Paxton estate settles with anesthesia group

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caligas

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www.nbcnews.com

Bill Paxton's family reaches $1 million settlement with medical group in lawsuit over actor's death

The settlement was struck between Paxton's family and General Anesthesia Specialists Partnership, court records say.
www.nbcnews.com www.nbcnews.com

Not sure what caused anesthesiologist to be dragged into this?
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caligas said:
www.nbcnews.com

Bill Paxton's family reaches $1 million settlement with medical group in lawsuit over actor's death

The settlement was struck between Paxton's family and General Anesthesia Specialists Partnership, court records say.
www.nbcnews.com www.nbcnews.com

Not sure what caused anesthesiologist to be dragged into this?
Click to expand...
“What caused the anesthesiologist to be dragged into this??”, was likely something MANY of us have experienced.

Namely, a surgeon doing cases that either shouldn’t be done, or cases that they don’t have the “chops” to do well...

The anesthesiologist knows it. The nurses know it. The HOSPITAL knows it, but nobody wants to “rock the boat”, and say “We’re not going to do/participate in these surgeries anymore. Send them where they can be done properly/safely, and/or STOP doing procedures that aren’t indicated.”.

The anesthesiologist likely did nothing MEDICALLY wrong. They simply got pushed by the hospital/AMC into working with a likely (take your pick) slow/incompetent/greedy/egotistical surgeon, and $1 million was a good alternative to having lawyers on his back for another 5 years, or getting caught (in this case) in a “celebrity death trial”...
 
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DirtDocMD said:
“What caused the anesthesiologist to be dragged into this??”, was likely something MANY of us have experienced.

Namely, a surgeon doing cases that either shouldn’t be done, or cases that they don’t have the “chops” to do well...

The anesthesiologist knows it. The nurses know it. The HOSPITAL knows it, but nobody wants to “rock the boat”, and say “We’re not going to do/participate in these surgeries anymore. Send them where they can be done properly/safely, and/or STOP doing procedures that aren’t indicated.”.

The anesthesiologist likely did nothing MEDICALLY wrong. They simply got pushed by the hospital/AMC into working with a likely (take your pick) slow/incompetent/greedy/egotistical surgeon, and $1 million was a good alternative to having lawyers on his back for another 5 years, or getting caught (in this case) in a “celebrity death trial”...
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This case is a lesson to all of you. You can and may be named in a lawsuit where you did absolutely nothing wrong. Then, you are told to settle for $1 million even though there is no medical malpractice. That's our system of justice.
 
DirtDocMD said:
“What caused the anesthesiologist to be dragged into this??”, was likely something MANY of us have experienced.

Namely, a surgeon doing cases that either shouldn’t be done, or cases that they don’t have the “chops” to do well...

The anesthesiologist knows it. The nurses know it. The HOSPITAL knows it, but nobody wants to “rock the boat”, and say “We’re not going to do/participate in these surgeries anymore. Send them where they can be done properly/safely, and/or STOP doing procedures that aren’t indicated.”.

The anesthesiologist likely did nothing MEDICALLY wrong. They simply got pushed by the hospital/AMC into working with a likely (take your pick) slow/incompetent/greedy/egotistical surgeon, and $1 million was a good alternative to having lawyers on his back for another 5 years, or getting caught (in this case) in a “celebrity death trial”...
Click to expand...


I’m sure the anesthesiologist involved did a TEE and if the allegations are to be believed, he had a duty to report that the aorta was not aneurysmal.
 
nimbus said:
I’m sure the anesthesiologist involved did a TEE and if the allegations are to be believed, he had a duty to report that the aorta was not aneurysmal.
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I guess that’s possible. While I’ve placed a probe hundreds/low thousands of times, and will occasionally do a “basic exam” (I’m not TEE certified, so don’t do formal evaluations or “make the call” based on such exams), I didn’t think most did a “formal” pre-op eval, but usually concentrated on the “post-op” eval.

