SA man says hospital forgot to sedate him during procedure, and he has a drug screening to prove it

[TheLoneWolf]

SA man says hospital forgot to sedate him during procedure, and he has a drug screening to prove it

A San Antonio man who said a hospital failed to sedate him during an outpatient procedure last fall went as far as to get an independent drug screening to prove the powerful drugs were not in his system.

www.ksat.com

I am leaning toward him not having received the medication if he had gone to an independent facility and tested negative for both opioids and benzos with a 6 hour window. 2 false negatives in a sample is rare.

Other potential possibility is he is running a scam with adulterated urine sample or non-own sample in order to setup for a lawsuit....but that's pretty out there and assuming some level of understanding of usual drugs used in Mac anesthesia settings, detection windows etc.

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[jwk]

My guess is that "anesthesia" wasn't involved with his case at all. Sounds more like conscious sedation which we are rarely involved in.

 

[Dr. Rude]

My guess is that "anesthesia" wasn't involved with his case at all. Sounds more like conscious sedation which we are rarely involved in.

probably true. But it does sound like the patient received nothing and was lied to about it.

 

[Ronin786]

Diversion is the first thing that comes to mind.

 

[Ezekiel2517]

Infiltrated or bad IV also a possibility. Anyways the proceduralist is an idiot for not stopping when the patient was wide awake and complaining of pain

 

[Morzh]

If you watch the video they show a screenshot of his itemized bill. No anesthesiologist involved, only conscious sedation by a GI nurse for a colonoscopy. It shows he was given 100mcg fentanyl and 2mg versed total . For a large man like this patient I don't have a hard time believing that he indeed was pretty much fully awake for the colonoscopy, even if those those wimpy doses were in fact given... especially if perhaps he has a bit of a "healthy metabolism" (MJ or EtOH use).

I don't know much about drug testing and whether or not a single dose of those meds would show up 6 hours later.

You would think he would have been complaining loudly during the colonoscopy, though... might have tipped off the RN / GI doc.

 

[secretasianman]

The whole at home drug testing thing sounds silly, and so is the $900 anesthesia charge for versed and fentanyl.

 

[coffeebythelake]

Sounds like another instance of "overpromised and underdelivered". GI doc probably told patient, "you won't remember or feel a thing!"

 

[nimbus]

Sounds like another instance of "overpromised and underdelivered". GI doc probably told patient, "you won't remember or feel a thing!"

I used to work with an orthopedist who got versed/Demerol for his colonoscopy. He remembered everything and loved it. Direct quote, “you could have driven a truck up my a** and I wouldn’t have cared!”

 

[coffeebythelake]

The whole at home drug testing thing sounds silly, and so is the $900 anesthesia charge for versed and fentanyl.

$900 charge for versed and fentanyl conscious sedation by a nurse should be criminal

 

[epidural man]

Sounds like another instance of "overpromised and underdelivered". GI doc probably told patient, "you won't remember or feel a thing!"

Yes - like surgeons who tell the patient that they will wake up and have no pain.

As I tell them "yep, a big knife just split your stomach open, and then large needles and thread put it back together. It is going to hurt of course.
There is no reason to think a large cut on your belly would be painless."

 

[chessknt]

He probably thinks some great crime was committed because he remembered the conoscopy like it is the same level as being paralyzed with an open abdomen. He'll be traumatized for life or so his lawyer will claim.

 

[DirtDocMD]

$900?? Is that for the medications, themselves, or the “sedation fee”?? For a 7 point case (5 start plus 2 time), an MD or CRNA couldn’t have even got that (unless they got $130 a point), and that’s not even $20 worth of drugs...

 

[deleted1156848]

new account.

I looked on the website for the lab he went to. The lab test for 10 drugs in urine including “expanded opiates” (sic) included:
Oxycodone, Hydrocodone, Oxymorphone, Hydromorphone, Codeine, and Morphine (vary by lab). Not synthetics.

No lab will test for midazolam metabolites.

 

[Morzh]

Screenshot of his itemized bill from the news video. Not sure where he's getting $900 for the drugs... more like $4.

On one hand it seems like he was probably a bit under sedated for his colonoscopy. On the other hand, it's a colonoscopy not an ex-lap. Come on, son!

And the going straight to a drug test seems kind of sketchy / weird. I'm not saying he's trying to pull a scam, but it's bizarre. I don't think the private lab results will hold up in court, either.

He definitely comes across as though he thinks that he is exposing some great scandalous awake-under-the-knife event (and looking for some mega-payout for his terrible physical and emotional damages). Gonna be disappointed.

