Anesthesiologist Who Killed Surgeon Goes To Jail

Just a follow up from a story from back in 2017. Dr. Stephen Kyosung Kim was charged with murder when his patient, Dr. Mark Greenspan, a 71 year old orthopedic surgeon, died after surgery. Blood and urine drug tests showed Dr. Kim had Demerol and Fentanyl in his system at the time of the incident.

Dr. Kim admitted that he had stolen Demerol 50 mg from the Rodeo Drive Plastic Surgery Center in Beverly Hills that morning. He administered a general anesthetic to Dr. Greenspan even though they had discussed using regional anesthesia. Dr. Kim then left the operating room to give himself Demerol and Toradol. He subsequently fell down and hit his head but came back to the OR to finish the case. While in recovery, Dr. Kim overdosed Dr. Greenspan with Demerol and the patient became apneic and went into cardiac arrest. Dr. Kim tried multiple times to intubate Dr. Greenspan but was not successful and the surgeon died. 

The anesthesiologist admitted to the prosecutors that he had a drug addiction and had taken narcotics over 150 times while at work. His medical license was subsequently revoked. After four years, Dr. Kim pleaded guilty on December 2021 to manslaughter and was immediately taken to jail. It is expected that he will return to court in December 2023 and be sentenced to two years of jail time which he will have already served. 

This tragic case once again illustrates the unfortunate link between anesthesiology and drug addiction. It's well known that anesthesiologists have one of the highest incidents of addiction in medicine. I have unfortunately covered multiple incidents of drug addiction among anesthesiologists, including here and here. Eighty percent of US anesthesiology residencies have had at least one drug impaired resident. Almost a fifth of all residencies have experienced the death of a resident due to drug overdose. Male anesthesiologists are considered the highest risk for drug addiction and suicide among all physicians. A deadly combination of high stress work and easy access to narcotics makes drug addiction an ever-present risk of working in the field. If you suspect an anesthesia colleague may have an addiction problem, say something. It may save his, and his patients', lives.

"The Gig's Up". San Diego Anesthesiologist Caught Literally With His Pants Down.

Bradley Glenn Hay, MD

Anesthesiologists have long had a reputation for being the physicians who are most likely to have a drug addiction. One third of all medical residents who are treated for an addiction are anesthesiology residents, even though they make up less than five percent of all residents. Eighty percent of anesthesiology residencies reported having at least one resident with substance abuse problems. Almost twenty percent of anesthesia residencies have reported at least one fatal overdose in a ten year period. As you can see, drug addiction weighs disproportionately heavily on anesthesiologists and the profession.

So it's extremely disheartening to find an anesthesiologist in the news due to his substance abuse. Bradley Glenn Hay, MD, an anesthesiologist at the UC San Diego hospital system is being sued for causing patient harm while being under the influence of drugs. In his deposition, which you can read here, Dr. Hay states that he has been addicted almost throughout his residency and professional career. He started out as a heavy drinker in college, drinking a twelve pack of beer three to five times per week. He then moved on to heavy liquor like vodka and tequila. He would go to class or on rounds either drunk or with a hangover. He had been involved in two traffic accidents from DUI. Both times he underwent diversion treatments without much success.

Once he started anesthesia residency at UCSD, he started abusing narcotics. His drug of choice was usually fentanyl. He would check out far more narcotics than most anesthesiologists would use for a case. He would then give himself most if not all the drugs, causing his patients to wake up from surgery with extreme pain. Frequently he would "waste" leftover narcotics in a syringe with a witness when he had actually replaced the syringe with saline, giving himself the drugs he needed for himself. He would even talk his CRNA into falsifying the anesthesia records to make it look like they gave all the narcotics that were checked out.

Then in January 2017, he went to the staff restroom and shot up with some sufentanil, a narcotic far more potent than fentanyl. He almost immediately collapsed. The staff found him lying face down in a pool of vomit, with his pants down by his ankles. When he was revived, he saw all the staff standing around him and realized what happened. "Well I'm caught. The gig's up," he confessed.

