Trauma Surgeon named in law suit. What are your thoughts?

[Bluemirage]

Hi everyone,

I wanted to share something that I had found in the news to see what y'all think. Trauma surgeon Dr. David Parkus is currently being sued for medical battery for following a police search warrant to remove a non-life threatening bullet lodged in the plaintiff's skull (the bullet was a piece of evidence linked to a shooting). However, the patient did not give consent and is now filing this law suit.

Here's the link to the news report:
http://www.setexasrecord.com/news/213811-teen-with-bullet-in-head-sues-surgeon-that-tried-to-remove-it

Interestingly enough this was not the first time Dr. Parkus has been involved in the media. He assisted in restraining a gunman that opened fire at LAX back in 2002.
Link:
http://http://query.nytimes.com/gst/fullpage.html?res=9501E5DA1031F936A35754C0A9649C8B63

I just happened to learn more about him when I was watching my dose of "Trauma: Life in the ER" during my breakfast. He was a trauma surgeon at Vanderbilt who was one of the main characters of the episode.

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[dpmd]

This is a tough one. On the one hand I can't imagine doing anything to a patient who is voicing objections. On the other hand, if the cops came with a warrant and told me to do it I might believe I had to. I don't think the warrant should have ever been issued without specifically addressing the issue of consent and liability for the performing physician. I guess the precedent for doing medical procedures against the will of the suspect is set with legal blood draws for suspected DUI. Anyone know more about this?

 

[BlondeDocteur]

It is interesting. What's the difference between the forced extraction of a bullet and a cavity search? Both invade the body and are ordered by search warrants, and there's certainly no concept of consent in the latter.

Hopefully the case will be used to set legal precedent on that question, as well as the duty of an MD to obey the directives of law enforcement and the legal system, rather than actually award the scumbag plaintiff anything.

 

[San_Juan_Sun]

Bottom line: you never, ever do a procedure without the appropriate consent process taking place.

If the authorities have a warrant for the bullet, let THEM take it out.

 

[filter07]

The care of the patient is a physician's first priority. Police warrants and such are always secondary to the care of the patient. I believe the surgeon acted in error. That being said, I don't think the plaintiff will get very far with the suit.

 

[goldenwest]

In an era of defensive medicine, I understand why most people here would insist on patient consent (as did UTMB).

However, there was a valid court order authorizing its removal. The bullet was (at least at the time) considered crucial to make the case against a violent felon. The surgeon acted in the public good by attempting to remove it.

I salute him for having the balls to face down the lawsuit he knew was coming, in the interests of doing what is right.

I'd like to think that I will have the courage to do the same under similar circumstances.

Yes, but you could say the same of a police officer that breaks into a known drug dealers home without a warrant. Acting for the public good doesn't do much good if it isn't done lawfully. What good is the right thing if the villain gets away? Not that he'd get away in this particular instance, but my point is that it's important to always play by the rules.

 

[SOUNDMAN]

Yes, but you could say the same of a police officer that breaks into a known drug dealers home without a warrant. Acting for the public good doesn't do much good if it isn't done lawfully. What good is the right thing if the villain gets away? Not that he'd get away in this particular instance, but my point is that it's important to always play by the rules.

Umm he had a warrant so he was following what the law/judge was requiring. Your analogy isn't really the same.

 

[San_Juan_Sun]

Umm he had a warrant so he was following what the law/judge was requiring. Your analogy isn't really the same.

Really? What law requires the doc to remove the bullet? Cause I know which ones require a doc to get consent.

And I don't think the guy should be praised for facing down a lawsuit he knew was coming. You could just as easily say he was gutless caving to authorities asking him to perform an illegal procedure.

 

[San_Juan_Sun]

The procedure wasn't illegal. If it were, he would have been charged criminally.

Specious logic. I'm no lawyer, but I would think that charging the doc criminally would make it very, very easy for the bad guy's legal counsel to get the bullet forensics thrown out of court. Not every act in violation of the law is prosecuted.

In fact, it was the opposite of legal; it was explicitly authorized by the court.

Was the surgeon himself ordered to remove the bullet? Just because the cops have a warrant doesn't mean they can force the doc to actively assist in the execution of the warrant. We routinely remove bullets at my program, and once they are removed from the body they are passed off as evidence, but that doesn't mean we remove FB's just for the sake of helping the police (as much as we might like to).

And besides, courts order illegal things all the time. That's why we have a multitiered legal system that routinely overrules the findings of lower courts. Ain't our republic great?

Screw the idiot felon. May he rot.

I agree, after due process and the rule of law are satisfied.

 

[adrenalitis]

I know Dr. Parkus and all the other people in the Christus St. Elizabeth trauma unit. I had the honor of getting to shadow/pal around with them for two years and they wrote my letters of recommendation for med school. They are some of the best surgeons I've ever seen and a major influence on my wanting to go into surgery. When I left for school in July '08, he had been named in only one malpractice suit that was later dismissed (quite an accomplishment for a Trauma Surgeon). Dr. Parkus is anything but reckless and I've seen him save countless lives for little more than a thank you.

