglobulin]

According to the video made by patient's husband, she received 150 mcg Fentanyl and 0.5mg Dilaudid at the same time in PACU.

Even so, was she not connected to monitors?? I was trying to find some other news sources about what happened. Not sure the accuracy of all this but another website here says she was "without oxygen" for 6 minutes after given pain meds by an RN. Hard to imagine that happening in PACU/Phase 1...Sad story.

 

[Gern Blansten]

Even so, was she not connected to monitors?? I was trying to find some other news sources about what happened. Not sure the accuracy of all this but another website here says she was "without oxygen" for 6 minutes after given pain meds by an RN. Hard to imagine that happening in PACU/Phase 1...Sad story.

Sounds like an all day surgery that ended after hours (cleaning crew in for the night cleaning) and a skeleton crew of nurses present with no physician. Was this office based or ASC? For some facilities like this, there is not really much difference in phase I or II recovery. The opioid dose seems heavy handed, but just because that is what the husband reported does not mean that was the actual chain of events. Plus, we don't know the previous opioid dosing from the intraoperative period. However, 150mcg bolus of fentanyl in a fresh post op patient who had previously received 250-500mcg intraoperative is going to cause apnea almost every time. Add in 0.5 of hydromorphone and it is compounded even further.
I have seen PACU onset LAST and doses of local in these cases can be excessive and close to or higher than toxic levels. An acute event such as a PE cannot be ruled out except by autopsy. Cardiac event is unlikely , but should be considered. Sounds like an opioid event if the husband's description is accurate. If the surgery had finished 2 hours earlier and the full staff were present, to include an anesthesiologist, an opioid event could have been managed easily. As it stands, it sounds like the nurse had to take frequent breaks from the woefully inadequate resuscitation to go get equipment and naloxone. So, my bet is an opioid event exacerbated by inadequate staffing to deal with an emergency.
If the dosing described is accurate, I wonder what the experience level of the nurse caring for her was. Fentanyl 25 mcg q 10 minutes would be as aggressive as I would get in that scenario.
Moral of the story is, an all day vanity plastic surgery is not a walk in the park and should be approached with caution. If this involved tumescent liposuction in abdomen, buttocks, thighs, plus who knows what else (breast aug?), that is a lot of local administered. Lots of potential for fluid shifts putting those large volumes subcutaneously. Florida had a big problem with cases like this done in strip mall plastic surgeon offices a few years back. Numerous deaths, such that they basically put a moratorium on the surgeries for a while. Not sure the current status in Florida.
Very sad for the family. Sounds like this is all compounded by the fact that she was a social media influencer who was documenting her experience for her followers. Terrible all around.

 

[NPJR]

Sounds like an all day surgery that ended after hours (cleaning crew in for the night cleaning) and a skeleton crew of nurses present with no physician. Was this office based or ASC? For some facilities like this, there is not really much difference in phase I or II recovery. The opioid dose seems heavy handed, but just because that is what the husband reported does not mean that was the actual chain of events. Plus, we don't know the previous opioid dosing from the intraoperative period. However, 150mcg bolus of fentanyl in a fresh post op patient who had previously received 250-500mcg intraoperative is going to cause apnea almost every time. Add in 0.5 of hydromorphone and it is compounded even further.
I have seen PACU onset LAST and doses of local in these cases can be excessive and close to or higher than toxic levels. An acute event such as a PE cannot be ruled out except by autopsy. Cardiac event is unlikely , but should be considered. Sounds like an opioid event if the husband's description is accurate. If the surgery had finished 2 hours earlier and the full staff were present, to include an anesthesiologist, an opioid event could have been managed easily. As it stands, it sounds like the nurse had to take frequent breaks from the woefully inadequate resuscitation to go get equipment and naloxone. So, my bet is an opioid event exacerbated by inadequate staffing to deal with an emergency.
If the dosing described is accurate, I wonder what the experience level of the nurse caring for her was. Fentanyl 25 mcg q 10 minutes would be as aggressive as I would get in that scenario.
Moral of the story is, an all day vanity plastic surgery is not a walk in the park and should be approached with caution. If this involved tumescent liposuction in abdomen, buttocks, thighs, plus who knows what else (breast aug?), that is a lot of local administered. Lots of potential for fluid shifts putting those large volumes subcutaneously. Florida had a big problem with cases like this done in strip mall plastic surgeon offices a few years back. Numerous deaths, such that they basically put a moratorium on the surgeries for a while. Not sure the current status in Florida.
Very sad for the family. Sounds like this is all compounded by the fact that she was a social media influencer who was documenting her experience for her followers. Terrible all around.

Agreed. If what the husband says is accurate I think she died of opioid overdose. o.5 of dilaudid and 150mcg of FEnt is too much to push in an opioid naive person or any person. That last statement was creepy as hell, " Im out the money for the surgery"

I am curious who was doing the anesthesia because they are obligated to stay with the patient until recovered.

