Wednesday, January 18, 2012

15 Minute Coverup

It's sad to read about fellow anesthesiologists who perform below standard of care, because to be perfectly honest, the standards of care are the minimum we are all expected to achieve in order to safely guide a patient through surgery. The LA Times yesterday reported on the state of surgery centers in Los Angeles that are affiliated with the ubiquitous Lap Band procedures that are advertised all over the city. Five deaths have occurred in these places over the last two years. The centers are now being sued by former employees who alleged that they were fired because they reported the "horrific and gruesome conditions" of these places. They also alleged that patient care was poor in order to maximize profits for the centers.

As an example they cite the death of Paula Rojeski from Orange County. In the lawsuit, the plaintiffs complain that there was a coverup by the anesthesiologist and the management of the surgery center over how the patient expired. According to the suit, the anesthesiologist, Dr. Deming Chau, did not heed the multiple warnings on his anesthesia monitors when something went wrong. Supposedly the patient's oxygen supply had somehow become disconnected during Rojeski's Lap Band operation. Then it sounds like the IV fell out, causing medication to pool on the O.R. floor. At one point the alarms were so incessant that the surgeon, Dr. Julius Gee stopped the procedure because the patient started to move and to ask if anything was wrong. Dr. Chau replied that the machines were malfunctioning. After the surgery the patient became apneic and pulseless. Dr. Chau reportedly did not notify anybody or ask for help for at least fifteen minutes. When the paramedics arrived he did not tell them the patient had been pulseless for all that time. She was pronounced dead at the hospital. The owner of the surgery center, Michael Omidi, instructed Dr. Chau to gloss over the fifteen minute delay in reporting the patient's dire condition. He also ordered all equipment in the operating room to be switched before inspectors from the coroner's office came to evaluate the center.

Sigh. If these allegations are even close to the true story, it just highlights how little autonomy we anesthesiologists have in deciding our future. We are completely dependent upon the surgeon and the hospital to give us work. If we're hungry enough, we will give anesthesia to anybody with a pulse. It doesn't matter if the patient is morbidly obese, has severe coronary artery disease, aortic valve stenosis, or any other critical conditions, some anesthesiologist somewhere will do the anesthesia. For most of these patients the outcome will be favorable. Unfortunately for others, they won't be so lucky.

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