This case is complete crap imho. The guy had a bullet lodged in his forehead and all Dr. Parkus did was attempt to remove it per the search warrant expressly stating that he remove it. He saw that the procedure was not just a simple removal due to the overgrowth of bone around the projectile, and halted. People are treated against their will all the time if the correct legal avenues are taken. I suspect that a signed warrant will prove protective. After all, later on in a plea deal, the felon agreed to the removal of the bullet after it was no longer needed for his trial.

 

[andexterouss]

I will agree with San_Juan_Sun on this one. Given this doctor's history, he seems all too eager to play hero. Patient consent must the hallmark of any doctor's practice. If the accused wants to die from a bullet lodged in this skull, let him! However, strapping him to a bed and shoving an instrument into his body to collect evidence is unethical. To me at least. I very much doubt that warrant would have been issued if the accused had a very good defense attorney.

It's a slippery slope. What if a rape victim doesn't want to submit to an exam for evidence collection? Do we get a court order to spread her legs apart?
Or do we draw the line only for victims?

 

[glypha1104]

some of you guys must never have lived in a bad neighborhood, where these low life's cause emotional distress to parents and grandparents who are afraid to have their children go outside because they might get shot.

 

[Winged Scapula]

some of you guys must never have lived in a bad neighborhood, where these low life's cause emotional distress to parents and grandparents who are afraid to have their children go outside because they might get shot.

The "low-lifey-ness" of the patient is irrelevant.

You treat the drug addled gangbanger who killed your mother the same as you do the Dalai Lama. In reality, its hard to separate our emotions about these patients but it must be done, othewise you have to remove yourself from the case.

 

[andexterouss]

The "low-lifey-ness" of the patient is irrelevant.

You treat the drug addled gangbanger who killed your mother the same as you do the Dalai Lama. In reality, its hard to separate our emotions about these patients but it must be done, othewise you have to remove yourself from the case.

I agree.

 

[dpmd]

It's a slippery slope. What if a rape victim doesn't want to submit to an exam for evidence collection? Do we get a court order to spread her legs apart?
Or do we draw the line only for victims?

Does the suspected rapist have to consent to the exam for evidence collection? Or is the doctor authorized to do so in response to a court order?

 

[San_Juan_Sun]

Does the suspected rapist have to consent to the exam for evidence collection? Or is the doctor authorized to do so in response to a court order?

I'm not a lawyer, but I can't see how a court can legally hijack a surgeon's skills to execute a warrant. But if I'm ever confronted with this situation, I know exactly what I'll do: I'm calling my hospital's risk management first.

Taking out a bullet fragment or collecting blood/semen from a rapist doesn't have to be done right away. It's not an emergency, and I won't violate informed consent even it's going to put a scumbag away. Let the lawyers fight it out.

 

[DrDre311]

The "low-lifey-ness" of the patient is irrelevant.

You treat the drug addled gangbanger who killed your mother the same as you do the Dalai Lama. In reality, its hard to separate our emotions about these patients but it must be done, othewise you have to remove yourself from the case.

So I jump ship in Hong Kong and make my way over to Tibet, and I get on as a surgeon at a hospital over in the Himalayas. A surgeon, you know, a cutter, a surgeon, a jock. So, I tell them I'm a pro jock, and who do you think they give me? The Dalai Lama, himself. Twelfth son of the Lama. The flowing robes, the grace, bald... striking. So, I'm on the first case with him. I give him the scalpel. He hauls off and whacks one - big hitter, the Lama - long, into a two hundred kilogram abdomen, right at the base of this pannus. Do you know what the Lama says? Gunga galunga... gunga, gunga-galunga.

 

[dgruntledmizzou]

So I jump ship in Hong Kong and make my way over to Tibet, and I get on as a surgeon at a hospital over in the Himalayas. A surgeon, you know, a cutter, a surgeon, a jock. So, I tell them I'm a pro jock, and who do you think they give me? The Dalai Lama, himself. Twelfth son of the Lama. The flowing robes, the grace, bald... striking. So, I'm on the first case with him. I give him the scalpel. He hauls off and whacks one - big hitter, the Lama - long, into a two hundred kilogram abdomen, right at the base of this pannus. Do you know what the Lama says? Gunga galunga... gunga, gunga-galunga.

"Stop traffic. Because when I go back to town, I'm actually gonna see an orthopedist about what you did to my back. And not just any orthopedist, I'm gonna see a Dr. Epstein who specializes in..."

 

[andexterouss]

Does the suspected rapist have to consent to the exam for evidence collection? Or is the doctor authorized to do so in response to a court order?

