Cosmetic Surgery Leaves Thornton Teen Brain Damaged

[XRanger]

Typically once you deliver Oxygen to a Hypoxic cardiac arrest, the situation miraculously improves.. THis story is sooo bizarre. Does not add up. IT's possible Meeker wasnt even there and they are scapegoating him. Even the most incompetent person could prevent something like this. Unless this guy's practice was soooo substandard that this would eventually happen.

Not if she’s been anoxic for 15 min. I think either he goose the tube and didn’t realize it (no monitors) or forgot to switch the ventilator and just left he room. Could also be he put lma and forgot to turn the sevo and pt laryngospasm but since he’s not in the room he didn’t realize.

The point is this could have been prevented if he just stays in the room and actually monitor the pt.

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[coffeebythelake]

Not if she’s been anoxic for 15 min. I think either he goose the tube and didn’t realize it (no monitors) or forgot to switch the ventilator and just left he room. Could also be he put lma and forgot to turn the sevo and pt laryngospasm but since he’s not in the room he didn’t realize.

The point is this could have been prevented if he just stays in the room and actually monitor the pt.

People can argue that bad things sometimes happen. That is true. But The patient abandonment aspect of this is what will do Meeker in.

 

[TAVR4life]

Someone email the girls lawyer telling them to sue the national nursing associations and email state senators to show them that CRNAs should not be unsupervised. Patient safety should always be number one. Anesthesiologist this is your chance to get your field back from mid level encroachment!

 

[caligas]

Yeah, unfortunately there are also examples of egregious cases involving MDs, so one case by a $hitty CRNA doesn’t save the specialty.

 

[TAVR4life]

Yeah, unfortunately there are also examples of egregious cases involving MDs, so one case by a $hitty CRNA doesn’t save the specialty.

Except the nurse propaganda machine actively market themselves and promote them to be equivalent to anesthesiologists—the marketing is whats deceiving. Patient should be informed of the differences and allowed to make an informed decision. The fact that their education and training is significantly less than anesthesiologists should be constantly emphasized to patients.

 

[hebel]

So hypothetically, if I ever anticipated a loved one getting cosmetic surgery similar to this...would you recommend the case being staffed by an anesthesiologist in a hospital OR (vs an office or surgery center)?

I'm actually pretty serious, as in what would you recommend for your loved ones (because this articles concerns me).

 

[TAVR4life]

So hypothetically, if I ever anticipated a loved one getting cosmetic surgery similar to this...would you recommend the case being staffed by an anesthesiologist in a hospital OR (vs an office or surgery center)?

I'm actually pretty serious, as in what would you recommend for your loved ones (because this articles concerns me).

Personally I would want someone with the most training and education. Someone who knows what to do when crap hits the fan—-you want someone who is competent and knows what to do in unexpected situations.

I would want an anesthesiologist for a loved one.

 

[IMGASMD]

So hypothetically, if I ever anticipated a loved one getting cosmetic surgery similar to this...would you recommend the case being staffed by an anesthesiologist in a hospital OR (vs an office or surgery center)?

I'm actually pretty serious, as in what would you recommend for your loved ones (because this articles concerns me).

What’s your loved ones budget? Does the surgeon even do them in the hospital OR? Plastic that came to our hospital had a set fee that they pay the hospital and anesthesia based on the length of the booking. So it will definitely cost more than if they do it in their own office and get their own “anesthesia providers.”

Like another poster said, ask questions before you go under. In general, the answer is always anesthesiologist in a hospital OR, if money is no concern.

Just like, you would recommend a psychiatrist not a NP for your loved ones.

 

[Noyac]

Personally I would want someone with the most training and education. Someone who knows what to do when crap hits the fan—-you want someone who is competent and knows what to do in unexpected situations.

I would want an anesthesiologist for a loved one.

And someone that can identify a tube in the esophagus.

 

[Noyac]

So it has been a long time since I have worked with Midlevels. Can someone tell me what kind of malpractice coverage they have these days? Is it $1,ooo,ooo/3,ooo,ooo or is it $10,000/30,000? Does it depend if they are supervised vs independent?

 

[coffeebythelake]

So it has been a long time since I have worked with Midlevels. Can someone tell me what kind of malpractice coverage they have these days? Is it $1,ooo,ooo/3,ooo,ooo or is it $10,000/30,000? Does it depend if they are supervised vs independent?

