Plastic surgery death. Ob-gyn acting as Anesthesiologist

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These are the people listed in the article. Plastic surgeon Dr Nees and OBGYN and amateur anesthetist Dr Muir. Shameful. Absolutely disgusting.
 
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nimbus said:
The irony is that in every single state, Medicare says the OB/gyn is qualified to “supervise” a CRNA. Plastic surgeons and gastroenterologists supervise CRNAs all the time. The hypocrisy is thick.
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That is a really excellent point. We (the ASA) advocate for physician supervision of CRNAs, even if that physician is a surgeon or gastroenterologist, knowing full well that, in a true emergency, those supervising physicians would not have the skill set to be much help far greater than 50% of the time. Now consider that such a physician is not supervising that anesthetic, but performing it. Now we have an issue with it because the real issue ( a great deal of physicians who supervise CRNAs have no idea what they’re doing related to anesthesiology) is fully on display.
It is sad that this family had to suffer such a loss. I believe I remember that Florida had a string of really egregious plastic surgery office based bad outcomes ~15 years ago and really tightened up on the rules surrounding this practice. It will be interesting to see the response. Events like this that are far out of bounds make it harder on everyone who is following the rules because government agencies will make new rules (sometimes completely ridiculous rules) that make our jobs harder to try and keep this from ever happening again.
 
Guess she was practicing at the “top of her license”😉.
It’s really bizarre that there are docs out there who are willing to try and deliver anesthesia without training. Would any of us attempt a hysterectomy? Even though we are technically qualified to practice “medicine and surgery”.
Was this an FMG with significant anesthesia experience in her home country who just couldn’t land an anesthesia residency? I’m trying to give the benefit of the doubt here but it is tough…..
 
dannyboy1 said:
Guess she was practicing at the “top of her license”😉.
It’s really bizarre that there are docs out there who are willing to try and deliver anesthesia without training. Would any of us attempt a hysterectomy? Even though we are technically qualified to practice “medicine and surgery”.
Was this an FMG with significant anesthesia experience in her home country who just couldn’t land an anesthesia residency? I’m trying to give the benefit of the doubt here but it is tough…..
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Millicent Muir did her medical school at University of Tennessee and has been an OBGYN for 20+ years. No idea why she would have thought practicing anesthesia would be appropriate. Is the OBGYN market that bad in Florida that she jumps over to doing something she is wholly unqualified for? I think Most likely arrogance is the reason for this tragedy.
 
coffeebythelake said:
Millicent Muir did her medical school at University of Tennessee and has been an OBGYN for 20+ years. No idea why she would have thought practicing anesthesia would be appropriate. Is the OBGYN market that bad in Florida that she jumps over to doing something she is wholly unqualified for? I think Most likely arrogance is the reason for this tragedy.
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I think she already had her license to practice OB/GYN restricted because of a bad outcome in 2012 by the Florida BOM but her medical license itself wasn't revoked. License status is Obligations/Active dating back to 2019? Details are available on the Florida BOM website.
 
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Helpful Troll said:
I think she already had her license to practice OB/GYN restricted because of a bad outcome in 2012 by the Florida BOM but her medical license itself wasn't revoked. License status is Obligations/Active dating back to 2019? Details are available on the Florida BOM website.
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License restricted in 2019. Easy enough to google. Looks like could not practice OB/Gyn so this was backup plan. I could be wrong. Sad. For all involved. https://mqa-internet.doh.state.fl.us/MQASearchServices/Document
 
Gern Blansten said:
That is a really excellent point. We (the ASA) advocate for physician supervision of CRNAs, even if that physician is a surgeon or gastroenterologist, knowing full well that, in a true emergency, those supervising physicians would not have the skill set to be much help far greater than 50% of the time. Now consider that such a physician is not supervising that anesthetic, but performing it. Now we have an issue with it because the real issue ( a great deal of physicians who supervise CRNAs have no idea what they’re doing related to anesthesiology) is fully on display.
It is sad that this family had to suffer such a loss. I believe I remember that Florida had a string of really egregious plastic surgery office based bad outcomes ~15 years ago and really tightened up on the rules surrounding this practice. It will be interesting to see the response. Events like this that are far out of bounds make it harder on everyone who is following the rules because government agencies will make new rules (sometimes completely ridiculous rules) that make our jobs harder to try and keep this from ever happening again.
Click to expand...
We can't have it both ways. Yes, advocating for CRNAs to be supervised by non-Anesthesiologist physicians is a flawed strategy. But is it really worse than no physician supervision at all? If you could wave a legislative magic wand and mandate that every anesthetic be supervised by an anesthesiologist, it would be nothing more than another unfunded mandate that would be meaningless.
 
