Sad story, another anesthesia death. Seems like only a matter of time before they impose changes on our profession.

[Flashes23]

After dental patient dies following routine procedure, widow calls for changes to anesthesia requirements

The North Carolina Dental Board is considering making sweeping changes to the way sedation dentistry is performed. The death of a well respected and greatly loved cardiologist in Wilmington during a routine dental procedure helped spur this movement.

www.wect.com

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Members don't see this ad.

 

[Flashes23]

Embattled oral surgeon Dr. Mark Austin permanently surrenders NC dental license

One year after a prominent Wilmington doctor died during a dental procedure in the care of Dr. Mark Austin, Austin has permanently surrendered his dental license. An investigative panel for the North Carolina State Board of Dental Examiners found Austin’s actions resulted in his patient’s death.

www.wect.com

I thought this happened years prior

Dental License Suspended After Opioid Allegations and Patient Death - Dentistry Today

The North Carolina State Board of Dental Examiners has suspended the license of Mark C. Austin, DDS, following allegations of opioid misuse and a patient death.

www.dentistrytoday.com

Also sounds like this guy had plenty of other issues sadly.

Ohh I saw it posted today, crazy..

 

[HockeyDocOMFS]

Embattled oral surgeon Dr. Mark Austin permanently surrenders NC dental license

One year after a prominent Wilmington doctor died during a dental procedure in the care of Dr. Mark Austin, Austin has permanently surrendered his dental license. An investigative panel for the North Carolina State Board of Dental Examiners found Austin’s actions resulted in his patient’s death.

www.wect.com

I thought this happened years prior

Dental License Suspended After Opioid Allegations and Patient Death - Dentistry Today

The North Carolina State Board of Dental Examiners has suspended the license of Mark C. Austin, DDS, following allegations of opioid misuse and a patient death.

www.dentistrytoday.com

Also sounds like this guy had plenty of other issues sadly.

I’m assuming this might be related, but I know North Carolina is now trying to enforce some sort of an anesthesiologist to be present for dental procedures under sedation (correct me if I’m wrong)

https://www.ncdentalboard.org/PDF/2021-12-07%20Notice%20of%20Text%20with%2016Q%20Rules.pdf

 

[HockeyDocOMFS]

You are wrong.
Its important to read rules and regulations carefully, especially if you will be doing IV conscious sedation in your own office. If you read that document carefully, you will see on page 10, that they will be requiring (if this bill makes its way through the legislature and gets passed) at the very least, for a dental assistant trained in dental anesthesia (for example, by having taken the DAANCE certification course from AAOMS) to be present for the sedation procedure-it does not have to be an RN, CRNA, or MD anesthesiologist. This is no different than what most OMFS are already doing anyways, and is already what the AAOMS recommends all OMFSs do in their offices :
----

"During a sedation procedure involving the administration of general anesthesia, moderate conscious sedation, or moderate pediatric conscious sedation, the permit holder performing the surgical or other dental treatment shall utilize either a dedicated sedation provider or a dedicated sedation auxiliary as set out in this Rule. The dedicated sedation provider or dedicated sedation auxiliary shall not perform the surgical or dental treatment or any other dental assisting tasks during the sedation procedure.

For purposes of this Rule, a "dedicated sedation auxiliary" shall mean an auxiliary with an unexpired ACLS 27 certification who is dedicated to patient monitoring and recording anesthesia or sedation data throughout the sedation 28 procedure.
The dedicated sedation auxiliary shall be:
(1) an RN licensed and practicing in accordance with the rules of the North Carolina Board of Nursing; or
(2) a dental assistant with proof of an unexpired dental anesthesia assistant certification from the Dental Anesthesia Assistant National Certification Examination program offered by the American Association of Oral and Maxillofacial Surgeons, or from another Board-approved dental anesthesia assistant certification program. A list of approved programs is available on the Board's website at www.ncdentalboard.org."

Thanks for clarifying!

 

[DocMon16]

Sad story. I've been following this story too for a while. The doc had a lot of other issues doing on. A bad apple shouldn't ruin it for well trained professionals that haven't had previous convictions or issues when it comes to controlled substances or for that matter any other issues.

 

[702]

Sad story. I've been following this story too for a while. The doc had a lot of other issues doing on. A bad apple shouldn't ruin it for well trained professionals that haven't had previous convictions or issues when it comes to controlled substances or for that matter any other issues.

This

 

[luisfigo]

Sad story. I've been following this story too for a while. The doc had a lot of other issues doing on. A bad apple shouldn't ruin it for well trained professionals that haven't had previous convictions or issues when it comes to controlled substances or for that matter any other issues.

Yeah, I'm definitely over stupid sh&* the rest of us have to go through because of *****s like this guy. After Texas had a string of deaths of peds patients they decided to get heavy handed with nitrous oxide restrictions and regulations as if that were a factor in their deaths

 

[coffeebythelake]

Sad story. I've been following this story too for a while. The doc had a lot of other issues doing on. A bad apple shouldn't ruin it for well trained professionals that haven't had previous convictions or issues when it comes to controlled substances or for that matter any other issues.

Are you attributing the bad outcome to the dentist's history of diverting controlled substances? Is there any suggestion to substantiate a claim that he was intoxicated at the time or that his mental state was altered in a way to prevent him from resuscitating or managing the patients airway during the emergency?

Here's the thing. This dentist has the same training in anesthesia that you have. The same with all those bad cases that happen with otherwise healthy kids and adults that show up in national news every once in a while, and rekindle the whole debate about why dentists are even allowed to simultaneously operate and sedate patients.

I think it is convenient to blame it on him being a bad apple, and that it couldn't happen otherwise, but I worry this shuts down the conversation and overshadows a long history of bad outcomes with dental sedation due to inadequate equipment, staff and training.

 

[bracketbuster68]

Are you attributing the bad outcome to the dentist's history of diverting controlled substances? Is there any suggestion to substantiate a claim that he was intoxicated at the time or that his mental state was altered in a way to prevent him from resuscitating or managing the patients airway during the emergency?

Here's the thing. This dentist has the same training in anesthesia that you have. The same with all those bad cases that happen with otherwise healthy kids and adults that show up in national news every once in a while, and rekindle the whole debate about why dentists are even allowed to simultaneously operate and sedate patients.

I think it is convenient to blame it on him being a bad apple, and that it couldn't happen otherwise, but I worry this shuts down the conversation and overshadows a long history of bad outcomes with dental sedation due to inadequate equipment, staff and training.

I mean, if the guy doesn't have the mental clarity to know diverting fentanyl is wrong, imagine what goes through his head when he practices. Unfortunately, we don't need to - he got someone killed.

 

[IMGASMD]

I mean, if the guy doesn't have the mental clarity to know diverting fentanyl is wrong, imagine what goes through his head when he practices. Unfortunately, we don't need to - he got someone killed.

This is the open paragraph of the news article.

“… When patients are put under anesthesia for medical procedures, an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) must be present in case something goes wrong. However, that safeguard is not in place for dentists and oral surgeons, and ****al Patel thinks it cost her husband his life.”

How do you feel about the conclusion the widow drew?

 

[coffeebythelake]

I mean, if the guy doesn't have the mental clarity to know diverting fentanyl is wrong, imagine what goes through his head when he practices. Unfortunately, we don't need to - he got someone killed.

I feel like the only thing you read was the first sentence I wrote.

 

[bracketbuster68]

I feel like the only thing you read was the first sentence I wrote.

You felt wrong - try thinking. I chose to respond to that part.

 

[coffeebythelake]

You felt wrong - try thinking. I chose to respond to that part.

Judging by your posts, you are either a dental resident or just finished it. "Try thinking?" That's a pretty arrogant statement from a newbie / trainee. Sit down while the grown ups talk and maybe you will learn something.

You chose to ignore everything else that was written and did exactly what I listed in my 3rd paragraph that some of you will do. You lack respect or appreciation for how quickly a sedated patient could spiral downward and that is a very dangerous way of thinking.