I imagine these midlevels get thr lowest possible insurance. If something goes awry, they know the family will go after the surgeons bigger pocket

 

[T-burglar]

Sickening.

This person and everyone involved who should have been able to rescue or recognize the problem needs to be punished severely. This is manslaughter.

 

[IMGASMD]

I imagine these midlevels get thr lowest possible insurance. If something goes awry, they know the family will go after the surgeons bigger pocket

I looked at our policy. They’re all covered under the corporate umbrella for us. So I assume they get the same coverage as us. (Whatever the local/hospital mandated amount). You don’t want more than that, for the reason the other poster mentioned. If you have deeper pocket than that, they possibly will go after you rather than someone else......

But take this as what my understand of med mal (which can be very Misinformed...)

 

[coffeebythelake]

I looked at our policy. They’re all covered under the corporate umbrella for us. So I assume they get the same coverage as us. (Whatever the local/hospital mandated amount). You don’t want more than that, for the reason the other poster mentioned. If you have deeper pocket than that, they possibly will go after you rather than someone else......

But take this as what my understand of med mal (which can be very Misinformed...)

This dude Meeker worked for himself under Rex Meeker Inc
He is the sole proprietor and I'm sure he gets his own malpractice insurance.
Probably gets the cheapest ones possible, so he can sell himself as a cheap option to these plastic surgeon clowns who don't know better.
Pretty sure lots of these independent practice CRNAs do the same

 

[jwk]

So it has been a long time since I have worked with Midlevels. Can someone tell me what kind of malpractice coverage they have these days? Is it $1,ooo,ooo/3,ooo,ooo or is it $10,000/30,000? Does it depend if they are supervised vs independent?

I believe Colorado requires $1M/3M for physicians. Not sure about free lance CRNAs.

 

[Crabbygas]

It will be interesting when the details come out. If I had to guess I suspect one of the earlier posters was on the right track. There are several things that could have caused her to code but not too many that would have resulted in a quick ROSC with some CPR. I very much doubt something like LAST or tension pneumo. As much as I hate to underestimate the ability of people to be stupid I also doubt that she was given GA and walked away from if for no other reason than the surgeon would likely want to get the show on the road as quick as possible. More likely she got some sedation for blocks in the OR then people didn't monitor her for the 15 minutes or so they thought it would take for the block to set up. But too much versed and fentanyl and she quits breathing once they quit poking her with a needle.
I also hate to say that as much as this case may be used to argue against CRNA independence it has almost nothing to do with the superior education of an anesthesiologist. Any remotely competent CRNA could have likely prevented this outcome had they only been paying attention. That said, I am tired of the AANA and hope somebody uses this case to burn them a bit. I would also like to see some explanation of the earlier death and what if any investigation the nursing board put into that. Oh, and why hasn't this guys license been suspended already pending further investigation. Wonder how many case he's done since this one?

 

[frog301]

following

 

[PieOHmy]

I say forget fighting the crnas.. Thats ridiculous. I say start lobbying HARDCORE for PAs in anesthesia, and AAs in every state.
PA-C's are licensed in every state. I say get them trained for 18 months to be used in the Operating ROOMS. This is what needs to happen.. Countering every crnas assertion of their superiority will perhaps win us some battles but it wont win the war..

 

[Paingas]

CRNA's once again proving no difference in patient outcomes

 

[coffeebythelake]

I say forget fighting the crnas.. Thats ridiculous. I say start lobbying HARDCORE for PAs in anesthesia, and AAs in every state.
PA-C's are licensed in every state. I say get them trained for 18 months to be used in the Operating ROOMS. This is what needs to happen.. Countering every crnas assertion of their superiority will perhaps win us some battles but it wont win the war..

Well I agree that we should promote AA's as they are easier to work with and less ego.
But to let the AANA go unfettered is how this whole mess become what it is in the first place.
They don't care about education and training, they care about sound bites. Get the word out there that they are somehow equivalent, no matter how ridiculous or unfounded their message is, throw in some money, and idiots (aka politicians) will believe them.