I wasn't really talking so much about its legality than whether it was ethical. Doctors adhere to a higher standard of ethics(at least I hope). The line starts to get blur when we start playing law enforcement agents. It's very easy to bend the rules when one side is viewed as the "bad guy". History hasn't been kind to us in that regard(German doctors). Also, just because the courts authorized something, doesn't make it ethical. There are judges that will authorize water-boarding(torture), animal testing, rounding of minorities into interment camps etc.

In terms of the legality, the Supreme Court has consistently upheld the right to privacy under which a woman has the right to her body. As a result, the government cannot tell her whether or not she can keep or abort her fetus(non-partial birth). Not even the father of the fetus. It's her body, her decision.
This fact alone can be grounds for appeal for the case being discussed. If an Appeals Court finds that the accused's privacy was violated, the whole case could be thrown out on grounds of fruit from the poisonous tree.

 

[SLUser11]

So I jump ship in Hong Kong and make my way over to Tibet, and I get on as a surgeon at a hospital over in the Himalayas. A surgeon, you know, a cutter, a surgeon, a jock. So, I tell them I'm a pro jock, and who do you think they give me? The Dalai Lama, himself. Twelfth son of the Lama. The flowing robes, the grace, bald... striking. So, I'm on the first case with him. I give him the scalpel. He hauls off and whacks one - big hitter, the Lama - long, into a two hundred kilogram abdomen, right at the base of this pannus. Do you know what the Lama says? Gunga galunga... gunga, gunga-galunga.

There will be no reimbursement. But when you die....on your deathbed....you will receive total consciousness.

 

[San_Juan_Sun]

There will be no reimbursement. But when you die....on your deathbed....you will receive total consciousness.

So you've got that going for you. Which is nice.

 

[JackADeli]

I'm not going to get into any details/specifics of this case....
But conceptually as a surgeon we need to consider a few points.

1. First do no harm.... if the bullet staying in hurt the patient or coming out helped the patient, then so be it. But simply performing an extraction because the police have a "warrant" is a problem. Physicians have tried to hide behind the... I was just a robot and ordered to do it type argument for years... and it doesn't wash.

2. I can't speak about anyone elses trauma experience, but I found during my training far too often the police came into the trauma room to A) try to obtain evidence without regard for the life saving work we were trying to do, B) attempt to interogate a trauma victim while they are under great stress and/or intoxicated (by themself or by our benzos & opiates).

We as physicians need to be sure we do not start judging our patients and deeming them less entitled to safe and indicated care because of real or presumed social or economic station in life. We should also be very careful about allowing ourselves to be "ordered" through warrant or other means to apply our training on a nonconsenting individual. Remember, a good physician does not get ordered by the patient or anyone else as to what the right care we provide. We advise on what our training and experience says the right care is and the patient choose to allow us to provide said care or not.....

just my opinions & thoughts

 

[Miami_med]

A warrant cannot force you to do a procedure. Period. If removal of the foregin body was medically necessary, it can force you to turn over the removed body. This should probably serve as notice to everyone that keeping a good lawyer on speed dial is the way to go in the modern medical world.

 

[JackADeli]

I went back and read the linked news article.
I stand by my original sentiments.

Telling points from the news article (presuming factually accurate):

1. The surgeon in question brought a healed patient into an ED room, NOT under general anesthesia in operative theatre, etc...
2. Unnecessary procedure aborted because of healing bone.
3. Alternate surgeon did NOT attempt procedure as a result of patient objection/non-consent.... even with apparent warrant.

Again, I am reading a news article. Maybe it is not factual. But, based onthe little I have read, I am disgusted. Does not sound like a well planned or thought out approach. This non-consenting individual was transported to and ED for a facial/head exploration. Apparently innadequate pre-op assessment and/or planning work-up. Does not sound like surgeon was qualified to perform the procedure attempted under the conditions chosen. The surgeon aborted this procedure. I guess after initiating a surgical procedure with NO benefit planned for the patient and only risk, the surgeon realized he could not perform said extraction as a result of bone growth. Leaving this patient with the risks of infection, bleeding, further scarring (on the face/head), etc.... and no intended benefit. I wonder if a "time out" was performed? I wonder if peri-operative IV antibiotics were given? What actual safeguards on behalf of the patient were taken?

The legal system may give the surgeon a pass on the lawsuit. But, from an ethics standpoint, the surgeon could have some problems. The action described sounds cavalier, dangerous, and unethical. IMHO, this action is contrary to the canons of medical ethics and the profession of surgery. I wonder if this surgeon did this for free or got paid by the prison system? If a patient is incarcerated, in many states fee for services is FULL, not percentages/etc... like medicare/HMOs. The surgeon had plenty of choice as demonstrated by the subsequent surgeon. Ultimately, we work for the patient and his/her medical interest. We do not work for the HMOs or anyone else paying.

J.