 

[coffeebythelake]

You're missing the whole point. The guy was diverting fentanyl. This is clearly someone who should have his dental license and sedation permit revoked. One person acting crazy does not mean that all dentists, particularly OMFS (who have 5-6 months of dedicated general anesthesia training), are incompetent with regards to anesthesia delivery and should have their sedation privileges revoked.

Every time an OMFS wants to administer IV Sedation drugs in their office, they have to file with the state and have an inspection done for a DEA permit to administer said anesthetics in their office. So, your comment about inadequate equipment, staff, and training, is not relevant with regards to OMFS.

Why do you think proper equipment, staff and training is not relevant?

Tragic death during dental procedure

https://www.wect.com/2022/02/03/after-dental-patient-dies-following-routine-procedure-widow-calls-changes-anesthesia-requirements/?fbclid=IwAR1IS2LHMrCY2IXsS8xdF62GAT6RiDsi3IJ0GFltjXAZyOImPY-SBB7QMFY Extremely sad story and unfortunate loss of life. Thoughts?

forums.studentdoctor.net

For context, this is what we are saying in the Anesthesiology forums about what happened.

 

[IMGASMD]

You're missing the whole point. The guy was diverting fentanyl. This is clearly someone who should have his dental license and sedation permit revoked. One person acting crazy does not mean that all dentists, particularly OMFS (who have 5-6 months of dedicated general anesthesia training), are incompetent with regards to anesthesia delivery and should have their sedation privileges revoked.

Every time an OMFS wants to administer IV Sedation drugs in their office, they have to file with the state and have an inspection done for a DEA permit to administer said anesthetics in their office. So, your comment about inadequate equipment, staff, and training, is not relevant with regards to OMFS.

You’re telling me that he has less training than a ca1 (forget about the one year internship, when they actually practice medicine). and we are should be okay with him doing the surgery and monitoring the airway at the same time? Or have a dental assistant monitor patient while he with the anesthesia training working on the implants?

I don’t think anyone is giving him a pass for diverting fentanyl, nor the fact he has problems with judgement. Our focal points are pretty far apart.

 

[bracketbuster68]

Judging by your posts, you are either a dental resident or just finished it. "Try thinking?" That's a pretty arrogant statement from a newbie / trainee. Sit down while the grown ups talk and maybe you will learn something.

You chose to ignore everything else that was written and did exactly what I listed in my 3rd paragraph that some of you will do. You lack respect or appreciation for how quickly a sedated patient could spiral downward and that is a very dangerous way of thinking.

Tell me how you really feel.

 

[DrOwnage]

There's literally a whole medical profession who trains for 4-5 years post-medical school to perform well skilled anesthesia; who routinely encounter issues and complications. Yet we can't have a simple conversation saying that hey, maybe it isn't worth the extra profits to risk people dying. I don't fix peoples' teeth, yet I don't pretend to. There's a very good reason most anesthesiologists will not have their kids or loved ones be anesthetized by a non-anesthesiologist.

 

[Beeftenderloin]

My anesthesiology residency program had a few dental anesthesia residents each year. Fully integrated into the residency, taking call, doing pretty much everything but OB and cardiac anesthesia. They would always talk about how they can’t believe what their dentist colleagues (or even OMFS, with their 4-6 whole months of anesthesia training…) were allowed to do with such limited experience. Heard plenty of sedation horror stories and near misses from their dental training.

These were actual dentists, from diverse backgrounds and different dental schools all over the country, many of them even practiced for a while first, who had now received formal anesthesia training. Year after year they all said the same thing: the sedation experience dentists receive is wholly inadequate and the sedation practices happening in many dental and oral surgery offices across the country are at best below standard of care and at worst recklessly endangering patients lives. There is a massive lack of respect for airway and hemodynamic complications that can arise and an even greater lack of understanding how to manage them when they do. This is peak dunning Krueger being committed by people who should be educated professionals and this cardiologist’s body is evidence of that. This dentist didn’t know what he didn’t know until their was a dead body laying in front of him. I hope this serves as a nidus for change.

 

[Xtract]

My anesthesiology residency program had a few dental anesthesia residents each year. Fully integrated into the residency, taking call, doing pretty much everything but OB and cardiac anesthesia. They would always talk about how they can’t believe what their dentist colleagues (or even OMFS, with their 4-6 whole months of anesthesia training…) were allowed to do with such limited experience. Heard plenty of sedation horror stories and near misses from their dental training.

These were actual dentists, from diverse backgrounds and different dental schools all over the country, many of them even practiced for a while first, who had now received formal anesthesia training. Year after year they all said the same thing: the sedation experience dentists receive is wholly inadequate and the sedation practices happening in many dental and oral surgery offices across the country are at best below standard of care and at worst recklessly endangering patients lives. There is a massive lack of respect for airway and hemodynamic complications that can arise and an even greater lack of understanding how to manage them when they do. This is peak dunning Krueger being committed by people who should be educated professionals and this cardiologist’s body is evidence of that. This dentist didn’t know what he didn’t know until their was a dead body laying in front of him. I hope this serves as a nidus for change.

Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019) - PubMed

The frequency of AEs (0.1%) and 0% mortality rate reported in this study demonstrate that the anesthesia team model used by oral and maxillofacial surgeons compares favorably to standardized intervention-based adverse anesthetic event outcomes reported by other nonanesthesiology specialties...

pubmed.ncbi.nlm.nih.gov

Keep hopin buddy. Numbers don’t lie, this guy is an outlier.

 

[yappy]

Do oral surgeons regularly go to the or to practice their advanced airway skills? Do oms regularly place ETT in practice?

 

[702]

Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019) - PubMed

The frequency of AEs (0.1%) and 0% mortality rate reported in this study demonstrate that the anesthesia team model used by oral and maxillofacial surgeons compares favorably to standardized intervention-based adverse anesthetic event outcomes reported by other nonanesthesiology specialties...

pubmed.ncbi.nlm.nih.gov

Keep hopin buddy. Numbers don’t lie, this guy is an outlier.

There are a few other studies like this and all demonstrate the rate of anesthesia adverse events being extremely low. malpractice insurance claims numbers are also congruent.

 

[GoSoxGo]

There are a few other studies like this and all demonstrate the rate of anesthesia adverse events being extremely low. malpractice insurance claims numbers are also congruent.

Please share some. I'm guessing that OMFS anesthesia training/resources/procedures/outcomes at the #1 hospital in the country are a bit different than 95% of OMFS sedation in the US.

 

[ShortShortsDad]

Why do you think proper equipment, staff and training is not relevant?

Tragic death during dental procedure

https://www.wect.com/2022/02/03/after-dental-patient-dies-following-routine-procedure-widow-calls-changes-anesthesia-requirements/?fbclid=IwAR1IS2LHMrCY2IXsS8xdF62GAT6RiDsi3IJ0GFltjXAZyOImPY-SBB7QMFY Extremely sad story and unfortunate loss of life. Thoughts?

forums.studentdoctor.net

For context, this is what we are saying in the Anesthesiology forums about what happened.

Terrible outcome but an outlier. Massive amount of ignorance in that thread on what training an Oral & Maxillofacial Surgeon has. Sad to see this exaggerated outrage in the face of anesthesiology’s fall and nurse anesthetists rise. In the military this safety for name only approach has seen more rules and certainly more paperwork but no change in patient outcomes. I’d be pissed too if I was an ologist, where else could you make half a mil scrolling on your phone for the morning - I can see why nurses wanted a piece of that pie. And the new CRNA pain fellowships are further rubbing salt in the wound

 

[Mauricio45]

Sad. Reminds me of a story here in Canada from Edmonton, Alberta a couple of years ago where a little girl suffered brain damage from dental sedation.

Stories like these and the OP are the reasons why I would never do sedation.

Family of Edmonton girl who suffered brain damage after dental visit sues for $26.5 million

Amber Athwal, now five years old, stopped breathing at some point, which was noticed at 12:15 p.m. on Sept. 7, 2016 while the girl was in recovery.

edmontonjournal.com

 

[deleted1047421]

I’m a practicing oral & maxillofacial surgeon who provides safe and effective general anesthesia to my patients daily. Our anesthesia team model has proven to be both safe and effective for over 90 years.