 

[cincincyreds]

Local anesthetic toxicity from the tumescence happens 12 hours after administration. Sounds more like a PE but obviously we don't have the chart.

 

[caligas]

Over sedated and under monitored

 

[UscGhost]

Given the poor quality of many pacu nurses..i wouldn't be surprised at an opiod overdose +/- inattentive nurses

 

[Gern Blansten]

Local anesthetic toxicity from the tumescence happens 12 hours after administration. Sounds more like a PE but obviously we don't have the chart.

Yeah, but she was in surgery for 11-12 hours, likely with repeated doses of tumescent local in different anatomical areas.

 

[Gern Blansten]

Agreed. If what the husband says is accurate I think she died of opioid overdose. o.5 of dilaudid and 150mcg of FEnt is too much to push in an opioid naive person or any person. That last statement was creepy as hell, " Im out the money for the surgery"

I am curious who was doing the anesthesia because they are obligated to stay with the patient until recovered.

Yeah, that was a weird thing to slip in at the end of the video.

 

[cittykat]

Yeah, but she was in surgery for 11-12 hours, likely with repeated doses of tumescent local in different anatomical areas.

I know it’s done all over this country but >4hr outpatient surgery should be banned. Stupid people sign up for stupid things.

 

[agammaglobulin]

I could be wrong, but I think there are already guidelines with how long outpatient surgery can be. However, I've seen (plastic) surgeons intentionally book cases short (under the threshold) and then they obviously run long. Not saying that is what happened here, but just that it happens.

 

[Norepi]

I could be wrong, but I think there are already guidelines with how long outpatient surgery can be. However, I've seen (plastic) surgeons intentionally book cases short (under the threshold) and then they obviously run long. Not saying that is what happened here, but just that it happens.

Depends on the state. Thought I read there are many states with no guidelines, hence patients getting 10 hour mommy makeovers in strip malls.

 

[PainDrain]

Yeah, but she was in surgery for 11-12 hours, likely with repeated doses of tumescent local in different anatomical areas.

Why would any free standing surgery center be doing 12 hour surgeries? That is a problem in and of itself. If a patient is under for that long and the procedure is that complex then why not do it in a hospital with better resources? I know the reason….money…. It just isn’t worth it. I personally wouldn’t be doing cases at a place like that.

 

[NPJR]

Why would any free standing surgery center be doing 12 hour surgeries? That is a problem in and of itself. If a patient is under for that long and the procedure is that complex then why not do it in a hospital with better resources? I know the reason….money…. It just isn’t worth it. I personally wouldn’t be doing cases at a place like that.

The reason is not money but money and who gets it. Not only that surgeons HATE working at hospitals and so do I. They get worse techs and nurses that talk back and dont do what they say. At the surgery center they control the variables to a much higher degree.
Secondarily, facility fees goes to them directly.

 

[PainDrain]

The reason is not money but money and who gets it. Not only that surgeons HATE working at hospitals and so do I. They get worse techs and nurses that talk back and dont do what they say. At the surgery center they control the variables to a much higher degree.
Secondarily, facility fees goes to them directly.

I understand how it works. It isn’t best for patients and it doesn’t make a good work environment. I’m sure you can bail yourself out the vast majority of the time but it only takes one. Everyone will be sued for this woman’s death. The surgeon will lose and pay millions; likely will never have malpractice again. The anesthesiologist will be sued and pay. The surgery center will lose and likely close.

 

[NPJR]

I understand how it works. It isn’t best for patients and it doesn’t make a good work environment. I’m sure you can bail yourself out the vast majority of the time but it only takes one. Everyone will be sued for this woman’s death. The surgeon will lose and pay millions; likely will never have malpractice again. The anesthesiologist will be sued and pay. The surgery center will lose and likely close.

So every surgery has to take place at a hospital for this one off event? I see many surgery centers who operate efficiently and play by the rules and do not push the envelope. Castigate the ones who do not follow rules and leave alone the ones who do operate in good faith and operate with patient safety in mind.

The problem is many surgeons actually do not know what is safe and what isnt. I kid you not. They have no idea that a 500 pounder is more risky than a 100 pounder. ALl they see is a bad gallbladder, bad knee bad carpal tunnel etc. You can enlist someone who knows to help you but now you have to pay that someone. Are you willing to review every case that goes to the surgery center every day? And how much would you charge?

It depends on if there was an anesthesiologist involved whether he or she or the surgeon will be sued and is to blame. If there was an anesthesiologist it depends on whether this event occurred in the recovery phase or not. If it happened in recovery, the anesthesiologist will be called into question. If there wasnt an anesthesiologist, I havent seen that there was, the surgeon will take the hit unfortunately.
This happened in Ohio. If it happened in NY NJ PA- easily 50 million dollar jury award. but this happened in ohio which has caps. Maybe a few million. Not sure if it is worth it for plaintiff attorneys.