He and the hospital are now being sued by former patients for causing bodily harm. Two lawsuits have claimed that while Dr. Hay was under the influence, his patients had received inadequate amounts of anesthesia. They claim to suffer awareness of their surgeries while experience excruciating pain but were too weak to let their predicaments be known. UCSD is being sued for essentially covering up Dr. Hay's addiction from his patients, nearly 800 over a two year period.

This is just a horrible tragedy all around. Hundreds of patients at UCSD may have suffered unbelievable horror movie scenarios while having surgery. The surgeons involved may have lost the faith of their patients. The hospital will spend millions of dollars in legal fees and fines for allowing this anesthesiologist to practice in their facilities. And Dr. Hay may never work as an anesthesiologist again. He has already lost his California medical license and his ABA board certification. I hope he finally gets the successful drug treatment he should have received prior to his overdose.

Sadly, Anesthesiologists Are Still Abusing Drugs

A new survey has been conducted to update information first gathered in the 1990's on the incidence of drug abuse among anesthesiologists. This time, information was gathered from anesthesia residency program directors for the period 2007-2017. The rate of response for the survey was 35% with 52 directors answering the questionnaire.

What the researchers discovered is as disheartening as the earlier poll. Among 2,100 residents in the programs that responded, 3.7% had substance abuse problems. The most common drug that was used was IV opioids with 39%. This was followed by Propofol (20%), and alcohol (15.2%).

The rate of anesthesia faculty abusing drugs was 1.16%. The most common substances used were alcohol (50%), IV opioids (23.7%), and smaller percentages of prescription medications, street drugs, and anesthetic agents.

For anesthesia residents who are found to be abusing drugs, it could be the end of their anesthesia careers. While 52% of the programs will pay for treatment, 13% felt it was the resident's own responsibility for their rehab. Worse, 43.6% of programs do not allow the residents to come back to finish their training. By comparison, the programs paid for faculty treatment 70% of the time. Many programs also continued to pay faculty salary and benefits while they're on sick leave.

These numbers demonstrate that we as a profession have a long way to go to identify and help people who may become or are already addicted to drugs. The rate of resident drug abuse is twice the percentage from twenty years ago. Anesthesiologists already have the highest rate of drug abuse and suicide among medical professionals. The ASA leadership and residency program directors need to conduct more education to prevent the next generation of anesthesiologists from falling into the abyss.

Finding The Anesthesiologist In The Bathroom

This is another sad story about how addiction ruins careers, reputations, and lives. Carlisle, PA anesthesiologist Gregory Theodore was found to have overdosed on Demerol while working at Carlisle Regional Medical Center.

His surgeon was trying to find him when wasn't answering his page. He went to the bathroom and could hear the beeper going off behind a stall door. When he managed to get the door open, he found the anesthesiologist unconscious on the seat with a syringe in his lap. When awakened, Dr. Theodore claimed he didn't feel well and had given himself some Zofran. However when he was sent down to the ER, he told the emergency physician that he had been taking Demerol for several years.

He is being charged by the Attorney General with administration of a controlled substance, acquiring a controlled substance, refusal to keep records of controlled substance, theft by unlawful taking, and possession of drugs with intent to manufacture or deliver. Dr. Theodore, your life is now totally f****d up. I hope you get the treatments you need, and a very good lawyer, to turn your life around. His formal arraignment is scheduled for July 21st.

As thousands of medical students graduate shortly and start their residencies, remember that no amount of stress is worth starting an addiction for. It may make you feel better for a very short period of time, but eventually it will completely devastate your life.

The Purple Patch

When King of Pop Michael Jackson died from propofol abuse, the drug became forever known colloquially as the "Michael Jackson drug". Now the devastating news that Prince has died from an overdose of fentanyl may bring notoriety to that pharmaceutical. Will fentanyl forever be linked to the singer's death? Can we expect to hear people call a fentanyl patch the Purple Patch?

Or maybe a fentanyl lozange a Purple Pop?

It's probably making the marketing department of these drugs start singing "Let's Go Crazy."