I want to clarify a few things:

Who can provide general anesthesia/deep sedation in dentistry and what is their training?

Oral surgeons (not general dentists) can provide general anesthesia, or deep sedation following their 4-6 years of residency training. Oral surgeons have a 5-month anesthesia rotation (4 month adult, 1 month pediatric). In addition, oral surgery residents rotate through multiple other areas including the ICU, internal medicine, cardiology etc further exposing them to complex patient care and anesthesia training (and they often intubate while on other rotations). Throughout their 4-6 year residency, they are also providing anesthesia in their own clinics for outpatient surgery; their anesthesia training is not just 5 months in the OR.


What about monitoring/safety equipment?

OMFS are required to complete mandatory office anesthesia evaluations. These include an evaluation of the facilities, emergency meds, emergency equipment, monitoring equipment, hands-on demonstration by the oral surgeon and his/her team of the management of simulated office emergencies, and observation of actual patient anesthesia/surgeries in the office.


What about staff training?

Oral surgery assistants are DAANCE certified and are ACLS certified. This means they have taken a course and have passed the Dental Anesthesia Assistants National Certification Exam. They are highly trained to assist in both monitoring and recovery. They are not just general dentistry assistants.


What about our track record?

Office based general anesthesia/deep sedation has been safely and successfully performed for over 90 years. You should ask your own president of what he thinks of oral surgeons.

In 2004, Roger W. Litwiller MD, President of the American Society of Anesthesiologists reviewed and concurred with AAOMS’s “Parameters of Care for Anesthesia and Outpatient Facilities,” the official document defining clinical practice guidelines in anesthesia. His statement regarding the use of the general anesthetic, Propofol, and its use by oral surgeons resulted from, “…a long history of safely using general anesthesia in the care of their patients…”

Here are some articles that come to mind:

Perrott DH, Yuen JP, Andresen RV, Dodson TB. Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2003;61:983-995

Lytle JJ, Yoon C. 1978 anesthesia morbidity and mortality survey: Southern California Society of Oral and Maxillofacial Surgeons. J Oral Surg. 1980;38:814-819.

Lytle JJ. Anesthesia morbidity and mortality survey of the Southern California Society of Oral Surgeons. J Oral Surg. 1974;32:739-744.

Lunn JN, Mushin WW. Mortality associated with anaesthesia. Anaesthesia. 1982;37:856.

Anesthesia and Sedation in the Dental Office. NIH Consensus Statement. 1985 Apr 22-24;5:1-18. Available at: http://consensus.nih. gov/1985/1985AnesthesiaDental050html.htm. Accessed September 1, 2016

Steven J Wiemer et al. Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019). May 2021. J Oral Maxillofac Surg

 

[jwk]

There are a few other studies like this and all demonstrate the rate of anesthesia adverse events being extremely low. malpractice insurance claims numbers are also congruent.

There have been several high-profile deaths from dental anesthesia just in the last couple years. I realize that's not a high percentage of the overall number, but it's an indication of a problem.

 

[ShortShortsDad]

There have been several high-profile deaths from dental anesthesia just in the last couple years. I realize that's not a high percentage of the overall number, but it's an indication of a problem.

This is misleading since many of these cases were general dentists who employed CRNAs, dental anesthesiologists or medical anesthesiologists - I can’t tell you how many and that is a problem which is actively being worked on with a database being compiled presently. As mentioned in another thread the data we have show such a low rate of complications that the existing data is almost not believable. In addition to implementing new airway training programs our governing organization is collecting higher level and more current data to better document and communicate our century track record of safety.

 

[deleted1047421]

There have been several high-profile deaths from dental anesthesia just in the last couple years. I realize that's not a high percentage of the overall number, but it's an indication of a problem.

Let's not forget about these:

Parents of student who died after dental surgery sue for malpractice

This is an oral surgeon who had an anesthesiologist performing a sedation and a death still occurred in the office. Anesthesia has risks and no one is immune. Even having an anesthesiologist present will not prevent adverse outcomes.

Will having a CRNA present help? I don’t believe so. CRNAs have also encounter anesthesia problems in the dental setting.

Arizona nurse anesthetist sued over 2 dental patient deaths (beckersdental.com)

Washington boy, 4, dies after anesthesia used in dental procedure | wusa9.com

Here is another example of death in the dental setting with an anesthesiologist present. The list goes on and on. Bottom line is no one is immune to anesthesia complications.

 

[DocMon16]

Let's not forget about these:

Parents of student who died after dental surgery sue for malpractice

This is an oral surgeon who had an anesthesiologist performing a sedation and a death still occurred in the office. Anesthesia has risks and no one is immune. Even having an anesthesiologist present will not prevent adverse outcomes.

Will having a CRNA present help? I don’t believe so. CRNAs have also encounter anesthesia problems in the dental setting.

Arizona nurse anesthetist sued over 2 dental patient deaths (beckersdental.com)

Washington boy, 4, dies after anesthesia used in dental procedure | wusa9.com

Here is another example of death in the dental setting with an anesthesiologist present. The list goes on and on. Bottom line is no one is immune to anesthesia complications.

Silver arrow - thank you for chiming in on both of your responses. There are a lot of things being said this in thread. I want to add to this in a positive manner despite this being a terrible outcome. I am still in training, in my third year of OMFS training and adding on to what Silver arrow has mentioned, we now do 6 months of anesthesia training a long with numerous rotations in ICU training, medicine, and general surgery. Not only are we performing GA in the OR for 6 months (my program we do 2 months of just pediatric GA too) we perform hundreds and hundreds of IVS in the office which is very safe and effective. Do we run into complications, of course, this is part of our training as OMFS but this can happen to an anesthesiologist, CRNA, or DA. We are trained to learn how to safely and effectively deal with these complications that can arise. Putting someone to sleep has objective risks, period.

Our anesthesia training is completely different than that of someone who has even a moderate sedation license and is performing anesthesia in the office. In terms of the staff being trained properly, that was addressed earlier with the DAANCE and our offices have mandatory annual checks for anesthesia evaluations that check all our equipment to ensure the proper emergency equipment and medicines are acutely available to us if things happen to get hairy and we intubate someone in the office. This is all part of the 4-6 years of training that we go through in order to safely and routinely offer these services to our patients.

I am not saying this OS was under the influence while this death happened in his office - at least I haven't read anywhere that he was but he did have previous encounters with abusing controlled substances and not documenting properly. This is a red flag - whether it had something to do or not with the patients death.

I appreciate what Silver arrow has added to this thread as I think people should know that OMFS are very well equipped and can deliver safe and effective moderate/Deep and general anesthesia to patients in the office.

 

[DocMon16]

My anesthesiology residency program had a few dental anesthesia residents each year. Fully integrated into the residency, taking call, doing pretty much everything but OB and cardiac anesthesia. They would always talk about how they can’t believe what their dentist colleagues (or even OMFS, with their 4-6 whole months of anesthesia training…) were allowed to do with such limited experience. Heard plenty of sedation horror stories and near misses from their dental training.

These were actual dentists, from diverse backgrounds and different dental schools all over the country, many of them even practiced for a while first, who had now received formal anesthesia training. Year after year they all said the same thing: the sedation experience dentists receive is wholly inadequate and the sedation practices happening in many dental and oral surgery offices across the country are at best below standard of care and at worst recklessly endangering patients lives. There is a massive lack of respect for airway and hemodynamic complications that can arise and an even greater lack of understanding how to manage them when they do. This is peak dunning Krueger being committed by people who should be educated professionals and this cardiologist’s body is evidence of that. This dentist didn’t know what he didn’t know until their was a dead body laying in front of him. I hope this serves as a nidus for change.

This is misleading to say the least. I appreciate the post but none of DA residents had gone through 4-6 years of OMFS residency and completed the amount of anesthesia training prior to going to DA residency. They are right, general dentists performing any IVS under a moderate sedation license can arguably be sketchy because they certainly don't get adequate training (my opinion) comparable to DA or OMFS. OMFS anesthesia training is intense and we do 4-6 years of putting people to sleep in both the OR and MAC sedation.