While I might take a look at a bicuspid valve, or look at stenosis/regurg, would it be “routine” for the anesthesiologist to actually EVALUATE or MEASURE the size of the aorta before the procedure had been completed (seeing as how a formal study should have already been done before coming to the OR)??
 
DirtDocMD said:
I guess that’s possible. While I’ve placed a probe hundreds/low thousands of times, and will occasionally do a “basic exam” (I’m not TEE certified, so don’t do formal evaluations or “make the call” based on such exams), I didn’t think most did a “formal” pre-op eval, but usually concentrated on the “post-op” eval.

While I might take a look at a bicuspid valve, or look at stenosis/regurg, would it be “routine” for the anesthesiologist to actually EVALUATE or MEASURE the size of the aorta before the procedure had been completed (seeing as how a formal study should have already been done before coming to the OR)??
Click to expand...


Yes that’s part of the standard echo exam for cardiac anesthesiologists. Easy to grade AI and measure ascending aorta diameter. They’re not sophisticated measurements. I’m an advanced echo testamur but my echo skills are pretty rudimentary compared to my younger partners. I once brought a patient to the OR for type A dissection called by CT. Could not find it during postinduction TEE. We abandoned the procedure.

I’d expect a place like Cedars-Sinai with a cardiac anesthesia fellowship to have a very advanced echo service.
 
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nimbus said:
Yes that’s part of the standard echo exam for cardiac anesthesiologists. Easy to grade AI and ascending aorta diameter. I’m an advanced echo testamur but my echo skills are pretty rudimentary compared to my younger partners. They’re not sophisticated measurements. I once brought a patient to the OR for type A dissection called by CT. Could not find it during postinduction TEE. We abandoned the procedure.
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Thanks.

While we do a decent amount of hearts, we don’t do many valves at our facility, and a cardiologist is brought in to do a formal TEE on those as we’re coming off the pump.

No formal eval in OR, before cutting skin, so the outside “pre-procedure” echo is taken as gospel.
 
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It appears that the anesthesiology group settled with the family to avoid being dragged into the impending trial as co-defendants with Cedars-Sinai and the surgeon. Based on court filings where Cedars is hanging the surgeon out to dry by calling him a “cowboy” and publicizing his “AK-47” nickname, it seems this was a prudent move to control the potential damage.
 
These hospitals love to do anything and everything if it brings them money, and if you want to be the squeaky wheel who speaks up the you're out. So we get pulled into doing sketchy things all too often for my liking. I bet you this anesthesiologist was basically just an unlucky cog who's turn it was to work with this nonsense surgeon that day - that's probably all they did "wrong".

But it was smart for the group to settle for a million. You've got a dead celebrity's estate as a plaintiff and a surgeon that's clearly off the rails with their hospital enablers as codefendants. The surgeon and Cedars are now really, really on the hook for tons more.
 
I browsed the document linked by @nimbus but didn’t see any description of the anesthesiologists echo. I certainly may have missed it.

But my questions are; how was the actors ascending aortic aneurysm and whatever AV (presumably insufficiency) diagnosed? Who else was involved in the diagnosis? CT/CTA read? TTE? It’s hard for me to believe a surgeon, (Dr. Death notwithstanding) sees a patient let alone a celebrity with moderate AI or mild Ascending aortic dilation and just decides to do a valve, coronary reimplant, and hemiarch with DHCA oh just because. Who just decides to do a DHCA case on a celebrity/VIP for fun? There had to be preop imaging etc that justified booking the procedure.

The surgeons skills and “minimally invasive” training (or lack thereof) is another story and if covered up or turned a blind eye by the hospital certainly there’s something there. But what even is a minimally invasive arch replacement under DHCA? Are we sure it was always planned as such? Maybe it was a simple AVR but he dissected on cannulation or something. The whole complaint sounds odd to me.

Lastly, the anesthesiologists culpability. Yes, if booked for an AVR/hemiarch and post-induction TEE shows mild to moderate AI and a clearly non-dilated aorta then absolutely they are ethically bound to put a halt to it. But A.) are we sure that’s what happened? And B.) where’s the line? AVR and Ascending planned, but Ascending is only 4.8cm? You’re supposed to hit a stop button and tell the surgeon it’s assault or sham surgery if they do the ascending? What if the AV looks bicuspid but maybe it’s just a fused tricuspid?