Dr. Rude said:
We can't have it both ways. Yes, advocating for CRNAs to be supervised by non-Anesthesiologist physicians is a flawed strategy. But is it really worse than no physician supervision at all? If you could wave a legislative magic wand and mandate that every anesthetic be supervised by an anesthesiologist, it would be nothing more than another unfunded mandate that would be meaningless.
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Agree. I don’t know the solution but I have always thought the policy was flawed.
 
Helpful Troll said:
I think she already had her license to practice OB/GYN restricted because of a bad outcome in 2012 by the Florida BOM but her medical license itself wasn't revoked. License status is Obligations/Active dating back to 2019? Details are available on the Florida BOM website.
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Apparently came in late for a laboring patient who eventually died from post partum hemorrhage.

Seems like a great doc....
 
anonperson said:

Apparently came in late for a laboring patient who eventually died from post partum hemorrhage.

Seems like a great doc....
Click to expand...

Prison. That should be her fate. There is no excuse for what happened here. It is so far beyond malpractice.
 
Dr. Rude said:
We can't have it both ways. Yes, advocating for CRNAs to be supervised by non-Anesthesiologist physicians is a flawed strategy. But is it really worse than no physician supervision at all? If you could wave a legislative magic wand and mandate that every anesthetic be supervised by an anesthesiologist, it would be nothing more than another unfunded mandate that would be meaningless.
Click to expand...
We / the ASA should update their pathetic old “any physician” supervisory standard and at least have a guideline that an anesthesiologist must supervise CRNAs providing anesthesia, period. I can’t imagine any legitimate cohort of ASA members would disagree with this.
 
kidthor said:
We / the ASA should update their pathetic old “any physician” supervisory standard and at least have a guideline that an anesthesiologist must supervise CRNAs providing anesthesia, period. I can’t imagine any legitimate cohort of ASA members would disagree with this.
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There is a difference between being right and being effective. While I agree that you are right, such a strategy is likely to be the opposite of being effective.
 
Dr. Rude said:
There is a difference between being right and being effective. While I agree that you are right, such a strategy is likely to be the opposite of being effective.
Click to expand...
Well, the current approach is the opposite of being effective.
 
Gern Blansten said:
That is a really excellent point. We (the ASA) advocate for physician supervision of CRNAs, even if that physician is a surgeon or gastroenterologist, knowing full well that, in a true emergency, those supervising physicians would not have the skill set to be much help far greater than 50% of the time. Now consider that such a physician is not supervising that anesthetic, but performing it. Now we have an issue with it because the real issue ( a great deal of physicians who supervise CRNAs have no idea what they’re doing related to anesthesiology) is fully on display.
It is sad that this family had to suffer such a loss. I believe I remember that Florida had a string of really egregious plastic surgery office based bad outcomes ~15 years ago and really tightened up on the rules surrounding this practice. It will be interesting to see the response. Events like this that are far out of bounds make it harder on everyone who is following the rules because government agencies will make new rules (sometimes completely ridiculous rules) that make our jobs harder to try and keep this from ever happening again.
Click to expand...


And BBL is a relatively high risk procedure. Who wants to deal with fat embolus at a freestanding OPSC?


pubmed.ncbi.nlm.nih.gov

Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force - PubMed

Despite the growing popularity of gluteal fat grafting, significantly higher mortality rates appear to be associated with gluteal fat grafting than with any other aesthetic surgical procedure. Based on this survey, fat injections into the deep muscle, using cannulae smaller than 4 mm, and...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov



“The Brazilian Buttock Lift (BBL) is a procedure in which fat is taken from another part of the body, then injected into the buttocks. However, surgeons today warn it has the highest death rate (thought to be as high as 1 in 3,000 operations)[2] of all cosmetic surgery procedures, due to the risk of injecting fat into large veins that can travel to the heart or brain and cause severe illness and death. This risk has galvanised the BAAPS to distribute a recommendation to all members, suggesting they refrain from performing BBLs, at least until more data is available. This is going even further than the American and Australian[3] Societies, which only alert members to reporting outcomes.”
 
Obgyn, and a bad one at that, giving anesthesia.. wtf is going on down there? This is insane... doesnt happen anywhere else in the developed world afaik?
Except for maybe very remote, rural areas... and even then it is fam med or emerg docs with extra training or at least special interest in anesthesia..

Ob, ortho and a few others should be specifically contraindicated from giving anesthesia...