 

[OMSDoc]

The safety record for outpatient anesthesia performed by oral and maxillofacial surgeons, using the team model, is unparalleled. We have been doing it since the discovery of general anesthesia.

Numbers and facts do not lie. I have posted on this before. The statistical anesthesia-related mortality risk for patients is higher in an operating room in the hospital than in an OMS clinic. Indeed, the cases in Arizona in which a CRNA had bad outcomes disabuses the theory that having a separate CRNA or MD is ipso facto safer.

This is a case of which we only know what is printed in the paper. It is sad, and I have sympathy for the patient and his family.

I may have said this before, but after I completed my training program, I stayed on Staff as a Consultant (Attending), and in two years performed 800 general anesthetics on young children, in addition to another 500 on teenagers and adults. The physician anesthesiologists and CRNAs would bring their children to us for oral surgery procedures in our clinic. They had trained us and knew what we did.

It would devastate medical and dental care in the US if our ability to provide this service was taken away because of high profile, anecdotal cases, combined with politics.

Just last week, I had two odontogenic space infection patients that I could not admit because the hospital census was full. They were put to sleep by me and my trained staff, and they had straightforward surgical drainages and odontectomies. One patient was a 78-year-old ASA Class III-E patient. Both tolerated their procedures and anesthesia well.

 

[nade0016]

I’m assuming this might be related, but I know North Carolina is now trying to enforce some sort of an anesthesiologist to be present for dental procedures under sedation (correct me if I’m wrong)

https://www.ncdentalboard.org/PDF/2021-12-07%20Notice%20of%20Text%20with%2016Q%20Rules.pdf

I would read that again. I don't think that what is states.

As someone who reviews these cases for AAOMS I can say that it needs to be point of emphasis in our profession as no death is acceptable. That being said....Silver Arrow--> nailed it.

My take based on my reviews: 90% of the time it is poor patient selection. 9% it is lack of training or comfort with emergencies and 1% it is just that persons time (sadly).

AAOMS is putting a large amount of effort in NC to help counter some of the falsehood being peddled around the news stations and editorial pages.

All this being said: I do believe that a midlevel provider is the future of OMS and will make offices more profitable. With the corporate takeover of OMS offices this is coming as it make financial sense. Listen to the Podcast " Everyday Oral Surgery" with Grant Stucki, he has an episode with a doctor out of Denver using an NP for consults and post-ops as he can do more surgeries and it adds to the bottom line. He states it added about 500K to the bottom line. This seems like a win-win for OMS. This is similar to what Orthopedic surgeons utilize now. Dentistry and Oral Surgery are usually about 10-15 years behind medicine. So I think I see this coming like a freight train.

 

[D1Bound]

I would read that again. I don't think that what is states.

As someone who reviews these cases for AAOMS I can say that it needs to be point of emphasis in our profession as no death is acceptable. That being said....Silver Arrow--> nailed it.

My take based on my reviews: 90% of the time it is poor patient selection. 9% it is lack of training or comfort with emergencies and 1% it is just that persons time (sadly).

AAOMS is putting a large amount of effort in NC to help counter some of the falsehood being peddled around the news stations and editorial pages.

All this being said: I do believe that a midlevel provider is the future of OMS and will make offices more profitable. With the corporate takeover of OMS offices this is coming as it make financial sense. Listen to the Podcast " Everyday Oral Surgery" with Grant Stucki, he has an episode with a doctor out of Denver using an NP for consults and post-ops as he can do more surgeries and it adds to the bottom line. He states it added about 500K to the bottom line. This seems like a win-win for OMS. This is similar to what Orthopedic surgeons utilize now. Dentistry and Oral Surgery are usually about 10-15 years behind medicine. So I think I see this coming like a freight train.

What type of midlevel would be involved with OMS? One for consulting?

 

[Beeftenderloin]

The safety record for outpatient anesthesia performed by oral and maxillofacial surgeons, using the team model, is unparalleled. We have been doing it since the discovery of general anesthesia.

Numbers and facts do not lie. I have posted on this before. The statistical anesthesia-related mortality risk for patients is higher in an operating room in the hospital than in an OMS clinic. Indeed, the cases in Arizona in which a CRNA had bad outcomes disabuses the theory that having a separate CRNA or MD is ipso facto safer.

This is a case of which we only know what is printed in the paper. It is sad, and I have sympathy for the patient and his family.

I may have said this before, but after I completed my training program, I stayed on Staff as a Consultant (Attending), and in two years performed 800 general anesthetics on young children, in addition to another 500 on teenagers and adults. The physician anesthesiologists and CRNAs would bring their children to us for oral surgery procedures in our clinic. They had trained us and knew what we did.

It would devastate medical and dental care in the US if our ability to provide this service was taken away because of high profile, anecdotal cases, combined with politics.

Just last week, I had two odontogenic space infection patients that I could not admit because the hospital census was full. They were put to sleep by me and my trained staff, and they had straightforward surgical drainages and odontectomies. One patient was a 78-year-old ASA Class III-E patient. Both tolerated their procedures and anesthesia well.

This is an absolutely absurd statement to make. Of course mortality is higher in the main OR. You’re literally taking a population comprised predominantly of ASA1/2 patients (I’m sure plenty of soft 3s) getting exclusively minor outpatient procedures done and you’re comparing them to a cohort that also includes Type A aortic dissections, ruptured intracranial aneurysms and moribund penetrating trauma patients. OF COURSE patients are more likely to die in the hospital. Thank you for your consultant level analysis of the data on that one. The problem is the number of people that should die at the dentist office from anything other than an acute plaque rupture should be zero and it’s not. And no, not that type of plaque…

 

[Beeftenderloin]

I would read that again. I don't think that what is states.

As someone who reviews these cases for AAOMS I can say that it needs to be point of emphasis in our profession as no death is acceptable. That being said....Silver Arrow--> nailed it.

My take based on my reviews: 90% of the time it is poor patient selection. 9% it is lack of training or comfort with emergencies and 1% it is just that persons time (sadly).

AAOMS is putting a large amount of effort in NC to help counter some of the falsehood being peddled around the news stations and editorial pages.

All this being said: I do believe that a midlevel provider is the future of OMS and will make offices more profitable. With the corporate takeover of OMS offices this is coming as it make financial sense. Listen to the Podcast " Everyday Oral Surgery" with Grant Stucki, he has an episode with a doctor out of Denver using an NP for consults and post-ops as he can do more surgeries and it adds to the bottom line. He states it added about 500K to the bottom line. This seems like a win-win for OMS. This is similar to what Orthopedic surgeons utilize now. Dentistry and Oral Surgery are usually about 10-15 years behind medicine. So I think I see this coming like a freight train.

That 1% who you say “it’s just that person’s time” as they sat down in the dentists chair (shudder), I can promise you, they were not appropriately selected. Appropriately measuring the risk benefit of an anesthetic for a given procedure on a given patient is a skill that should be taught/learned in training. So when you really get down to it, it’s just lack of training.

 

[Hockeytalk]

I can promise you, they were not appropriately selected. Appropriately measuring the risk benefit of an anesthetic for a given procedure on a given patient is a skill that should be taught/learned in training. So when you really get down to it, it’s just lack of training.