 

[Modanq]

This is why I am a big advocate that anesthesiologists should not teach their craft to anesthesia nurses. They should be on their own...it will become quickly apparent that a physician level training pathway is a minimum requirement for the practice of anesthesiology. We all know it and we all see it day to day...oftentimes it doesnt bubble up to the surface like it did in this case but the cases will start mounting up.
A nerve palsy after a weekend course with improper technique and dosing
A stroke or cognition decline after hypotension and poor preop prediction
Several episodes of renal failure because of dosing and following surgeon orthopods instructions for controlled hypotension without thinking.

After practicing anesthesia for several years i am shocked to think that nurses are remotely even allowed to practice in this field. Hell other physicians that I talk to fret at the thought of doing anesthesiology and tackling its associated complications.

Events like this are the real benchmark to change the landscape. When the general public finds out what goes on... independent practice by CRNAs will take a massive massive step back to where it should have been limited for patient safety

 

[KungPOWChicken]

Most likely this event took place in the PACU or Phase 2 where they weren't monitoring appropriately. There was a PACU nurse where I work who was over treating a patient that had a very low pain tolerance. Probably one of those people who can barely open their eyes but their pain is ten. Well this nurse gave the patient dilaudid and shortly sent them to phase 2. Luckily the nurse in phase 2 caught it otherwise the same outcome could have easily happened. I highly doubt the CRNA was gone for 15min unless this happened post op. Things like this can easily happen there or on the floor even. That's why you need good pacu nurses that you trust because ultimately we'll be held responsible for them. That's why I stress to these pacu nurses not to over treat a demanding low tolerance patient.

 

[coffeebythelake]

Most likely this event took place in the PACU or Phase 2 where they weren't monitoring appropriately. There was a PACU nurse where I work who was over treating a patient that had a very low pain tolerance. Probably one of those people who can barely open their eyes but their pain is ten. Well this nurse gave the patient dilaudid and shortly sent them to phase 2. Luckily the nurse in phase 2 caught it otherwise the same outcome could have easily happened. I highly doubt the CRNA was gone for 15min unless this happened post op. Things like this can easily happen there or on the floor even. That's why you need good pacu nurses that you trust because ultimately we'll be held responsible for them. That's why I stress to these pacu nurses not to over treat a demanding low tolerance patient.

Well the article says in the operating room, and it also said the surgery didnt take place because of the "bradycardia" (ahem cardiac arrest)

 

[jw3600]

I say forget fighting the crnas.. Thats ridiculous. I say start lobbying HARDCORE for PAs in anesthesia, and AAs in every state.
PA-C's are licensed in every state. I say get them trained for 18 months to be used in the Operating ROOMS. This is what needs to happen.. Countering every crnas assertion of their superiority will perhaps win us some battles but it wont win the war..

Nah F PAs. They are all on board the independent schtick. Read some of their latest position (read: propaganda) statements.

 

[PieOHmy]

Nah F PAs. They are all on board the independent schtick. Read some of their latest position (read: propaganda) statements.

They (PAs) report to the board of medicine.

 

[PieOHmy]

This is why I am a big advocate that anesthesiologists should not teach their craft to anesthesia nurses. They should be on their own...it will become quickly apparent that a physician level training pathway is a minimum requirement for the practice of anesthesiology. We all know it and we all see it day to day...oftentimes it doesnt bubble up to the surface like it did in this case but the cases will start mounting up.
A nerve palsy after a weekend course with improper technique and dosing
A stroke or cognition decline after hypotension and poor preop prediction
Several episodes of renal failure because of dosing and following surgeon orthopods instructions for controlled hypotension without thinking.

After practicing anesthesia for several years i am shocked to think that nurses are remotely even allowed to practice in this field. Hell other physicians that I talk to fret at the thought of doing anesthesiology and tackling its associated complications.

Events like this are the real benchmark to change the landscape. When the general public finds out what goes on... independent practice by CRNAs will take a massive massive step back to where it should have been limited for patient safety

The problem with your prediction is... they are already independent in MANY places.. And even in states that are NOT opt out they are doing cases independent of the anesthesiologists with surgeons supervising while the schmuck anesthesiologist is doing his/her own cases in the next room..

