Comments on: A patient dies after doctors fail to communicate in the operating room

By: Richard Geier

Richard Geier — Wed, 14 Oct 2009 13:25:01 +0000

This is a classic case of incentives driving behavior. Most surgical centers are setup with “eat what you kill” contracts for anesthesiologists. This creates an incentive to keep surgeons happy because otherwise the anesthesiologist will not be requested for cases. Even worse, the anesthesiologist will be black listed by the surgeon’s colleagues as being obstructed and forced to leave the pracitce. It is very typical to bend the rules of safety to accomodate surgeons for these reasons but rarely is there a frank breach as in this case. I can only imagine that the anesthesiolgoists was worried about his/her job. This is as much a system problem as it is a people problem.

By: jimeyers

jimeyers — Mon, 21 Sep 2009 16:59:11 +0000

I can’t read the surgeon’s mind. I have in my article and subsdequent comments offerred every explanation given. Including qestioning whether an anaphylactic reaction had occured. The nature of the reaction was truely not in question. All the indicia of such a reaction were recorded in the records by the anesthesiologist who resusitated the patient. I have an an educated guess, that the surgeon was so upset that the anesthesiologist questioned the surgeon’s conclusions that the surgeon lost track in his reasoning of the consequences to the patient. When he was questioned again by a different anesthesiologist just before the second administration of the drug, he reacted similarly. I gather that the timidity of the anesthesia, tough inexcusable, is nevertheless a reality in hospitals where surgeons wield unrestrained power. This case simply represents an extreme example.

By: edita falco

edita falco — Mon, 21 Sep 2009 12:57:53 +0000

i have read with great interest about that case
.Am a doctor working on patient safety and are now studying about what induces a doctor to make a wrong decision. Some cases are just arrogance and disrecpect as violate very well know procedures , others are just difficult to undertand We got a case were tha anestesiologist failed to monitor the patiene it was a very imprudent guy that had many accidentes before he got a suspension You find people like that that must be excluded from practice..
but some times good people make incredible decisions and i wonder why
was such this case? or a crazy guy like my anesthesiologist?
thank you
what was the the surgeon `s explanation ?

By: jimeyers

jimeyers — Thu, 17 Sep 2009 21:23:32 +0000

The comments to my article have been rather polarizing. That was not the intent of my message. On this blog the subject of medical malpractice seems to routinely have this effect.
Since the facts of the case discussed have been lost in this dialogue a brief repetition of certain facts may be useful to some.

First, this was a prescription of a prophylactic antibiotic so there was no need to balance carefully to find another appropriate medication.

This patient actually suffered a cardiac arrest from this initial administration. There had only been two drugs administered and if one disregards the e3dvidence which actually made the cefotetan more likely, certainly the surgeon was aware that there wqas at the very least a 50% chance that a second administration of the drug could be fatal.

Once a drug has caused an anaphylactic reaction the allergy is no longer dose related. There was no safety in giving a little.
The anesthesiologist present for the second administration of the drug admitted to being aware of that principle.

Some of the commentators were incredulous that a licensing board would exonerate a physician if the facts I related were true. It is undoubted the case that there are licensing boards who would have acted otherwise. The failure to take such actions virtually irrespective of circumstance is commonplace for the board in question.

Those who want media verification of the facts forgot that in the state where this matter occurred, confidentiality is required for all settlements.

Finally, The surviving husband, didn’t know what to do. He didn’t want money he did want the surgeon suspended. After everything he learned because of my investigation and believing that the filing of the case and investigation made it less likely that the catastrophe would be repeated, a settlement was reached which was of sufficient magnitude as assurred the matter had been taken seriously.

I was paid a portion of the settlement proceeds as my contingent fee. Before you decide whether the fee was earned you would have to know facts I cannot share with you. I can tell you that the settlement occurred just before trial and that the delay was due to the obstinence of the surgeon.

By: Marie

Marie — Thu, 17 Sep 2009 21:15:57 +0000

OK, Alex, having just (belatedly) read your comment, I will amend mine to begin “If this story is true and accurate as presented…”

However even if it is not, one could argue it makes a good academic hypothetical situation. In which case my comment would be the same.

By: Marie

Marie — Thu, 17 Sep 2009 21:09:32 +0000

Oy. I’m loving reading these articles weeks before I have surgery myself. lol

I am a nurse and it is indeed extremely difficult to stand up to a powerful physician. I can only imagine what went through the heads of the nurse and the anesthetist. But I know what would have gone through mine.

I would have thought about losing my job (and I am a widow with four children, a lot to consider there). But within seconds I would have realized losing my job would be nothing compared to having to live with the fact that I was complicit in a murder. Because this was nothing less than murder.

Although I believe they were wrong, my heart aches for the two who could have stopped it. That is a terrible burden to carry.

By: Mike

Mike — Thu, 17 Sep 2009 17:10:19 +0000

The patient explicitly refused treatment, multiple times if this recounting of events is correct. Is there, then, any other side of this story?

By: Primary Care Internist

Primary Care Internist — Sun, 13 Sep 2009 03:30:31 +0000

Is it necessarily so wrong, and career-ruining malpractice, to give a drug that in your professional judgment the benefits outweigh the risks, that happens to cause a bad outcome?

Lots of people claim to have a penicillin allergy, yet when they have a pneumonia, often rocephin is a reasonable and safely-administered choice, despite a theoretical 10% cross-reactivity with penicillins.

Should every time a physician errs on the side of giving the better drug, at the small unpredictable risk of causing a bad outcome, be deemed malpractice? If so, then we should find a wonder-drug for each condition, and only use that, all the time. Anything else should be punishable by firing squad (forget about a silly malpractice suti!)

By: Chris

Chris — Sat, 12 Sep 2009 18:48:14 +0000

“And, of course, all doctors cover up for each other.”

Which is why this story is posted on a highly-read physician’s blog? You might want to re-think that, Classof65.

By: SarahW

SarahW — Fri, 11 Sep 2009 22:31:37 +0000

Missing from any discussion is the patient’s right to refuse a treatment. A physician who feels put out by this has rights of his own, but not the right to administer the treatment.