Roswell High School football quarterback Robbie Roper dies after surgery

REST IN PEACE: Robbie Roper, the quarterback for Roswell High School, has died after complications from surgery, his family has confirmed. He was 18 years old.

www.fox5atlanta.com

College baseball pitcher Sang Ho Baek dies from complications following Tommy John elbow surgery

The 20-year-old Patriots pitcher passed away unexpectedly after undergoing the procedure common for young baseball players.

www.usatoday.com

https://www.washingtonpost.com/sports/2019/08/15/high-school-football-star-made-his-college-choice-next-day-he-died-during-acl-surgery/

Anesthesiologist, 2 others reach $5.5M settlement over death of well-known principal, veteran - Becker’s ASC

A high-profile medical malpractice lawsuit against an anesthesiologist, Hackensack (N.J.) Anesthesiology Associates and the John Theurer Cancer Center in Hackensack was settled for $5.5 million, TAP into Westfield reported on Nov. 11.

www.beckersasc.com

Former Anesthesiologist Pleads Guilty in Death of Fellow Doctor

A former anesthesiologist pleaded guilty on Friday to involuntary manslaughter in the death of a fellow doctor who was undergoing an outpatient surgery in Beverly Hills — admitting that he injected himself before the operation with Demerol stolen from the surgical center and then left the...

www.nbclosangeles.com

Outrage over San Diego surgeon, nurse who can keep practicing despite being charged in patient's death

Outraged family members are speaking out about a local plastic surgeon and nurse who have been charged with involuntary manslaughter but can keep practicing without notifying their patients, for the time being.

www.10news.com

Melissa Rivers Settles Medical Malpractice Lawsuit Over Joan Rivers’ Death

"Moving forward, my focus will be to ensure that no one ever has to go through what my mother, Cooper and I went through," the 'Fashion Police' executive producer and co-host said in a statement.

www.hollywoodreporter.com

Anesthesiologist investigated over woman who died during childbirth

Dr Dmitry Shelchkov, 60, has had his license suspended pending an investigation by New York state health officials into the July 2020 death of Sha-Asia Washington, 26, during childbirth.

www.dailymail.co.uk

$2M plus settlement in cosmetic surgery death

The doctor and nurse involved in a breast augmentation surgery causing the death of a 19-year-old woman have been ordered to pay $2 million to the family in a wrongful death lawsuit settlement.

kdvr.com

Chesco Jury Awards $20M Following Death of Spinal Surgery Patient | The Legal Intelligencer

The jury deliberated less than 90 minutes before returning the verdict against the Laser Spine Institute and Dr. Glenn Rubenstein.

www.law.com

Trumbull surgical center settles death case

BRIDGEPORT - A Trumbull surgical center has agreed to pay a settlement to the family of a...

www.ctpost.com

 

[Robotic Wis-Hipple]

Full disclosure from the start, I’m an anesthesiologist. There’s been “discussion” over in our forum but I’m interested in attending/practicing dentist/OMFS level discourse so I’m here to make some statements/ask some questions:

Right off the bat, you’re never going to convince an Anesthesiologist that the 6mo of anesthesia training you guys do in residency is adequate to perform solo deep sedation or general anesthesia. For context this would be like us doing 1/2 of our first year of training after our medical/surgical internship, or 1/6th of our actual anesthesia residency training. As a CA1 (our 1st year of anesthesia training) literally nobody would let us perform an anesthetic without close supervision by a boarded anesthesiologist. There’s no moonlighting in surgicenters/endo suites because it’s “just sedation”.

If I quit anesthesia residency after 6mo there is not a state medical board or hospital that would credential me, I could not be anesthesia boarded. I couldn’t run work in a sports ortho surgicenter doing sedations or LMA generals on healthy ASA 1 athletes. Ask yourself why this is?

So then, admittedly highly trained specialists in dentistry and oral surgery are allowed to do just that. Perform solo anesthesia. You may call it sedation, but you and I both know many if not most of these are likely deep sedation with periods of general anesthesia. But it’s not just that you’re performing anesthesia solo. You’re doing the procedure as well. Can you honestly say you believe this is best? Some of your trainees over in our forum stated that not only is it ok or safe but they believe they deliver a better and safer anesthetic to their patients while actually operating concomitantly than any anesthesiologist could do. Now even despite mine and your clear biases this is certifiably nonsense.

As an aside, ask any anesthesiologist where they feel is most prone to errors, or potential badness and they will say offsite locations (Endosuites, IR, MRI, cath lab, etc). Why? Because the staff is less familiar with general anesthesia, associated possible issues, emergency equipment, where it’s stored, if it’s been restocked, etc. Events are quite rare obviously, but in a way this makes things worse. Staff can’t remember the last time they needed to break the ambubag/BVM out of its bag over on the wall. Oh, did you notice the hospital changed suppliers and the ambubag bag doesn’t come with a PEEP valve anymore? Who cares, why would you need that? Will the endosuite nurse know where to run find one quickly? And that’s in hospitals, with us around en masse.

The argument that patients also have bad outcomes with anesthesiologists or CRNAs so it therefore follows that anyone with a bare minimum of training should be allowed to do it is silly. Why are surgical PAs not doing appys and gallbladders? Rad techs not giving the official CT read or maybe just the chest X-ray? Why is there even an OMFS specialty if regular ol’ dentists can pull teeth? All of these are pure nonsense and the level of cognitive dissonance involved to convince yourself otherwise is quite astounding.

Even if we assumed that your 6mo equaled our 3+ years, or your patient cohort is less sick, less obese, younger, etc than ours, or that the difference in morbidity/mortality between us was within a standard error you still are doing too much. You’re the surgeon AND us(anesthesia) in your own little offsite. We all know why this occurs. Your boards are different from ours. You aren’t held to our standard of care or the medical board. Your governing body says this is fine. Most of you (hopefully) will never kill a patient. Your training pathway evolved to include 6mo of anesthesia training which again, your board says is adequate.

But here’s the question; let’s say your training could be reduced 6mo, you were no longer required to do 6mo of anesthesia…. would you like that? If an anesthesia trained “provider” was then present. Does that sound good? If not, I ask again, why is that?

 

[Gustavo dos Santos]

Right off the bat, you’re never going to convince an Anesthesiologist that the 6mo of anesthesia training you guys do in residency is adequate to perform solo deep sedation or general anesthesia. For context this would be like us doing 1/2 of our first year of training after our medical/surgical internship, or 1/6th of our actual anesthesia residency training. As a CA1 (our 1st year of anesthesia training) literally nobody would let us perform an anesthetic without close supervision by a boarded anesthesiologist. There’s no moonlighting in surgicenters/endo suites because it’s “just sedation”.

If I quit anesthesia residency after 6mo there is not a state medical board or hospital that would credential me, I could not be anesthesia boarded. I couldn’t run work in a sports ortho surgicenter doing sedations or LMA generals on healthy ASA 1 athletes. Ask yourself why this is?

To clarify on the above point, I’m assuming that you are aware that OMFS resident training in anesthesia isn’t only 6 months on service and then they never touch it again until they are in their own clinic/private practice. That they continue providing sedation/ga almost daily for the remaining 3 years of their residency. It’s not entirely clear from your post though.

If you were not aware, below is some write up from 10+ years ago of someone addressing this point.

We are by no means fully trained as Anesthesiologists, but our training is the most extensive and comprehensive of any medical specialty after Anesthesiologists and CRNAs.

OMFS residents are required to spend a minimum of 4 months as rotating residents in the department of Anesthesiology. They spend this time at the PGY 1 or PGY 2 level. But that is not the end of the anesthesia training that OMFS residents get... They spend about 3 more years providing IV Sedation and General Anesthesia on an almost daily basis in the OMFS clinic. In addition, the OMFS residents are BLS/CPR, ACLS and ATLS trained/certified..and also usually re-certify prior to completing the residency. (Our other off service rotations only reinforce our medical training... Internal Medicine 2 months, ER 1 month, Trauma Surgery 2 months, General Surgery 2 months, ENT 1 month, ICU 1 month).

At my program we spend a total of 5 months on the Anesthesia Service. We also spend a month strictly providing pediatric anesthesia. Then for the remainder of our residency while we are on the OMFS service (3 years) we provide IV and GA anesthesia 2-4 times per week on 4-6 patients per day. We receive formal anesthesia lectures 2 times per month. In fact one of our attendings holds appointments to both the OMFS and Anesthesia Departments. At our institution we also have the option to do a 1 year Anesthesia fellowship in the department of anesthesiology after completion of our residency.

In our program, we get Anesthesia trained for 4 months in the first year or residency in order to maximize our anesthesia experience over the remainder of our residency. By the 2nd or 3rd week we are expected to run our own rooms... In our 3rd year we return to the Anesthesia service for additional pediatric training (Although I would say that probably 90% of the private OMFS won't sedate peds in their office).

I can tell you that our program prepares us to provide safe and effective GA and IV Sedation for ASA I/II and some III's... We can manage the airway pretty effectively, and are prepared for cricothyroidotomy or tracheostomy (since we are the primary trach service in the hospital).