 

[GassYous]

I think it is weird that he got an at home drug test in hours and a same day drug test. Sounds like he was trying to get a lawsuit going?

 

[Agast]

That was pretty quick thinking of him. Maybe something in the nurse’s demeanor made him extra suspicious?

 

[BobLoblaw78]

The $900 anesthesia charge for versed and fentanyl.

I was asked by the hospital to take over the endoscopy sedation performed by the endoscopist after a couple bad outcomes. I was surprised to run into major resistance from the endoscopist. I couldn’t understand why….until I found out how much he got charging for sedation. As they say “Follow the money”

 

[coffeebythelake]

What kind of bad outcomes happen with judiciously administered conscious sedation? Or is it a problem w patient selection and medical optimization?



I was asked by the hospital to take over the endoscopy sedation performed by the endoscopist after a couple bad outcomes. I was surprised to run into major resistance from the endoscopist. I couldn’t understand why….until I found out how much he got charging for sedation. As they say “Follow the money”

 

[MirrorTodd]

What kind of bad outcomes happen with judiciously administered conscious sedation? Or is it a problem w patient selection and medical optimization?



I was asked by the hospital to take over the endoscopy sedation performed by the endoscopist after a couple bad outcomes. I was surprised to run into major resistance from the endoscopist. I couldn’t understand why….until I found out how much he got charging for sedation. As they say “Follow the money”

More fentanyl until they stop breathing into desaturation, aspiration from not even knowing/following the basic rules regarding fasting guidelines etc etc is my guess.

 

[BobLoblaw78]

What kind of bad outcomes happen with judiciously administered conscious sedation? Or is it a problem w patient selection and medical optimization?

More fentanyl until they stop breathing into desaturation, aspiration from not even knowing/following the basic rules regarding fasting guidelines etc etc is my guess.

Actually he was using propofol. He had one patient die and another almost die within 6 months. I can't remember the specifics as this was over 10 years ago. I believe the first one was a sick patient that got more propofol than they needed. The second one was an ICU patient that they gave propofol through the arterial line. Patient had intense pain so they gave more. Noticed it was not infusing easily. Recognized it was arterial line. Subsequently gave more propofol through PIV (his belief was arterial propofol wouldn't work). Patient became very hypotensive and required intubation, ventilation, increased vasopressors, rapid response team, etc

Here is the best part. In a sit down with the hospital the Gastroenterologist quoted me worldwide stats on the safety of endoscopist-directed propofol (EDP) sedation over 10 years. He quoted the study which stated that with the millions (I don't remember exact #) of procedures there had only been 2 deaths worldwide over that period. He had been so arrogant and condescending up to that point. He even stated he was actually better than anesthesiologists because he had done much more endoscopy sedation than we had. So I relished saying, "Wow, you have single-handedly almost killed as many people as the rest of the world has in just a fraction of the time." Then I told him he was done using propofol for his sedation since it was under anesthesia to grant privileges. Hospital admin stepped in and made it a moot point. They forced him to use anesthesia. The kicker was that he was getting paid more for sedation than what anesthesia could legally charge. It is a messed up world.

 

[VA Hopeful Dr]

Screenshot of his itemized bill from the news video. Not sure where he's getting $900 for the drugs... more like $4.

On one hand it seems like he was probably a bit under sedated for his colonoscopy. On the other hand, it's a colonoscopy not an ex-lap. Come on, son!

And the going straight to a drug test seems kind of sketchy / weird. I'm not saying he's trying to pull a scam, but it's bizarre. I don't think the private lab results will hold up in court, either.

He definitely comes across as though he thinks that he is exposing some great scandalous awake-under-the-knife event (and looking for some mega-payout for his terrible physical and emotional damages). Gonna be disappointed.

I recall reading in this forum about anesthesiologists who post here getting scoped with no sedation because they didn't trust the GI or RN to give them the meds for it.