At least cardiac or thoracics know something about physiology... ob know literally nothing outside of the ctg and oxytocin in 100% of my interactions with them
 
coffeebythelake said:
Millicent Muir did her medical school at University of Tennessee and has been an OBGYN for 20+ years. No idea why she would have thought practicing anesthesia would be appropriate. Is the OBGYN market that bad in Florida that she jumps over to doing something she is wholly unqualified for? I think Most likely arrogance is the reason for this tragedy.
Click to expand...
I think ignorance is the most likely reason. I can imagine the OB thinking...It's just sedation, not anesthesia. My 2 cents.
 
Dr. Rude said:
We can't have it both ways. Yes, advocating for CRNAs to be supervised by non-Anesthesiologist physicians is a flawed strategy. But is it really worse than no physician supervision at all? If you could wave a legislative magic wand and mandate that every anesthetic be supervised by an anesthesiologist, it would be nothing more than another unfunded mandate that would be meaningless.
Click to expand...
Yes it is worse. CRNA’s want independence. They should have it and all that comes with it.
 
Just want to point out that there is a lot we don’t know.
All we know is that she came for surgery and “never woke up”. And that an OB GYN was doing the sedation.
Was there a post - mortem ? Maybe there was indeed a fat embolus. Maybe there was anaphylaxis. Maybe it was LAST (they inject quite a bit of local in plastic’s cases) How experienced was this OBGYN at delivering anesthesia. It could be she had been doing it for many years on thousands of patients. Maybe she had taken a lot of “sedation courses”
When we talk about criminal charges, that is usually reserved for the most egregious reckless behavior. If she was “experienced” and “credentialed” it could be a hard sell to a jury.
I’m not defending her. Just pointing out there is alot we don’t know….
 
dannyboy1 said:
Just want to point out that there is a lot we don’t know.
All we know is that she came for surgery and “never woke up”. And that an OB GYN was doing the sedation.
Was there a post - mortem ? Maybe there was indeed a fat embolus. Maybe there was anaphylaxis. Maybe it was LAST (they inject quite a bit of local in plastic’s cases) How experienced was this OBGYN at delivering anesthesia. It could be she had been doing it for many years on thousands of patients. Maybe she had taken a lot of “sedation courses”
When we talk about criminal charges, that is usually reserved for the most egregious reckless behavior. If she was “experienced” and “credentialed” it could be a hard sell to a jury.
I’m not defending her. Just pointing out there is alot we don’t know….
Click to expand...

I know you are playing devil's advocate. It's possible what you've suggested but I think very unlikely.
 
coffeebythelake said:
I know you are playing devil's advocate. It's possible what you've suggested but I think very unlikely.
Click to expand...
Of course. Likely, being a butt lift in a surgicenter, this was a prone “sedation” gone wrong. Just pointing out that criminal charges against a doctor for malpractice are extremely rare. Most likely this doctor had some sort of credentialing for sedation and this was not her first patient. Anesthesia is not without its risks and these things happen with anesthesiologists present as well (just ask Joan rivers). Of course, I would like them to throw the book at her and the surgicenter. Having an OBGYN (especially one with prior license restrictions) delivering anesthesia is sketchy as fu(k. Just not sure it will be a slam dunk case…..
 
dannyboy1 said:
Of course. Likely, being a butt lift in a surgicenter, this was a prone “sedation” gone wrong. Just pointing out that criminal charges against a doctor for malpractice are extremely rare. Most likely this doctor had some sort of credentialing for sedation and this was not her first patient. Anesthesia is not without its risks and these things happen with anesthesiologists present as well (just ask Joan rivers). Of course, I would like them to throw the book at her and the surgicenter. Having an OBGYN (especially one with prior license restrictions) delivering anesthesia is sketchy as fu(k. Just not sure it will be a slam dunk case…..
Click to expand...
It would also be interesting to know if this doctor was credentialed by the surgicenter to administer anesthesia.
 
GassYous said:
I don't know any group of doctors that knows less about anesthesiology than obgyns. It is especially egregious because they work closely with us on L and D.
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Tragically ironic since an epidural would have worked fine for this prone case and taken the airway out of the equation.
 
Awhile ago I had a back-and-forth with a semi-rural EM doc in another forum trying to get tips on how to provide anesthesia for optho and urology cases at a surgery center. I suggested to them that it wasn’t a good idea and that a lot can go wrong, hence the whole anesthesiologists providing anesthesia thing. But they claimed it was “within their scope of practice” and remained determined to do this as an “easy side gig” because it’s “just sedation”.