It’s a slippery slope; we’ve all done a valve that was booked for severe regurg but is barely moderate on intraop echo…sure we assume it’s loading conditions/anesthetic etc but we’ve done em. What about a planned MVR and upon looking at the TV there’s a good bit of TR and it’s borderline dilated so surgeon goes well we’re here let’s ring it. And those are the easy ones to defend as grey or regarded as “reasonable” to perform by our various committees. But are we going to be held to knowing the indications of all surgeries? Or the evidence based medicine of approach/surgery A vs approach/surgery B and if we don’t and the Surgeon chooses the wrong one we are liable? Can any of you honestly say you have any idea why bowel surgery or foregut surgery A is done rather than a different procedure?

I think sham surgery is probably like pornography and you know it when you see it, but there’s a huge amount of grey that will pass that poorly sensitive test.
 
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caligas said:
IDK but docs do weird $hit when celebrities are involved
Click to expand...

It's crazy that people think they should practice in a way different from the standard of care. It's the same delusion that people have about day trading. Occasionally it works but most of the time the outcomes are worse.

I've taken care of some very high profile and billionaire patients, and I have never practiced in a way different from any other patient.
 
coffeebythelake said:
It's crazy that people think they should practice in a way different from the standard of care. It's the same delusion that people have about day trading. Occasionally it works but most of the time the outcomes are worse.

I've taken care of some very high profile and billionaire patients, and I have never practiced in a way different from any other patient.
Click to expand...
They hate when I say this but I treat the VIPs the same way I treat the crackhead down the street.
 
coffeebythelake said:
It's crazy that people think they should practice in a way different from the standard of care. It's the same delusion that people have about day trading. Occasionally it works but most of the time the outcomes are worse.

I've taken care of some very high profile and billionaire patients, and I have never practiced in a way different from any other patient.
Click to expand...
How about nerve blocks on pro athletes or somebody who gives you a bad medicolegal vibe?
 
Dr. Rude said:
How about nerve blocks on pro athletes or somebody who gives you a bad medicolegal vibe?
Click to expand...
The pro athlete debate has happened before on the forum. I probably wouldn’t do a PNB unless they were asking for it and in that case we’d have a good discussion and thoroughly document that discussion. I’d probably sleep the later as we’ll depending on the vibe I’m getting (ie, is their lawyer in preop with them)
 
Dr. Rude said:
How about nerve blocks on pro athletes or somebody who gives you a bad medicolegal vibe?
Click to expand...


Not a pro athlete but I did a single shot ISB on a bariatric surgeon I work with because that’s how I do all my rotator cuff repairs. We had a risk/benefit discussion and he actually requested that I do what I usually do. Thankfully he had no pain for over 24hrs, never had much pain on POD 2,3,4 (I’m sure that’s due to the orthopedist more than the block) and didn’t have any complications.
 
Dr. Rude said:
How about nerve blocks on pro athletes or somebody who gives you a bad medicolegal vibe?
Click to expand...

Anesthesia can be done safely in many different ways, and my statement was not meant to say only one prescriptive method is the standard of care. We have non athlete patients refuse nerve blocks all the time. So if they don't want one they get a GA. Thats a reasonable and viable alternative and within usual practices. This is not VIP special anesthesia care. Risk and benefit discussion is the most important here, if an athlete wants a nerve block and understands the risks involved then I would do it and document accordingly.

What I mean by VIP special care is doing something that is clearly not a reasonable plan. For instance, placing an LMA instead of intubating an opera singer for bowel obstruction because you are afraid the ETT would damage their singing voice. No anesthesiologist in their right mind would consider that an appropriate standard of care.
 
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nimbus said:
No way to know if the allegations are true but the lawsuit is pretty damning…alleges a non-indicated Bentall procedure. Seems like anybody involved would be at risk. Then it’s less surprising why they ponied up.