 

[MirrorTodd]

Actually he was using propofol. He had one patient die and another almost die within 6 months. I can't remember the specifics as this was over 10 years ago. I believe the first one was a sick patient that got more propofol than they needed. The second one was an ICU patient that they gave propofol through the arterial line. Patient had intense pain so they gave more. Noticed it was not infusing easily. Recognized it was arterial line. Subsequently gave more propofol through PIV (his belief was arterial propofol wouldn't work). Patient became very hypotensive and required intubation, ventilation, increased vasopressors, rapid response team, etc

Here is the best part. In a sit down with the hospital the Gastroenterologist quoted me worldwide stats on the safety of endoscopist-directed propofol (EDP) sedation over 10 years. He quoted the study which stated that with the millions (I don't remember exact #) of procedures there had only been 2 deaths worldwide over that period. He had been so arrogant and condescending up to that point. He even stated he was actually better than anesthesiologists because he had done much more endoscopy sedation than we had. So I relished saying, "Wow, you have single-handedly almost killed as many people as the rest of the world has in just a fraction of the time." Then I told him he was done using propofol for his sedation since it was under anesthesia to grant privileges. Hospital admin stepped in and made it a moot point. They forced him to use anesthesia. The kicker was that he was getting paid more for sedation than what anesthesia could legally charge. It is a messed up world.

JFC

 

[Twiggidy]

I can certainly see where diversion comes to mind, but also in today's era of just about everyone on the corner being some sort of scam artist, i can 100% see testing "clean" urine. The problem is that in the field of medicine, across the board, the court of public opinion makes us guilty until proven innocent.

 

[Dr. Rude]

I can certainly see where diversion comes to mind, but also in today's era of just about everyone on the corner being some sort of scam artist, i can 100% see testing "clean" urine. The problem is that in the field of medicine, across the board, the court of public opinion makes us guilty until proven innocent.

Dude is going to have a hard time collecting damages.

 

[TheLoneWolf]

Actually he was using propofol. He had one patient die and another almost die within 6 months. I can't remember the specifics as this was over 10 years ago. I believe the first one was a sick patient that got more propofol than they needed. The second one was an ICU patient that they gave propofol through the arterial line. Patient had intense pain so they gave more. Noticed it was not infusing easily. Recognized it was arterial line. Subsequently gave more propofol through PIV (his belief was arterial propofol wouldn't work). Patient became very hypotensive and required intubation, ventilation, increased vasopressors, rapid response team, etc

Here is the best part. In a sit down with the hospital the Gastroenterologist quoted me worldwide stats on the safety of endoscopist-directed propofol (EDP) sedation over 10 years. He quoted the study which stated that with the millions (I don't remember exact #) of procedures there had only been 2 deaths worldwide over that period. He had been so arrogant and condescending up to that point. He even stated he was actually better than anesthesiologists because he had done much more endoscopy sedation than we had. So I relished saying, "Wow, you have single-handedly almost killed as many people as the rest of the world has in just a fraction of the time." Then I told him he was done using propofol for his sedation since it was under anesthesia to grant privileges. Hospital admin stepped in and made it a moot point. They forced him to use anesthesia. The kicker was that he was getting paid more for sedation than what anesthesia could legally charge. It is a messed up world.

I guess he is so much better than everyone at my prior shop, all MD, at least 70 years of anesthesia training between us (and not counting the decades of PP work) and we still had 2-3 emergency events per month in the endo suites- usually laryngospasm. Maybe this guy can share his secrets to the unbelievably low mortality rate of 2 worldwide deaths per decade. If true, probably safer to have endoscopist directed propofol sedation than uh i dunno, using an elevator or drinking the occasional coffee.

Does he crack open the bottle, push 10mg then call it a successful EDP case. Probably the only way without having complications

 

[chessknt]

Dude is going to have a hard time collecting damages.

Exactly. I imagine he collected the sample unwitnessed which wouldn't stand up for a valid drug screen in any scenario.

 

[anonperson]

I recall reading in this forum about anesthesiologists who post here getting scoped with no sedation because they didn't trust the GI or RN to give them the meds for it.

In medical school, one of the GIs I rotated with said he did his screening colonoscopy without any type of sedation because he had to work later that morning. Said it was no big deal.

 

[BobLoblaw78]

In medical school, one of the GIs I rotated with said he did his screening colonoscopy without any type of sedation because he had to work later that morning. Said it was no big deal.

UpToDate

www.uptodate.com

Reminds me of a patient that woke up during a colonoscopy. He opened one eye and says, "I'm not gay or anything but this isn't that bad." Propofol was quickly rebolused (alas, this story didn't actually happen to me but belongs to one of my buddies)

 

[anbuitachi]

900 is criminal for nurse conscious sedation

 

[Twiggidy]

In medical school, one of the GIs I rotated with said he did his screening colonoscopy without any type of sedation because he had to work later that morning. Said it was no big deal.

