Saturday, April 5, 2014

House Of GAWD (Giving Anesthesia While Distracted)

This cautionary tale should be a shot across the bow for any anesthesia resident or attending surfing and posting on the web during the middle of a case. It involves Dr. Christopher Spillers, an anesthesiologist practicing in Medical City Hospital in Dallas. Dr. Spillers is accused of neglecting his patient during a routine AV node ablation. His inattentiveness to his charge supposedly caused him to miss his patient's hypoxia for 15-20 minutes leading to her eventual death.

When the cardiologist in the procedure, Dr. Robert Rinkenberger, gave his deposition for the inevitable medical malpractice case, he specifically focused the blame at the anesthesiologist. Dr. Rinkenberger said whenever he looked over at Dr. Spillers, he seemed to be distracted by his cell phone or pad. When asked by the lawyer if the anesthesiologist was watching the patient, the cardiologist replied, "No." Ouch. Dr. Rinkenberger complained about the anesthesiologists he's seen working in his cath lab, "You know, we see this sort of thing with these procedures. I mean, they're long procedures. We see this kind of thing, and usually I--it's not--doesn't seem to be a problem especially with relatively short cases. What can I say? I mean it happens."

As Dr. Spillers took his turn giving his deposition under oath, he initially claimed he always paid complete attention to his patients in the operating room. Unfortunately for him, his initial flat out denial of surfing the net while working in the OR was all too easy for the attorneys to shoot down. He started backpedaling by claiming he only looked on the web to check patient information, email, or schedules.

That's when the lawyers started bringing out the embarrassing evidence. He was asked specifically if he ever posted on Facebook while giving anesthesia. He again denied doing so without qualification. When asked if posting on social media would be an unsafe practice, he replied, "It wouldn't be recommended." Well, why not? In his best oral boards answer, he said, "Because you're supposed to be monitoring the patient. You wouldn't want to be spending time in extraneous activities that were not related to patient care. Is it possible to do so safely? Yes, because we have ways of monitoring the patient. But I don't do that." When asked again whether he ever posted on Facebook while doing a case, he again answered with single syllable certainty, "No."

At this point, they presented their most damning evidence--his own Facebook page. It has since been erased of nearly all posts but at that time was chock full of easy fodder for the attorneys. Dr. Spillers was asked to read what he posted on one Christmas Day, "Just sitting here--sitting here watching the tube on Christmas morning. Ho ho ho." It was accompanied by a picture of an anesthesia monitor with vital signs on it. He conceded that the monitor was attached to his patient at the time he took the picture but denied the patient's privacy was compromised because there are no identifying names or numbers in the picture. He claimed he may have posted the picture after the case was finished, not while doing the case. However when the attorney pointed out that the caption under the picture was written in a present tense, he had to admit that it was placed while he was doing the case. Now he has painted himself into a corner because initially he said he never posted on social media while anesthetizing a patient. Now he has admitted doing so in the past, even some with derogatory comments about his patients.  Check and mate.

I don't know what happened to Dr. Spillers since then. I do know that on his now sparsely posted Facebook page he identifies himself as having "worked" at Tx-An Anesthesia, the name of his anesthesia group. His case is scheduled to go to trial in September.

In this age of electronic media, nearly everything we do can be traced back to us. Electronic medical records keep track of nearly every keystroke we enter. Hospital computers monitor every website we surf to. Personal cell phones and tablets maintain logs of each phone number and web page we use. While those can be considered private information, a smart lawyer can easily get a subpoena for the phone company to release that data.

So don't become another occupant in the House of GAWD. While some long cases may present a challenge to the anesthesiologist to simply stay alert, posting on social media during a case for entertainment is never a good idea. Medicolegally it is impossible to justify and it goes against every anesthesia doctrine about patient safety.

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