 

[PainDrain]

So every surgery has to take place at a hospital for this one off event? I see many surgery centers who operate efficiently and play by the rules and do not push the envelope. Castigate the ones who do not follow rules and leave alone the ones who do operate in good faith and operate with patient safety in mind

Read what I said above. A 12 hour procedure at a surgery center? Probably not a great idea. I know it is within the regulations but surgical time directly correlates with complications. Why bother? If you’re that hard up for an anesthesia job then maybe.

 

[NPJR]

Read what I said above. A 12 hour procedure at a surgery center? Probably not a great idea. I know it is within the regulations but surgical time directly correlates with complications. Why bother? If you’re that hard up for an anesthesia job then maybe.

It can be a 100 hour surgery. If its safe, its safe. There is incompetence at hospitals too ya know.

 

[Dantrolene FC]

It's hard to know what happened without seeing the documentation. But, it may be possible that she was staying overnight in the facility. So it is possible she met PACU discharge criteria, anesthesiologist (if there was one) goes home and the patient dies overnight. The Bold is taken from the article. It is the surgeon's quotes.

"Rachel’s surgery was completed successfully and without complications," Tork wrote. She was in "excellent condition" when she was taken to the recovery room for monitoring overnight, he said.

Tork said he is "heartbroken" for Tussey and her family. He said he doesn't know how this happened.

"Because Rachel was scheduled to remain overnight, her post-operative monitoring was overseen by staff contracted by the independent facility, not by my practice," Tork said. "I have discontinued all procedures at that surgery center."


If the nurse truly gave 150 mcg of fentanyl and 0.5 mg of Dilaudid at one (we don't know), that is very excessive. We do 25 mcg fentanyl and 0.2 mg Dilaudid where I'm at.

 

[Dantrolene FC]

Yeah, that was a weird thing to slip in at the end of the video.

I think he was trying to say they're still billing him even since she died.

 

[Gern Blansten]

I think he was trying to say they're still billing him even since she died.

I know. Just weird to say that. It didn’t fit well with the rest of the story. Maybe it would be better in a separate message.

 

[PainDrain]

It's hard to know what happened without seeing the documentation. But, it may be possible that she was staying overnight in the facility. So it is possible she met PACU discharge criteria, anesthesiologist (if there was one) goes home and the patient dies overnight. The Bold is taken from the article. It is the surgeon's quotes.

"Rachel’s surgery was completed successfully and without complications," Tork wrote. She was in "excellent condition" when she was taken to the recovery room for monitoring overnight, he said.

Tork said he is "heartbroken" for Tussey and her family. He said he doesn't know how this happened.

"Because Rachel was scheduled to remain overnight, her post-operative monitoring was overseen by staff contracted by the independent facility, not by my practice," Tork said. "I have discontinued all procedures at that surgery center."


If the nurse truly gave 150 mcg of fentanyl and 0.5 mg of Dilaudid at one (we don't know), that is very excessive. We do 25 mcg fentanyl and 0.2 mg Dilaudid where I'm at.

I looked up this surgery center and it isn’t your typical surgery center but a bariatric surgery center. It’s odd that such a place would be so heavy handed with opiates considering their clientele.

 

[Beach bum]

I understand how it works. It isn’t best for patients and it doesn’t make a good work environment. I’m sure you can bail yourself out the vast majority of the time but it only takes one. Everyone will be sued for this woman’s death. The surgeon will lose and pay millions; likely will never have malpractice again. The anesthesiologist will be sued and pay. The surgery center will lose and likely close.

Did it say there was a physician anesthesiologist attending, etc.?

 

[Beach bum]

It's hard to know what happened without seeing the documentation. But, it may be possible that she was staying overnight in the facility. So it is possible she met PACU discharge criteria, anesthesiologist (if there was one) goes home and the patient dies overnight. The Bold is taken from the article. It is the surgeon's quotes.

"Rachel’s surgery was completed successfully and without complications," Tork wrote. She was in "excellent condition" when she was taken to the recovery room for monitoring overnight, he said.

Tork said he is "heartbroken" for Tussey and her family. He said he doesn't know how this happened.

"Because Rachel was scheduled to remain overnight, her post-operative monitoring was overseen by staff contracted by the independent facility, not by my practice," Tork said. "I have discontinued all procedures at that surgery center."


If the nurse truly gave 150 mcg of fentanyl and 0.5 mg of Dilaudid at one (we don't know), that is very excessive. We do 25 mcg fentanyl and 0.2 mg Dilaudid where I'm at.

Stay overnight?? With who inexperienced RNs and the janitors???

 

[PainDrain]

Stay overnight?? With who inexperienced RNs and the janitors???

I have heard of some of these places employing docs and/or mid levels to babysit overnight.

 

[cittykat]

I looked up this surgery center and it isn’t your typical surgery center but a bariatric surgery center. It’s odd that such a place would be so heavy handed with opiates considering their clientele.

I didn’t know such places exist. All the freestanding places I know have BMI cutoffs. But one place I use to staff has a medical director who will sign off on high BMI patients and then be off on the date of their surgery. I resigned from that place for obvious reasons.