 

[Mikkel]

Most likely this event took place in the PACU or Phase 2 where they weren't monitoring appropriately. There was a PACU nurse where I work who was over treating a patient that had a very low pain tolerance. Probably one of those people who can barely open their eyes but their pain is ten. Well this nurse gave the patient dilaudid and shortly sent them to phase 2. Luckily the nurse in phase 2 caught it otherwise the same outcome could have easily happened. I highly doubt the CRNA was gone for 15min unless this happened post op. Things like this can easily happen there or on the floor even. That's why you need good pacu nurses that you trust because ultimately we'll be held responsible for them. That's why I stress to these pacu nurses not to over treat a demanding low tolerance patient.

Read the civil complaint and look at the photos of the office surgical suite.

There ain't a PACU and the patient wasn't in it.

 

[PieOHmy]

Doesnt stop them from doing thisView attachment 290264

I dont see anything in that ad that says anesthesiologists are lazy, coffee drinking louses that do not bring any value to patient care.
Which is the Rhetoric of the nurse anesthesia lobby

 

[dabears505]

I'm sure the AANA will try to find some way to blame anesthesiologists for this

If only the anesthesiologists weren't so militant and trained us properly, this wouldn't have happened!

 

[Propofool123]

I truly hope criminal charges are brought forward and the nurse involved in this is given jail time. No monitors, walking out for 15 min, holding the patient in the clinic for hours before calling 911 - it’s all unforgivable.

The sad thing is this is not the first time it’s happened.

I always say - if you cross the street without looking both ways, you’ll get run over one day. For this ***** CRNA, they didn’t learn their lesson the first time.

 

[AdmiralChz]

I dont see anything in that ad that says anesthesiologists are lazy, coffee drinking louses that do not bring any value to patient care.
Which is the Rhetoric of the nurse anesthesia lobby

Trust me, PAs and NPs Are united in their front and have already made huge inroads against physicians (see: primary care and EM). There’s a huge movement inside the PA world to change their name to “Physician Associate” - sound familiar?

Both are taught from day 1 how expensive, impersonal and lacking physician care is and shown bogus non-inferiority studies “proving” the superiority of mid level care. The brain of a doctor, heart of a nurse nonsense comes out of the NP world. I wouldn’t believe what I am writing if I haven’t seen it first-hand from several friends going through a horrendously inadequate NP education.

 

[coffeebythelake]

Trust me, PAs and NPs Are united in their front and have already made huge inroads against physicians (see: primary care and EM). There’s a huge movement inside the PA world to change their name to “Physician Associate” - sound familiar?

Both are taught from day 1 how expensive, impersonal and lacking physician care is and shown bogus non-inferiority studies “proving” the superiority of mid level care. The brain of a doctor, heart of a nurse nonsense comes out of the NP world. I wouldn’t believe what I am writing if I haven’t seen it first-hand from several friends going through a horrendously inadequate NP education.

Dont get me started on NP education. Absolutely appallingly weak. Those advertisements all over facebook about doing a DNP part time in 1.5 years. It's a ****ing race to the bottom.

 

[Vandalia]

Dont get me started on NP education. Absolutely appallingly weak. Those advertisements all over facebook about doing a DNP part time in 1.5 years. It's a ****ing race to the bottom.

I posted this several months ago on the EM board:

My barber was very proud of his granddaughter. She had just completed the completely online courses of her NP program; she just had to do the practicum. He said that she had intended to spend the time with her sister-in-law, but her sister-in-law had had to have been an NP for a year before she could supervise someone, so she would have to find someone else for the first 6 weeks.

Then last week he complained that she had to get a job working as an inpatient nurse, since no one was hiring NPs in the area.

 

[TAVR4life]

I’m a cardiologist but I feel for you guys. NP/PA are encroaching everywhere and it needs to stop. Their training and education is a joke while our so-called MD leaders keep adding years to our already extremely rigorous education and training in the name of patient care. It doesn’t add up until you realize we are all part of a cost cutting effort by hospital administrators—we are cheap labor when we are trainees hence the incentive to keep adding years to our training and mid levels are cheaper alternatives to paying anesthesiologist level salary. None of this should have been ever allowed to get to this level if we had actual MD/DO leaders.

 

[fivehourenergy_MD]

Just saw the story on Fox News (Colorado teen, 18, severely brain-damaged after breast implant surgery gone wrong, family says). Looks like the story is spreading. Unfortunately, looking at the comments section, it seems like the average non-medical reader is missing the point entirely. Most comments were about the patient's life choices and some even blamed the patient for getting the surgery. I only saw a few comments directed at the nurse anesthetist that completely botched her anesthesia. Sad.