It’s all a side effect of us making it look easy I guess.
 
kidthor said:
Awhile ago I had a back-and-forth with a semi-rural EM doc in another forum trying to get tips on how to provide anesthesia for optho and urology cases at a surgery center. I suggested to them that it wasn’t a good idea and that a lot can go wrong, hence the whole anesthesiologists providing anesthesia thing. But they claimed it was “within their scope of practice” and remained determined to do this as an “easy side gig” because it’s “just sedation”.

It’s all a side effect of us making it look easy I guess.
Click to expand...

If I wanted to practice at the top of my license I would be doing everything within the realm of Medicine. Neurosuegery in the morning, some OB at noon, and then maybe down to the morgue to do some forensic pathology work in the afternoon. Finish that off by going through a bunch of radiographic images before dinner. I don't because I recognize my ljmitations. Experience, training and competency rather than the legalese that comes with the degree and license should dictate what one can and cannot do. There seem to be a lot of nonanesthesiologists who think they can do what we do despite knowing nothing about what we do.
 
kidthor said:
Awhile ago I had a back-and-forth with a semi-rural EM doc in another forum trying to get tips on how to provide anesthesia for optho and urology cases at a surgery center. I suggested to them that it wasn’t a good idea and that a lot can go wrong, hence the whole anesthesiologists providing anesthesia thing. But they claimed it was “within their scope of practice” and remained determined to do this as an “easy side gig” because it’s “just sedation”.

It’s all a side effect of us making it look easy I guess.
Click to expand...
This has to be the most insane post here. Hard to believe. Ok sedation for eye cases, fine. But doing urology cases ….. I bet the ED doc wouldn’t even cancel a sedation case for a non NPO patient.
 
nimbus said:
And BBL is a relatively high risk procedure. Who wants to deal with fat embolus at a freestanding OPSC?


pubmed.ncbi.nlm.nih.gov

Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force - PubMed

Despite the growing popularity of gluteal fat grafting, significantly higher mortality rates appear to be associated with gluteal fat grafting than with any other aesthetic surgical procedure. Based on this survey, fat injections into the deep muscle, using cannulae smaller than 4 mm, and...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov



“The Brazilian Buttock Lift (BBL) is a procedure in which fat is taken from another part of the body, then injected into the buttocks. However, surgeons today warn it has the highest death rate (thought to be as high as 1 in 3,000 operations)[2] of all cosmetic surgery procedures, due to the risk of injecting fat into large veins that can travel to the heart or brain and cause severe illness and death. This risk has galvanised the BAAPS to distribute a recommendation to all members, suggesting they refrain from performing BBLs, at least until more data is available. This is going even further than the American and Australian[3] Societies, which only alert members to reporting outcomes.”
Click to expand...

Apparently, a lot.

I'm a PCP in South Florida. We get a ton of "pre-op" requests every year for BBLs that are to be done at these "plastic surgery centers." Strax, which used to employ the plastic surgeon in that article, is one of the most infamous, but there are lots of them. They are all very questionable and sketchy, but that doesn't stop people from flocking there to get cheap lipo/BBLs/fat transfers, etc. A flashy website/Instagram page and a catchy jingle from their radio ads cover up a multitude of sins, in the patient's eyes - not that most of the patients even know what to look for, anyway.

I guarantee that none of those plastic surgery centers are using anesthesiologists or, even, CRNAs at their centers. It is far more likely, from what I have seen and heard from patients who have been there, that the anesthesia is being provided by a "general practitioner" who has never done a residency in the US, but was a surgeon in Cuba/Honduras/Brazil. I can guarantee that some of the surgeries are being provided by such people too.
 
smq123 said:
Apparently, a lot.

I'm a PCP in South Florida. We get a ton of "pre-op" requests every year for BBLs that are to be done at these "plastic surgery centers." Strax, which used to employ the plastic surgeon in that article, is one of the most infamous, but there are lots of them. They are all very questionable and sketchy, but that doesn't stop people from flocking there to get cheap lipo/BBLs/fat transfers, etc. A flashy website/Instagram page and a catchy jingle from their radio ads cover up a multitude of sins, in the patient's eyes - not that most of the patients even know what to look for, anyway.

I guarantee that none of those plastic surgery centers are using anesthesiologists or, even, CRNAs at their centers. It is far more likely, from what I have seen and heard from patients who have been there, that the anesthesia is being provided by a "general practitioner" who has never done a residency in the US, but was a surgeon in Cuba/Honduras/Brazil. I can guarantee that some of the surgeries are being provided by such people too.
Click to expand...

Didn't know the wild west of healthcare was actually in the south. Scary. Greed.
 
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