Our intubation training continues outside of the OR and is reinforced in our clinic where we continue to provide Oral and Nasal intubations, including blind awake nasal intubation, fiberoptic intubation, retrograde intubation. Oh yah, we all get comfortable with submental intubation as well... sparing people uncessary tracheostomies...

Also consider the nature of the majority of the surgical procedures we provide in our clinics/private offices... fast procedures where we are intimately involved with and close to airway... therefore better able to monitor the airway.

Finally, we are tested in Anesthesia, Medicine, and Medical Emergencies as part of our Written and Oral Boards...

wow, that was a longer response than I anticipated... hope this helps.

 

[Robotic Wis-Hipple]

To clarify on the above point, I’m assuming that you are aware that OMFS resident training in anesthesia isn’t only 6 months on service and then they never touch it again until they are in their own clinic/private practice. That they continue providing sedation/ga almost daily for the remaining 3 years of their residency. It’s not entirely clear from your post though.

If you were not aware, below is some write up from 10+ years ago of someone addressing this point.

This is a good and fair point. So once you’ve done anesthesia months aside an anesthesia department you go provide anesthesia to your operative patients 2 days a week on average.

I would still ask how that works. Are you as a trainee just doing the sedation while the attending OMFS surgeon and a resident perform the surgery? Or are you simultaneously training on the surgery and the sedation? Do you see our questions? We don’t believe you can do both well. If you’re learning how to perform the surgery you clearly aren’t going to be as focused on the sedation technique, or vitals etc. If you’re the dedicated sedation provider is anyone watching you aside from the acting surgeon?

I’ll give you that it’s clear you do more than just 6 months and then never give sedation/general anesthesia again until you’re in practice. I’m just not convinced the training is as effective as you guys believe.

But good rebuttal. 👍🏻

 

[OMSDoc]

This is an absolutely absurd statement to make. Of course mortality is higher in the main OR. You’re literally taking a population comprised predominantly of ASA1/2 patients (I’m sure plenty of soft 3s) getting exclusively minor outpatient procedures done and you’re comparing them to a cohort that also includes Type A aortic dissections, ruptured intracranial aneurysms and moribund penetrating trauma patients. OF COURSE patients are more likely to die in the hospital. Thank you for your consultant level analysis of the data on that one. The problem is the number of people that should die at the dentist office from anything other than an acute plaque rupture should be zero and it’s not. And no, not that type of plaque…

Who knew that Beeftenderloin is Latin for vituperative?

OMSDoc is Latin for Type A, detail-oriented, obsessive-compulsive, Board-certified (twice renewed) oral and maxillofacial surgeon.

In the first week of July 1989, I performed endotracheal general anesthetics for the following: thyroidectomy x 2, thoracotomy for removal of a large anterior mediastinal mass, hernia repair x 2, mastectomy, kidney transplant, and the removal of a pheochromocytoma .

What were you doing in July 1989?

If you read my previous posts on anesthesia morbidity and mortality in the oral and maxillofacial surgery office compared to the operating room with MDA's and CRNA's (with references), you will see that the literature is clear on the better statistics in our clinics with healthy ASA Class I patients.

Although, I will grant you, I have never put anyone to sleep who had an active, ruptured intracranial aneurysm to place an dental implant.

Uffda.

 

[ShortShortsDad]

Full disclosure from the start, I’m an anesthesiologist. There’s been “discussion” over in our forum but I’m interested in attending/practicing dentist/OMFS level discourse so I’m here to make some statements/ask some questions:

Right off the bat, you’re never going to convince an Anesthesiologist that the 6mo of anesthesia training you guys do in residency is adequate to perform solo deep sedation or general anesthesia. For context this would be like us doing 1/2 of our first year of training after our medical/surgical internship, or 1/6th of our actual anesthesia residency training. As a CA1 (our 1st year of anesthesia training) literally nobody would let us perform an anesthetic without close supervision by a boarded anesthesiologist. There’s no moonlighting in surgicenters/endo suites because it’s “just sedation”.

If I quit anesthesia residency after 6mo there is not a state medical board or hospital that would credential me, I could not be anesthesia boarded. I couldn’t run work in a sports ortho surgicenter doing sedations or LMA generals on healthy ASA 1 athletes. Ask yourself why this is?

So then, admittedly highly trained specialists in dentistry and oral surgery are allowed to do just that. Perform solo anesthesia. You may call it sedation, but you and I both know many if not most of these are likely deep sedation with periods of general anesthesia. But it’s not just that you’re performing anesthesia solo. You’re doing the procedure as well. Can you honestly say you believe this is best? Some of your trainees over in our forum stated that not only is it ok or safe but they believe they deliver a better and safer anesthetic to their patients while actually operating concomitantly than any anesthesiologist could do. Now even despite mine and your clear biases this is certifiably nonsense.

As an aside, ask any anesthesiologist where they feel is most prone to errors, or potential badness and they will say offsite locations (Endosuites, IR, MRI, cath lab, etc). Why? Because the staff is less familiar with general anesthesia, associated possible issues, emergency equipment, where it’s stored, if it’s been restocked, etc. Events are quite rare obviously, but in a way this makes things worse. Staff can’t remember the last time they needed to break the ambubag/BVM out of its bag over on the wall. Oh, did you notice the hospital changed suppliers and the ambubag bag doesn’t come with a PEEP valve anymore? Who cares, why would you need that? Will the endosuite nurse know where to run find one quickly? And that’s in hospitals, with us around en masse.

The argument that patients also have bad outcomes with anesthesiologists or CRNAs so it therefore follows that anyone with a bare minimum of training should be allowed to do it is silly. Why are surgical PAs not doing appys and gallbladders? Rad techs not giving the official CT read or maybe just the chest X-ray? Why is there even an OMFS specialty if regular ol’ dentists can pull teeth? All of these are pure nonsense and the level of cognitive dissonance involved to convince yourself otherwise is quite astounding.

Even if we assumed that your 6mo equaled our 3+ years, or your patient cohort is less sick, less obese, younger, etc than ours, or that the difference in morbidity/mortality between us was within a standard error you still are doing too much. You’re the surgeon AND us(anesthesia) in your own little offsite. We all know why this occurs. Your boards are different from ours. You aren’t held to our standard of care or the medical board. Your governing body says this is fine. Most of you (hopefully) will never kill a patient. Your training pathway evolved to include 6mo of anesthesia training which again, your board says is adequate.

But here’s the question; let’s say your training could be reduced 6mo, you were no longer required to do 6mo of anesthesia…. would you like that? If an anesthesia trained “provider” was then present. Does that sound good? If not, I ask again, why is that?

Why are you here on your soapbox? You clearly have your mind made up on this issue and like everyone spiraling out of control in that anesthesia forum have no interest in our documented history of safe practice.

As to what someone other than my colleagues think of my competency providing surgery and anesthesia to my patients I couldn’t give a **** about your uninformed opinion. Don’t get me wrong, we care very deeply about our patient outcomes, just not at all about what your opinion is.

As much as you dislike it, this practice model is the standard of care and it has been this way for decades. Our goal is zero adverse outcomes and while thats statistically impossible we are continually working to minimize complications - just this year we have instituted a more realistic airway training program. The “solution” of all cases being done in a hospital by an anesthesiologist is laughably unrealistic.