The Most Addictive Drugs In The World

This sounds like a trivia game you can play with your anesthesia friends after a few rounds of mojitos. What are the most addictive drugs in the world? The answer of course is dependent on who is answering the question. But a group of researchers in the U.K. attempted to rank addictive substances based on their ability to cause physical harm, social harm, and dependence. These five are considered to be the worst offenders.

1. Heroin--Using heroin causes the brain to increase its dopamine release, its reward center, up to 200% greater than baseline. It is also extremely dangerous with a very narrow therapeutic window. Its lethal dose is only five times greater than its recreational dose. Over half a million people in the United States used heroin in 2012 and the number is still rising, especially among the millenial generation. Over 156,000 tried heroin for the first time in 2012, far higher than the 90,000 in 2006.

2. Cocaine--The brain's ability to turn off the dopamine reward center is impeded, thus causing dopamine levels to rise to three times greater than normal. Cocaine is considered so addictive that one fifth of people who ever tried it will become dependent. About 20 million people in the world use cocaine creating a market worth $75 billion per year.

3. Nicotine--How addictive is nicotine? Over two-thirds of people who ever tried smoking will become lifelong smokers. Nicotine causes dopamine levels in the brain to increase 25-40%. Over one billion people in the world smoke and by the year 2030, eight million people worldwide will die from smoking related illnesses annually.

4. Barbiturates--Also known as "downers". These drugs were prescribed for treating anxiety but at low doses can lead to euphoria. Though highly addictive, they are not as prevalent anymore due to easy access of other drugs.

5. Alcohol--Over one fifth of people who ever drank alcohol will become alcoholics. Alcohol bumps up the brain's dopamine level from 40-360%. And the more you drink, the higher the dopamine level. That's part of the reason why binge drinking is so popular. Over two billion people in the world drink alcohol and three million will die from alcohol related illnesses.

What, propofol didn't make it on this list? I've never tried four of the five substances that are on this list so I guess I'm good. My personal addiction is sour cream flavored potato chips. Mmm. Sour cream and chives Lay's potato chips. Pardon me while I go binge on a bag.

It's A Wonder More Anesthesiologists Aren't Drug Addicts

The New York Times last week wrote that fentanyl is now the go to drug for former heroin addicts. Fifty times more powerful than heroin, fentanyl works faster and is cheaper to acquire on the streets. Last year in New Hampshire, fentanyl was attributed to 158 deaths while heroin only 32. A drug dealer can easily obtain fentanyl from his wholesaler and make $35,000 per week.

As the epidemic of drug addictions continues to spread around the country, to me it is a testament to the willpower and resolve of anesthesiologists that not more of us aren't addicts. Let's face it, anesthesiologists alone are the only physicians who routinely draw up and administer medications to patients without the aid of another person. All other doctors write orders for drugs which must be retrieved from the pharmacy and given to the patient by another party. We anesthesiologists have nearly unfettered access to highly addictive substances like fentanyl, methadone, ketamine, and yes propofol. Nobody bats an eye when we order up a narcotic and charts its use with nary any oversight. Whether we actually gave it to the patient is knowable only to the anesthesiologist.

Even the use of the Pyxis machine to dispense drugs is dependent on the trustworthiness of the anesthesiologist. When I need to document the return of any unused narcotic to the machine, I need to have another person witness my half used syringe as the drug I claim to be returning, usually a nurse in the recovery room. However, it is only a syringe of clear liquid with a label on top. It could be a syringe of sterile water that I labeled as fentanyl or dilaudid and the nurse would never know. They are trusting me as the physician to tell the truth about the drugs I am wasting. If an anesthesiologist is truly a drug addict, it would be all too easy to save the actual leftover narcotic for themselves and waste the fake syringe.

So instead of mischaracterizing anesthesiologists as junkies who got a medical degree, one should admire our fortitude to resist the enormous temptations that accompany our job every day. Though an unfortunate number of us do succumb to an addiction, the vast majority handle these dangerous substances with expert care and professionalism. Sadly, too many Americans are not able to do the same.

Anesthesiology Residency Is One Of The Most Dangerous Jobs In America

Among medical professionals, it is widely believed that anesthesiologists are one of the most likely physicians to develop a drug addiction, now known as substance use disorder (SUD). But is that true? And how likely will a person who begins training in anesthesia develop SUD? The July 2014 issue of the ASA Newsletter shines some light on this common idea.

