Plastic surgery death. Ob-gyn acting as Anesthesiologist

[lobelsteve]

Florida mother dies following plastic surgery, doctor was ‘unqualified’ to give anesthesia

A young Florida mother has died after undergoing plastic surgery.

www.wfla.com

Nopes.

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[deleted1147063]

Florida mother dies following plastic surgery, doctor was ‘unqualified’ to give anesthesia

A young Florida mother has died after undergoing plastic surgery.

www.wfla.com

Nopes.

This guy should go to prison.

 

[DocVapor]

This guy should go to prison.

I would be comfortable extending that fate to several people, including the plastic surgeon and the top 3 ranking members of the company that owns the ASC.

 

[nimbus]

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.

 

[coffeebythelake]

Craziness

This is criminal

 

[epidural man]

Holy crap. I need more details. This is shocking.

 

[coffeebythelake]

These are the people listed in the article. Plastic surgeon Dr Nees and OBGYN and amateur anesthetist Dr Muir. Shameful. Absolutely disgusting.

 

[Gern Blansten]

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.

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.

 

[dannyboy1]

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…..

 

[coffeebythelake]

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…..

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.

 

[Gern Blansten]

I think many docs look at 95% of what we do and say, “I could do that. I’ve intubated before and I have taken care of ICU patients. How hard can it be?”

 

[Helpful Troll]

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.

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.

 

[lobelsteve]

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.

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

 

[Dr. Rude]

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.

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.

 

[GassYous]

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.

 

[Gern Blansten]

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.

Agree. I don’t know the solution but I have always thought the policy was flawed.

 

[anonperson]

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.

A Florida ob/gyn played anesthesiologist for fatal Brazilian butt lift, state says

The only disciplinary action on the ob/gyn’s license is from 2019, but it also involves the death of a patient.

www.google.com

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

Seems like a great doc....

 

[coffeebythelake]

A Florida ob/gyn played anesthesiologist for fatal Brazilian butt lift, state says

The only disciplinary action on the ob/gyn’s license is from 2019, but it also involves the death of a patient.

www.google.com

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

Seems like a great doc....

Prison. That should be her fate. There is no excuse for what happened here. It is so far beyond malpractice.

 

[1halfMVsquared]

This is incredibly sad. They need to be prosecuted to the maximum. I'd happily be an expert witness for this case.

 

[dannyboy1]

This is incredibly sad. They need to be prosecuted to the maximum. I'd happily be an expert witness for this case.

Agreed. This is basically a Micheal Jackson situation except the patient is not a celebrity.

 

[kidthor]

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.

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.

 

[Dr. Rude]

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.

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.

 

[kidthor]

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.

Well, the current approach is the opposite of being effective.

 

[forchinet121]

Disgusting

 

[nimbus]

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.

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

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

THE BOTTOM LINE

“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.”

 

[PpfSuxTube]

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

 

[Angus Avagadro]

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.

I think ignorance is the most likely reason. I can imagine the OB thinking...It's just sedation, not anesthesia. My 2 cents.

 

[IlDestriero]

I suspect she’ll successfully lose her license this time. Criminal charges would be reasonable as well. It’s an impressive level of arrogance and ignorance.
The ASC and surgeon should brace for impact as well. Hopefully the malpractice checks cleared.

 

[epidural man]

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.

Yes it is worse. CRNA’s want independence. They should have it and all that comes with it.

 

[dannyboy1]

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….

 

[coffeebythelake]

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….

I know you are playing devil's advocate. It's possible what you've suggested but I think very unlikely.

 

[dannyboy1]

I know you are playing devil's advocate. It's possible what you've suggested but I think very unlikely.

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…..

 

[cincincyreds]

Florida mother dies following plastic surgery, doctor was ‘unqualified’ to give anesthesia

A young Florida mother has died after undergoing plastic surgery.

www.wfla.com

Nopes.

There are a few people who belong in jail for a long time for murder.

 

[Angus Avagadro]

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…..

It would also be interesting to know if this doctor was credentialed by the surgicenter to administer anesthesia.

 

[ranvier]

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.

Tragically ironic since an epidural would have worked fine for this prone case and taken the airway out of the equation.

 

[MirrorTodd]

Tragically ironic since an epidural would have worked fine for this prone case and taken the airway out of the equation.

An OB putting in an epidural sure seems like a good way for a tuohy to end up in the aorta.

 

[Dr. Rude]

An OB putting in an epidural sure seems like a good way for a tuohy to end up in the aorta.

There used to be plenty of small hospitals where OBs did their own epidurals. Showing my age

 

[kidthor]

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.

 

[coffeebythelake]

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.

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.

 

[Test Boy]

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.

Possibly ortho

 

[Test Boy]

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. FL DOH MQA Search Portal | Index

Looks like she’s not board certified in her own specialty (ob/gyn) either.

 

[repititionition]

god with baseline level of screech from the average OBG can you even imagine how she likely handled this once she actually recognized it was an emergency?

 

[kidthor]

god with baseline level of screech from the average OBG can you even imagine how she likely handled this once she actually recognized it was an emergency?

Not to pile on, but would urology need to come repair the severed ureter too?

 

[Blockit]

There used to be plenty of small hospitals where OBs did their own epidurals. Showing my age

Yep! I remember a few that did them also.

 

[Gasworks]

I live and practice in “rural” Florida.. the level of sketch and corner cutting is mind boggling. They can scream about staffing shortages and medical necessity all they want but it all comes down to squeezing a buck.

 

[Angus Avagadro]

Yep! I remember a few that did them also.

And they were pretty ****ty at it.

 

[deleted875186]

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.

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.

 

[smq123]

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

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

THE BOTTOM LINE

“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.”

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.

 

[coffeebythelake]

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.

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

 

[Iso4ane]

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.

I had at least one OB/Gyn confuse nitrous oxide and nitroglycerin.