“The aorta is not that big and the AI is not bad.”


Click to expand...
how do you find all these pdfs of lawsuits. is there a website that can find all this stuff? are they all public or something?
 
anbuitachi said:
what about your OB c section patients that want GA instead of spinal/epidural
Click to expand...

Wirh advanced airway tools, the risks of GA with obstetrics nowadays is much lower than it used to be. Latest statistics indicate risk is nearly the same as neuraxial. It is a reasonable alternative. Now I don't know how many women would prefer to be completely unconscious during childbirth (and basically miss the first moments of their newborns life), but if they really want to be put under it is not something that is necessarily inappropriate.
 
Dr. Rude said:
How about nerve blocks on pro athletes or somebody who gives you a bad medicolegal vibe?
Click to expand...
I’ve had a few scholarship college athletes, that I’ve NOT done blocks on. I tell them why, and also let them know that if they choose, we can do one AFTER the case (in PACU) if pain is too much to handle, even with meds.
 
nopain1234 said:
Crazy to think a movie star wouldn’t have the best CV team in the region
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But that's the issue, in my opinion. We think because someone is the only person to be killed by a Terminator, an Alien, and a Predator, that we had bring out all the special skills when in reality Mr. Paxton should've gotten the same care as the PA on set because they both deserve the best care. Sometimes, myself included, we get too much in our heads because someone has fame and find ourselves "doing too much" to the detriment of the patient
 
nimbus said:
It’s very hard to tell who’s good and who’s not unless you’re on the inside.


There is also a chance that Paxton’s surgeon is excellent but that he was being innovative and still on the learning curve.
Click to expand...

It sounds like the CV surgeon overpromised and underdelivered. Being known as a "cowboy surgeon" isn't a badge of honor. I would want a surgeon who is experienced and comfortable doing a particular surgery.
 
Happen to a buddy of mine. Except he was the pain doc doing procedure. So he was procedurist. Usual infection. Fat lady usual DM CAD. Ended in death months later

Basically it’s gonna to cost 2-3 million to settle.

Since he worked for the hospital as w2. His portion was settled at 1 million. Hospital settled for another 1 million. His case had been going on since 2012/2013 ish. 7 plus years of litigation.

Legal fees for medical insurance company had already total in excess of 300k. That’s just for defendant side. I’m sure the plaintiff side cost around the same (and I’m sure that was added or subtracted from the settlement).

So anesthesia settling for 1 million to avoid a prolonged court battle may just make more sense.
 
“As per Deadline, the $1 million partial settlement that involved the anesthesiologist on Paxton's surgery, Dr. Moody Makar, will be dismissed from the suit without any payment from his side. Reportedly, the General Anesthesia group has denied liability, but will disburse compensation that will help hold back Dr. Makar from "an expensive and time-consuming litigation."”
 
Twiggidy said:
Sometimes, myself included, we get too much in our heads because someone has fame and find ourselves "doing too much" to the detriment of the patient
Click to expand...

I don't do anything different for anybody, from athletes to friends mom's or the random trauma patient that rolls in. I intentionally do not do anything special for anybody, because if it is not what I usually do it is not the best care.
 
DirtDocMD said:
I guess that’s possible. While I’ve placed a probe hundreds/low thousands of times, and will occasionally do a “basic exam” (I’m not TEE certified, so don’t do formal evaluations or “make the call” based on such exams), I didn’t think most did a “formal” pre-op eval, but usually concentrated on the “post-op” eval.

While I might take a look at a bicuspid valve, or look at stenosis/regurg, would it be “routine” for the anesthesiologist to actually EVALUATE or MEASURE the size of the aorta before the procedure had been completed (seeing as how a formal study should have already been done before coming to the OR)??
Click to expand...
Seriously?!
 