 

[jw3600]

Just saw the story on Fox News (Colorado teen, 18, severely brain-damaged after breast implant surgery gone wrong, family says). Looks like the story is spreading. Unfortunately, looking at the comments section, it seems like the average non-medical reader is missing the point entirely. Most comments were about the patient's life choices and some even blamed the patient for getting the surgery. I only saw a few comments directed at the nurse anesthetist that completely botched her anesthesia. Sad.

The one time we need the stupid public to be outraged they let us down.

 

[Modanq]

The problem with your prediction is... they are already independent in MANY places.. And even in states that are NOT opt out they are doing cases independent of the anesthesiologists with surgeons supervising while the schmuck anesthesiologist is doing his/her own cases in the next room..

Good point. We need to think hard about what type of anesthetic anesthesiologists need to be involved with and or be present for as in supervise. We need a finer gradation then the curent system in place. And even then you will have some misses and near misses. But I can positively state The ASA score is a dinasour in the current system where the medical record can risk stratify across 30 variables automatically and basic standard of care should be implemented systemically.

 

[scoopdaboop]

. I only saw a few comments directed at the nurse anesthetist that completely botched her anesthesia. Sad.

it’s on Fox News. Seems reasonable

 

[deleted126335]

When a state scope of practice issue comes up in your area, feel free to communicate with your state rep or state senator the elements of this case... Take a few minutes to craft a thoughtful letter. Get involved with your state society. Get off your ass. Write a check to ASAPAC and your local state PAC.

 

[coffeebythelake]

The one time we need the stupid public to be outraged they let us down.

Seems like some people are getting the message.

 

[GaseousClay]

View attachment 290348

Seems like some people are getting the message.

Just wait until CRNAs start participating in the forum.

 

[coffeebythelake]

Just wait until CRNAs start participating in the forum.

Cant wait for them to start blaming everyone except themselves.

 

[Mikkel]

CRNAs already claiming to be doing "residency" and "med school". Amazing.

 

[coffeebythelake]

CRNAs already claiming to be doing "residency" and "med school". Amazing.

They should be sued. Sanctioned. Lose their license. This is impersonating a physician.

 

[sevo00]

https://localtvkdvr.files.wordpress.com/2019/12/nguyen-complaint-docketed.pdf

court files from the case thus far. The plaintiff's attorney and email are listed on the first page: [email protected]

 

[GaseousClay]

the surgeon and crna are toast

 

[coffeebythelake]

the surgeon and crna are toast

Yep. The plaintiff family will take everything.
Meeker will lose his license and never practice again. May be criminally charged.
The surgeon? Who knows, but will probably be sanctioned.

 

[PieOHmy]

The problem with the independent crna model is that very quickly the standards will devolve into "very little standards" They cant stand toe-to-toe with the surgeons who wanna do dumb ****. "just give me a little sedation i wont be long", "Just put an lma for that tonsil", Just LMA that septoplasty etc etc etc... next thing you know all sorts of ridiculous stuff is going on.

 

[deleted126335]

The problem with the independent crna model is that very quickly the standards will devolve into "very little standards" They cant stand toe-to-toe with the surgeons who wanna do dumb ****. "just give me a little sedation i wont be long", "Just put an lma for that tonsil", Just LMA that septoplasty etc etc etc... next thing you know all sorts of ridiculous stuff is going on.

I have seen more than one anesthesiologist do seriously questionable **** to please a surgeon And keep their job. Sketchy things that some docs do get discussed on this board all the time. They are just less likely to get burned than a CRNA because they are more skilled.


Sent from my iPhone using SDN mobile

 

[Mikkel]

The problem with the independent crna model is that very quickly the standards will devolve into "very little standards" They cant stand toe-to-toe with the surgeons who wanna do dumb ****. "just give me a little sedation i wont be long", "Just put an lma for that tonsil", Just LMA that septoplasty etc etc etc... next thing you know all sorts of ridiculous stuff is going on.

LMA for tonsils/septoplasty is not dumb ****. I want to do that for most ENTs because it works great, but not all ENTs are on board with it.

The CRNA problem is they don't think through everything, they just do and react, it's the nursing education that comes out in stressful situations which can actually hurt the patients because the nursing education is not designed for medical problems.