We have several GI docs at our facility/large practice and only one uses anesthesiologists consistently for his procedures. I there’s a lot of “versed + fentanyl” GI docs out there

 

[Twiggidy]

UpToDate

www.uptodate.com

Reminds me of a patient that woke up during a colonoscopy. He opened one eye and says, "I'm not gay or anything but this isn't that bad." Propofol was quickly rebolused (alas, this story didn't actually happen to me but belongs to one of my buddies)

I must admit….this did cross my mind. How different is it than a couple of cocktails and getting extra “randy” with your partner….asking for a friend lol

 

[FutureInternist]

$900 charge for versed and fentanyl conscious sedation by a nurse should be criminal

Welcome the American “Health”care system… 😏

 

[aneftp]

900 is criminal for nurse conscious sedation

$200 for po Tylenol should be a felony than for hospitals.

 

[anbuitachi]

$200 for po Tylenol should be a felony than for hospitals.

yes it should. same as charging 100$ for a tiny box of tissues

 

[nimbus]

yes it should. same as charging 100$ for a tiny box of tissues

I’d say no thank you, go into the bathroom and grab a wad of toilet paper.

 

[anbuitachi]

I’d say no thank you, go into the bathroom and grab a wad of toilet paper.

what make you think toilet paper is cheaper??

 

[GassYous]

I must admit….this did cross my mind. How different is it than a couple of cocktails and getting extra “randy” with your partner….asking for a friend lol

Remind me not to have any cocktails with your "friend"

 

[Twiggidy]

Remind me not to have any cocktails with your "friend"

What if my friend is Scarlett Johansson? Lol

 

[GassYous]

What if my friend is Scarlett Johansson? Lol

Not if she makes me her bitch

 

[Aether2000]

Drug screens will never show these medications

 

[deleted875186]

Drug screens will never show these medications

Not true. Commercial labs have this capability. Depends what type of test is being done. Pain clinic tests for both drugs and their metabolites, in addition to other benzos and metabolites, all the traditional opioids, as well as drugs of abuse.

 

[deleted1156848]

Not true. Commercial labs have this capability. Depends what type of test is being done. Pain clinic tests for both drugs and their metabolites, in addition to other benzos and metabolites, all the traditional opioids, as well as drugs of abuse.

Just not at “lab tests NOW!” Or whatever clown name the place he went to had.

 

[Aether2000]

Not true. Commercial labs have this capability. Depends what type of test is being done. Pain clinic tests for both drugs and their metabolites, in addition to other benzos and metabolites, all the traditional opioids, as well as drugs of abuse.

Urine drug screening uses ELISA or other enzyme based methods to detect the presence or absence of targeted drugs (with significant overlap of other drugs in the class) at a threshold limit based on the technique and drug, with the results displayed as a "+" or "-". No urine drug screen will detect metabolites of midazolam or detect fentanyl due to lack of sensitivity. There is one test strip that claims to be able to detect midazolam (but not the metabolite) but because the half life is 1.5 hours and the threshold is set very high at more than 6200 ng/ml, this test will not detect midazolam from anesthesia. In order to detect those substances in the urine, a colorimetric spectrophotometer system using an immunoassay (still with significant overlap with other medications) or an analytical quantitative drug testing method such as GC/MS or HPLC/MS is needed. So no, urine drug screens will not detect fentanyl/midazolam in the urine, but some quantitative analytic methods will.

 

[deleted875186]

Urine drug screening uses ELISA or other enzyme based methods to detect the presence or absence of targeted drugs (with significant overlap of other drugs in the class) at a threshold limit based on the technique and drug, with the results displayed as a "+" or "-". No urine drug screen will detect metabolites of midazolam or detect fentanyl due to lack of sensitivity. There is one test strip that claims to be able to detect midazolam (but not the metabolite) but because the half life is 1.5 hours and the threshold is set very high at more than 6200 ng/ml, this test will not detect midazolam from anesthesia. In order to detect those substances in the urine, a colorimetric spectrophotometer system using an immunoassay (still with significant overlap with other medications) or an analytical quantitative drug testing method such as GC/MS or HPLC/MS is needed. So no, urine drug screens will not detect fentanyl/midazolam in the urine, but some quantitative analytic methods will.

Correct. Ask any pain clinic, they’re doing urine testing with a lab that does this type of testing. As stated above, unlikely that the place this person went has a lab on site that does this, but it is possible. There are small labs that do this. GC and MS isn’t overly sophisticated, it’s available in a lot of labs.

 

[Aether2000]

The term screening is a dipstick or embedded strip, and is different than quantitative analysis. GC/MS and HPLC/MS are not urine drug screens, they are quantitative specific drug testing. The article cited by the OP used the term "urine drug screening", not quantitative analysis or drug testing. I would imagine the guy getting the test did not know the difference.