Mman said:
I don't do anything different for anybody, from athletes to friends mom's or the random trauma patient that rolls in. I intentionally do not do anything special for anybody, because if it is not what I usually do it is not the best care.
Click to expand...

exactly,
I sleep well at night knowing that I give every patient the best care I can
 
coffeebythelake said:
exactly,
I sleep well at night knowing that I give every patient the best care I can
Click to expand...
Most of us would choose a block for ourselves and our families for shoulder surgery. How about blocking the patient with a below average surgeon who is on disability, hx of fibromyalgia, chronic pain issues, who has the same last name as a local personal injury attorney? Throw in working in a below average medicolegal jurisdiction for giggles.
 
Dr. Rude said:
Most of us would choose a block for ourselves and our families for shoulder surgery. How about blocking the patient with a below average surgeon who is on disability, hx of fibromyalgia, chronic pain issues, who has the same last name as a local personal injury attorney? Throw in working in a below average medicolegal jurisdiction for giggles.
Click to expand...

I would choose a block for myself or family because those issues don't apply. If the patient has medical (or surgeon) issues that are different I might choose a different plan for them. The same last name as a local attorney would not impact decision at all, although perhaps I would document things a little more thoroughly.
 
BlueRug said:
Seriously?!
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Yes, seriously. Have I offended you? Does the pizzing/“dick measuring” contest start now?? What??

(and thanks to Nimbus for simply answering the question...)
 
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Mman said:
I don't do anything different for anybody, from athletes to friends mom's or the random trauma patient that rolls in. I intentionally do not do anything special for anybody, because if it is not what I usually do it is not the best care.
Click to expand...
Not me. I do what'd best for everyone and that includes myself and my colleagues. I treat every patient individually based on his/her circumstance and weigh the risk/benefit for every procedure I do. My decades of experience have shown me that in my neck of the woods patients won't hesitate to sue for just about any reason.

www.si.com

Diving Into Sharrif Floyd's $180M suit vs. Dr. Andrews

Sharrif Floyd's lawsuit against Dr. James Andrews won’t be an easy case to settle, riddled with challenges in proving $180 million in damages.
www.si.com www.si.com

Not only was the surgery unsuccessful but Floyd experienced a post-operation treatment that he says was unnecessary and that caused him irreparable injury. One of Andrews’s colleagues, Dr. Gregory Hickman, performed a “post-operative adductor-canal nerve block” on Floyd—a decision that Floyd insists was done without his consent. This post-op procedure entailed the administration of substances to numb Floyd’s pain. However, Floyd notes that the “post-operative adductor-canal nerve block carried the risk of career-ending complications” and was unwarranted in the circumstances. As Floyd notes, not only did he not offer consent to the nerve block—to that point, as an NFL player, Floyd is accustomed to dealing with pain and would seem less likely than the typical person to okay a procedure to blunt pain—but even if Floyd had consented, it would not have been a legally-binding, informed consent since he was heavily medicated at that time. Floyd stresses he “would have preferred to remain in pain rather than undergo such a non-essential procedure that gambled his entire career.”

Worse yet for Floyd, the nerve block was (as Floyd claims) “negligently misplaced” by Hickman. The misplacement allegedly caused “permanent injury” to Floyd by “destroying portions of Floyd’s femoral/saphenous nerves and attendant musculature (e.g. the quadriceps and vastus medialis muscles.)
 
theanesthesiaconsultant.com

WOULD YOU GIVE AN NFL QUARTERBACK A PERIPHERAL NERVE BLOCK? - The anesthesia consultant

You’re scheduled to anesthetize an NFL quarterback. He earns $20 million dollars per year. Would you do an interscalene block on an NFL quarterback?
theanesthesiaconsultant.com theanesthesiaconsultant.com

I submit that no anesthesia provider would feel comfortable inserting a needle in the neck of this $20 million-dollar-a-year man. No anesthesia provider would feel comfortable doing an interscalene block for his shoulder arthroscopy. Why not? Even though the above data show that peripheral nerve injury can occur following shoulder arthroscopy with either general or interscalene anesthesia, the anesthesiologist will likely be sued only if he or she performs the interscalene anesthesia.
 
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