I would have assumed that anesthesia forum dumpster fire may have singled to you there was very little point to beating your drum over here - feel free to see yourself out, I imagine that rabid OMS resident has hours a day free to hate-text while he sits on his phone during his anesthesia rotation

 

[deleted1047421]

Roswell High School football quarterback Robbie Roper dies after surgery

REST IN PEACE: Robbie Roper, the quarterback for Roswell High School, has died after complications from surgery, his family has confirmed. He was 18 years old.

www.fox5atlanta.com

College baseball pitcher Sang Ho Baek dies from complications following Tommy John elbow surgery

The 20-year-old Patriots pitcher passed away unexpectedly after undergoing the procedure common for young baseball players.

www.usatoday.com

https://www.washingtonpost.com/sports/2019/08/15/high-school-football-star-made-his-college-choice-next-day-he-died-during-acl-surgery/

Anesthesiologist, 2 others reach $5.5M settlement over death of well-known principal, veteran - Becker’s ASC

A high-profile medical malpractice lawsuit against an anesthesiologist, Hackensack (N.J.) Anesthesiology Associates and the John Theurer Cancer Center in Hackensack was settled for $5.5 million, TAP into Westfield reported on Nov. 11.

www.beckersasc.com

Former Anesthesiologist Pleads Guilty in Death of Fellow Doctor

A former anesthesiologist pleaded guilty on Friday to involuntary manslaughter in the death of a fellow doctor who was undergoing an outpatient surgery in Beverly Hills — admitting that he injected himself before the operation with Demerol stolen from the surgical center and then left the...

www.nbclosangeles.com

Outrage over San Diego surgeon, nurse who can keep practicing despite being charged in patient's death

Outraged family members are speaking out about a local plastic surgeon and nurse who have been charged with involuntary manslaughter but can keep practicing without notifying their patients, for the time being.

www.10news.com

Melissa Rivers Settles Medical Malpractice Lawsuit Over Joan Rivers’ Death

"Moving forward, my focus will be to ensure that no one ever has to go through what my mother, Cooper and I went through," the 'Fashion Police' executive producer and co-host said in a statement.

www.hollywoodreporter.com

Anesthesiologist investigated over woman who died during childbirth

Dr Dmitry Shelchkov, 60, has had his license suspended pending an investigation by New York state health officials into the July 2020 death of Sha-Asia Washington, 26, during childbirth.

www.dailymail.co.uk

$2M plus settlement in cosmetic surgery death

The doctor and nurse involved in a breast augmentation surgery causing the death of a 19-year-old woman have been ordered to pay $2 million to the family in a wrongful death lawsuit settlement.

kdvr.com

Chesco Jury Awards $20M Following Death of Spinal Surgery Patient | The Legal Intelligencer

The jury deliberated less than 90 minutes before returning the verdict against the Laser Spine Institute and Dr. Glenn Rubenstein.

www.law.com

Trumbull surgical center settles death case

BRIDGEPORT - A Trumbull surgical center has agreed to pay a settlement to the family of a...

www.ctpost.com

I guess we send a strike team to take out the patients family too so they won't talk. Im being sarcastic.. in case you dentists don't get it.

Here is another one that I remember over the years. Our past president of AAOMS Jay Malmquist, oral surgeon, hired an MD anesthesiologist in his office. His anesthesiologist sexually assaulted his patients and was put in prison. Needless to say it was a huge unnecessary headache for Malmquist and not to mention the damages done to the patients at the hands of this anesthesiologist.

Woman, molested under sedation, files lawsuit

PORTLAND — A Portland woman molested by an anesthesiologist during surgery filed a multimillion-dollar lawsuit Thursday, claiming his employer and her dentist knew of the anesthesiologist’s history of molestation.

theworldlink.com

To all my dental colleagues beware of which anesthesiologist you hire as you don’t know if they are going to molest your patients. Especially the young female type.

Coffeebythelake - I’m being sarcastic in case you didn’t get it.

Unfortunately this is exactly what you sound like.
If anyone is going to engage in any discussion with you they better put their knee high boots on because they will be crawling though ——

 

[Robotic Wis-Hipple]

Why are you here on your soapbox? You clearly have your mind made up on this issue and like everyone spiraling out of control in that anesthesia forum have no interest in our documented history of safe practice.

As to what someone other than my colleagues think of my competency providing surgery and anesthesia to my patients I couldn’t give a **** about your uninformed opinion. Don’t get me wrong, we care very deeply about our patient outcomes, just not at all about what your opinion is.

As much as you dislike it, this practice model is the standard of care and it has been this way for decades. Our goal is zero adverse outcomes and while thats statistically impossible we are continually working to minimize complications - just this year we have instituted a more realistic airway training program. The “solution” of all cases being done in a hospital by an anesthesiologist is laughably unrealistic.

I would have assumed that anesthesia forum dumpster fire may have singled to you there was very little point to beating your drum over here - feel free to see yourself out, I imagine that rabid OMS resident has hours a day free to hate-text while he sits on his phone during his anesthesia rotation

Why are you here on your soapbox? You clearly have your mind made up on this issue and like everyone spiraling out of control in that anesthesia forum have no interest in our documented history of safe practice.

As to what someone other than my colleagues think of my competency providing surgery and anesthesia to my patients I couldn’t give a **** about your uninformed opinion. Don’t get me wrong, we care very deeply about our patient outcomes, just not at all about what your opinion is.

As much as you dislike it, this practice model is the standard of care and it has been this way for decades. Our goal is zero adverse outcomes and while thats statistically impossible we are continually working to minimize complications - just this year we have instituted a more realistic airway training program. The “solution” of all cases being done in a hospital by an anesthesiologist is laughably unrealistic.

I would have assumed that anesthesia forum dumpster fire may have singled to you there was very little point to beating your drum over here - feel free to see yourself out, I imagine that rabid OMS resident has hours a day free to hate-text while he sits on his phone during his anesthesia rotation

Sure, soapbox it was, though yours isn’t any less so. And trust me, we all understand there aren’t enough of us to provide anesthesia for every procedure in the country, I sure as hell would rather never go to any offsite let alone a clinic somewhere.

But that’s not the point, not really. I’m not trying to drum up more business for anesthesia. I’m not trying to say or advocate for every anesthetic to be delivered in a hospital. I agree, it’s completely unrealistic.

What I continue to say is that I’m not sure your “proven track record of safety” is as bulletproof as you want it to be. But that’s also fine, if you guys are fine with 1% or even 0.1% negative or suboptimal outcomes, fine. It’s your game, it’s your boards that monitor these things. And if all parties are fine with it, well, the people have spoken.

But I really can’t believe you all actually believe it’s the best possible way to do things. With split focuses. On surgery and anesthesia.

I just came to give my 0.02, and clearly you are not a buyer. This is fine. It’s no skin off my back, I’m perfectly content knowing the training I have and the care I deliver without the desire to be both interventionalist and anesthetist.

Though I do think the juvenile “having hours a day to be on the phone during anesthesia” jab is interesting. It shows your lackadaisical approach or lack of respect for the act of/period of anesthesia. It implies you believe it’s easy, and nothing could ever happen. It’s grossly underestimating it’s importance and also giving away your feelings on the time your own residents spend on our service. Even if I was on my phone all day, I could be more distracted, you know, by operating.

 

[Beeftenderloin]

Who knew that Beeftenderloin is Latin for vituperative?

OMSDoc is Latin for Type A, detail-oriented, obsessive-compulsive, Board-certified (twice renewed) oral and maxillofacial surgeon.

In the first week of July 1989, I performed endotracheal general anesthetics for the following: thyroidectomy x 2, thoracotomy for removal of a large anterior mediastinal mass, hernia repair x 2, mastectomy, kidney transplant, and the removal of a pheochromocytoma .

What were you doing in July 1989?

If you read my previous posts on anesthesia morbidity and mortality in the oral and maxillofacial surgery office compared to the operating room with MDA's and CRNA's (with references), you will see that the literature is clear on the better statistics in our clinics with healthy ASA Class I patients.

Although, I will grant you, I have never put anyone to sleep who had an active, ruptured intracranial aneurysm to place an dental implant.

Uffda.

Scribble that down in in your diary 30 years ago? “Did my first thoracic case today! Also managed to bag an incisor while placing the DLT, that counts as an extraction under sedation, right?”

Who are you trying to convince of your qualifications? It certainly isn’t me. The fact that you even feel the need to try should tell you all you need to know.

I have nothing against any of you, I’m certainly not coming for your jobs (I have no interest whatsoever in performing office based anesthetics). I literally just want dentists to stop killing people. As long as the person administering the anesthetic and monitoring the patient is the same person thats performing the procedure, you will always be viewed as grossly under qualified to do both these jobs simultaneously.


Edit: If any of you dental/OMFS folks have any recommendations with all your experience and superior safety profile how I can make my hospital based anesthesia practice safer, I’m all ears. Would hate for this to be a one way street.