A collaborative study between the American Board of Anesthesiology and the Mayo Clinic examined the incidence of SUD in anesthesiology residents from 1975-2009. They looked at ABA training records, state medical board disciplinary actions, and the National Death Index, which describes causes of death. What they found was that there were 384 anesthesia residents found to have substance abuse out of a total of 44,612 residents during that 35 year time period, or 0.86%. The lowest incidence of SUD occurred in the years 1996-2002, which just happens to be the nadir of anesthesia residency training. Perhaps the residents who went into anesthesiology at that time were just more motivated to succeed. The highest incidence of SUD has been in the last few recent years. Currently about one in 87 residents will likely develop SUD.

During the study period, of the 384 residents who had SUD, 28, or 7%, died during training. Of those who survived, 56% completed residency training. But only 44% of SUD survivors eventually became board certified. Unfortunately 29% will relapse and death was the first indication of the relapse in 13%. Overall, of the 384 resident who developed substance abuse, 53 are now dead. The cause of death are known in 49 of them and SUD was the fatal factor in 44 of them, or 90%.

You may think that those numbers don't sound so threatening. After all, out of thousands of physicians who have successfully completed anesthesia training, only a few hundred have had problems with substance abuse. To get a better perspective on all this data, the study helpfully compared anesthesia residency mortality to other "dangerous" occupations using numbers from the Bureau of Labor Statistics. With 28 deaths found in 177,848 resident-years of training, that works out to an annual rate of 15.7 deaths per 100,000 anesthesia residents. According to the BLS, the most dangerous job in America is farming and fishing, with a mortality rate of 21.2 deaths per 100,000 workers. Policemen have a mortality of 18.6 per 100,000. Firefighters, though each of their deaths is considered a national tragedy, have a mortality of only 2.5 per 100,000. Among all healthcare workers, it is only 0.7 per 100,000. Think about that. You are more likely to die in anesthesia training than you are to get hit by lightening, die from a bee sting, or succumb in a plane crash. In fact, the odds of death among anesthesia residents is almost the same as getting shot with a firearm in America.

To all you CA1's starting your new careers, have a nice day. And be careful out there.

Man Up!

A nurse in Minnesota has been accused of stealing narcotics from a patient during a surgical procedure. Sarah Casareto was giving conscious sedation to a patient during a nephrostomy tube placement when the patient started complaining about severe pain. Ms. Casareto told the patient she could not give him too much narcotics and to "man up". She tried to soothe the patient by saying "go to your beach...go to your special place." Ha ha. That is a good one. The pain was so intense the staff had to physically hold him down to finish the procedure.

The operating room staff noticed Ms. Casareto was slurring her words and unsteady. They even noticed she was falling asleep in the procedure room. She had checked out 500 mcg of fentanyl (!) for the procedure but had given the patient only 150 mcg. For some reason, it was not mentioned in the article, the patient contacted the police after his excruciating procedure. That's when Ms. Casareto refused a drug test and resigned.

It's sad for the patient that he had to go through such torture for a pretty simple and routine procedure. It's worse that the doctor doing the procedure didn't suspect something was wrong when the patient had to be physically restrained on the operating room table because he wanted to get the heck out of that torture chamber. But it seems unconscionable that if the patient was experiencing so much discomfort that the staff didn't call somebody else in to assist with pain control and sedation. The doctors noted that this procedure normally isn't that painful. But when it is for this patient, it baffles me that they didn't do something about it instead of just holding him down while a clearly intoxicated nurse was falling asleep instead of watching the patient. There were no anesthesiologists around that could give an urgent assist to the operating team? How would any of those people like to have a large catheter jabbed into their kidneys while being held down against his will. Sounds like some torture routine from an Iranian prison. Clearly Ms. Casareto has a lot of explaining and cleaning up to do. But the staff,who were not under the influence of narcotics, also need to clear things up with the patient, the hospital, and the police as to why they allowed this battery of the patient to continue.