 

[Hockeytalk]

Sure, soapbox it was, though yours isn’t any less so. And trust me, we all understand there aren’t enough of us to provide anesthesia for every procedure in the country, I sure as hell would rather never go to any offsite let alone a clinic somewhere.

But that’s not the point, not really. I’m not trying to drum up more business for anesthesia. I’m not trying to say or advocate for every anesthetic to be delivered in a hospital. I agree, it’s completely unrealistic.

What I continue to say is that I’m not sure your “proven track record of safety” is as bulletproof as you want it to be. But that’s also fine, if you guys are fine with 1% or even 0.1% negative or suboptimal outcomes, fine. It’s your game, it’s your boards that monitor these things. And if all parties are fine with it, well, the people have spoken.

But I really can’t believe you all actually believe it’s the best possible way to do things. With split focuses. On surgery and anesthesia.

I just came to give my 0.02, and clearly you are not a buyer. This is fine. It’s no skin off my back, I’m perfectly content knowing the training I have and the care I deliver without the desire to be both interventionalist and anesthetist.

Though I do think the juvenile “having hours a day to be on the phone during anesthesia” jab is interesting. It shows your lackadaisical approach or lack of respect for the act of/period of anesthesia. It implies you believe it’s easy, and nothing could ever happen. It’s grossly underestimating it’s importance and also giving away your feelings on the time your own residents spend on our service. Even if I was on my phone all day, I could be more distracted, you know, by operating.

When an omfs does a sedation the surgery is in the oral cavity. There are 4 hands ready to go with suction in their mouth already. There is another person at the head. Taking out wisdom teeth is a short, predictable procedure that I am doing in the mouth with a bite block in place.
IF I was on my phone, it would be more novel, stimulating and distracting then taking out teeth.

When I see MAC being done in the OR. I see a lone crna charting with their back to the patient and monitors. I see them drawing up meds for the next patient. I see them on their phone. I am the one giving a jaw thrust sometimes. Sometimes they are thankful. Other times they say dont worry about desaturation, get passive aggressive and turn the monitors away so I can no longer see them.

 

[DocVapor]

When an omfs does a sedation the surgery is in the oral cavity. There are 4 hands ready to go with suction in their mouth already. There is another person at the head. Taking out wisdom teeth is a short, predictable procedure that I am doing in the mouth with a bite block in place.
IF I was on my phone, it would be more novel, stimulating and distracting then taking out teeth.

When I see MAC being done in the OR. I see a lone crna charting with their back to the patient and monitors. I see them drawing up meds for the next patient. I see them on their phone. I am the one giving a jaw thrust sometimes. Sometimes they are thankful. Other times they say dont worry about desaturation, get passive aggressive and turn the monitors away so I can no longer see them.

I just want to say that I'm sorry that's your OR experience. It is far below standard of care for a CRNA to be doing that. CRNA's at my place can and have been fired over such behavior. As an Anesthesiologist, I consider procedures where the airway is shared to be in the top 3 most dangerous anesthetics I perform despite the long track record of safety. Working in a collegial and respectful manner with the proceduralist/surgeon/dentist/OMFS/whoever (while expecting the same in return) and providing the patient my undivided attention is only the bare minimum necessary for the safety of the patient.

 

[Hockeytalk]

I just want to say that I'm sorry that's your OR experience. It is far below standard of care for a CRNA to be doing that. CRNA's at my place can and have been fired over such behavior. As an Anesthesiologist, I consider procedures where the airway is shared to be in the top 3 most dangerous anesthetics I perform despite the long track record of safety. Working in a collegial and respectful manner with the proceduralist/surgeon/dentist/OMFS/whoever (while expecting the same in return) and providing the patient my undivided attention is only the bare minimum necessary for the safety of the patient.

Agreed. I hated doing it as a resident.

I can argue charting and preparing for the next case no matter if there is a secured airway is a distraction.
What pressures are there to churn through a room full of 8 MACs at a surgicenter, a GI, peds ENT, peds ophtho room?
Sometimes the anesthesiologist is nice and charts for the crna because they get it. Most of the time they dont. I see this at multiple different institutions and settings of care. My impression is this happens everywhere around the country.

 

[DocVapor]

Agreed. I hated doing it as a resident.

I can argue charting and preparing for the next case no matter if there is a secured airway is a distraction.
What pressures are there to churn through a room full of 8 MACs at a surgicenter, a GI, peds ENT, peds ophtho room?
Sometimes the anesthesiologist is nice and charts for the crna because they get it. Most of the time they dont. I see this at multiple different institutions and settings of care. My impression is this happens everywhere around the country.

Generally, all of the same pressures put on you guys to churn get passed on to us. Sometimes they get magnified. Like everything else in healthcare, it's a highly complex issue with lots of emotional charge and frankly unrealistic expectations from insurers, the government, and laypeople. As much huffing and puffing that goes on on the world wide web, I hope that the vast majority of individuals in healthcare deep down know that nothing we do is completely safe and guaranteed to have a good outcome. At best, news articles like the one in the OP are a reminder of that despite the lack of detail which inevitably leads to finger-pointing and false conclusions. We should use them to have honest, open discussions about finding the proper balance of risk mitigation, and then how to properly inform the public so that they can have accurate information to guide their healthcare decisions.

As far as CRNAs go, that's a whole truckload of cans of worms. I'll say that I try to help my CRNAs when I can, but when I'm supervising, it's multiple rooms so I physically cannot stay and help much of the time after induction. However, I have trusted CRNAs that do call me when anything even starts smelling fishy. New CRNAs learn quickly that I have a habit of popping in rooms at times which seem random to them so they learn they can't get comfortable doing something they're not supposed to. I think that having to chart actually helps keep focus on the patient (as long as they aren't pre-charting for the next patient), and in optimized procedure rooms with proper patient selection, the turnover/setup flow well enough that prepping for the next case while one is happening is not necessary.

 

[ShortShortsDad]

Generally, all of the same pressures put on you guys to churn get passed on to us. Sometimes they get magnified. Like everything else in healthcare, it's a highly complex issue with lots of emotional charge and frankly unrealistic expectations from insurers, the government, and laypeople. As much huffing and puffing that goes on on the world wide web, I hope that the vast majority of individuals in healthcare deep down know that nothing we do is completely safe and guaranteed to have a good outcome. At best, news articles like the one in the OP are a reminder of that despite the lack of detail which inevitably leads to finger-pointing and false conclusions. We should use them to have honest, open discussions about finding the proper balance of risk mitigation, and then how to properly inform the public so that they can have accurate information to guide their healthcare decisions.

As far as CRNAs go, that's a whole truckload of cans of worms. I'll say that I try to help my CRNAs when I can, but when I'm supervising, it's multiple rooms so I physically cannot stay and help much of the time after induction. However, I have trusted CRNAs that do call me when anything even starts smelling fishy. New CRNAs learn quickly that I have a habit of popping in rooms at times which seem random to them so they learn they can't get comfortable doing something they're not supposed to. I think that having to chart actually helps keep focus on the patient (as long as they aren't pre-charting for the next patient), and in optimized procedure rooms with proper patient selection, the turnover/setup flow well enough that prepping for the next case while one is happening is not necessary.

That’s a very level headed and civil response, thank you for that. It’s unfortunate how charged this issue gets and I’m more guilty than most. It’s not nice to be painted as a butcher literally slaughtering patients for cash as that’s just not our reality. I completely agree about nothing being 100% safe, to achieve that I’d have to retire and switch to a non medical career. I believe my colleagues and I have our patients best interests at heart and try to inform them of their options. I can honestly say I have never pushed someone to get sedated, they either ask or demand. My military patients are healthy 99% of the time but in private practice I have people pissed at me on a daily basis for refusing to put them to sleep due to health or airway concerns. That doesn’t excuse any of what happened with the case OP posted about but I hope after the anger abates people really don’t feel we are pushing people to gamble with their lives to line our pockets.

 

[Big Time Hoosier]

I will grant you, I have never put anyone to sleep who had an active, ruptured intracranial aneurysm to place an dental implant.

But could you?

Big Hoss