Cosmetic Surgery Leaves Thornton Teen Brain Damaged

[coffeebythelake]

There was a comment about not working for an attorney for less than $1M/hr. To that I will tell you that there are people that practice far below what everyone would consider the standard of care. I’ve seen the records. I’ve read the reports. These people deserve to be sued, sanctioned, and potentially lose their license. They cause avoidable harm and destroy lives. I’m not talking about bad luck, surgical misadventures, etc. I’m referring to gross malpractice.
Completely negligent care obvious to everyone in the field.
It happens. It likely happened above if 1/2 the facts are true.
The legal system is appropriate for that and there is no reason to not support those cases. This family should receive compensation for their damages, ongoing care for their neurologically devastated child, etc. If any of the allegations are true it’s indefensible and avoidable harm. Which is why it will settle and the details never known.
Perhaps the patient got “sedation” for the block and then the CRNA left during set up for lunch or a dump or whatever. That’s difficult to defend as anything less than abandonment and malpractice, if not criminal negligence.

The plaintiffs attorney should not settle this. If even a small fraction of the allegations are true, this case cannot lose. The question is just how much meeker and surgeon will lose. The family needs to take them out professionally so they never practice again, and that means making everything public and everyone aware of what happened. This needs to be more than about money, this needs to be about justice. Meeker has done this before. The colorado board of nursing has failed them. It will help prevent another tragedy from happening in the future.

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[Southpaw]

Thanks for the interesting discussion.

I’m not so sure it’s completely your call...I usually need cooperation for certain parts of the case (eyelid) and prefer a deep MAC (“general without a tube”) for the rest of it. The advantages I see are that patients wake up quicker, I can get cooperation if I need it, and it makes the case faster. I don’t think rigid adherence to that philosophy makes sense as my anesthesia colleagues usually can get me what I want with propofol and a nasal cannula. The face is draped but not covered so on the odd occasion the patient starts obstructing, we do a jaw thrust, lighten it up, and if need be, throw an LMA in. You’re right that not every patient is appropriate for this but I feel 80% are.

It does require more monitoring and adjustment, but it is not onerous or impossible, from my viewpoint. Also, it is a huge pain to maneuver around the tube when doing a neck lift compared to nasal cannula.

And for what it’s worth, I would never hire a CRNA and supervise in my office bc I don’t want to take on that responsibility, I only operate at ASCs with MDs supervising.

Am I off base? I’m just surprised that so many feel so strongly against a nice snoring propofol MAC with nasal cannula which is 80% of what I do and ask for.


Sent from my iPhone using SDN

Propofol MAC is fine for your needs in the vast majority of, though certainly not all, patients. You seem to get that. It also seems as if you’d be pleasant to work with. Definitely keep an eye on the O2 though when using bovie for those small facial/eye cases. Thanks for stopping by.

 

[deleted126335]

There was a comment about not working for an attorney for less than $1M/hr. To that I will tell you that there are people that practice far below what everyone would consider the standard of care. I’ve seen the records. I’ve read the reports. These people deserve to be sued, sanctioned, and potentially lose their license. They cause avoidable harm and destroy lives. I’m not talking about bad luck, surgical misadventures, etc. I’m referring to gross malpractice.
Completely negligent care obvious to everyone in the field.
It happens. It likely happened above if 1/2 the facts are true.
The legal system is appropriate for that and there is no reason to not support those cases. This family should receive compensation for their damages, ongoing care for their neurologically devastated child, etc. If any of the allegations are true it’s indefensible and avoidable harm. Which is why it will settle and the details never known.
Perhaps the patient got “sedation” for the block and then the CRNA left during set up for lunch or a dump or whatever. That’s difficult to defend as anything less than abandonment and malpractice, if not criminal negligence.

No. I have seen docs win cases they deserved to lose, and lose cases (or pay settlements) that they should not have. The plaintiff's bar are scum to me. No matter how egregious an offense that a health care practitioner commits, I will not ever assist them in that forum.
Peer review. Yes. State Board sanction/suspension/removal of license. Yes. But not in this ****hole tort system.

 

[BLADEMDA]

"Malpractice" cases should go before a qualified review panel and not a jury of ignorant civilians. This panel would review and decide cases based on facts and the rule of law. The panel's decision would be binding but each side could appeal the decision in a court of law but the panel's recommendations and review of facts would be admissible in a court room.

Our current system favors lawyers looking to sue to collect money based on outcome and sympathy for the defendant; the facts have little to do with many lawsuits. There are hired guns (MDs) online who make their living giving testimony at trial and at depositions. These hired guns can be a very unscrupulous bunch contributing to the problem in this country.

This young woman clearly deserves compensation for her lifelong injuries due to negligence. I simply disagree with how the current system works and promotes numerous lawsuits without merit.

 

[MirrorTodd]

I think there was a case at Madigan where a child got burned during an ENT case for mac with nasal cannula and a simple cyst removal from around the eye...point being that it's probably not worth the potential slam dunk case for an airway/facial fire just to do a quick mac + open oxygen case.

 

[BLADEMDA]

The plaintiffs attorney should not settle this. If even a small fraction of the allegations are true, this case cannot lose. The question is just how much meeker and surgeon will lose. The family needs to take them out professionally so they never practice again, and that means making everything public and everyone aware of what happened. This needs to be more than about money, this needs to be about justice. Meeker has done this before. The colorado board of nursing has failed them. It will help prevent another tragedy from happening in the future.

The plaintiff's attorney is in it for the money. Justice has nothing to do with this case or any other. The goal is to strip the defendants of everything they own in this world in order for the plaintiff's attorney to get rich. The process will then rinse and repeat without mercy.

For justice to occur in this case Mr. Meeker must be punished by the Board of Nursing which IMHO should include loss of license to practice as a CRNA.

 

[pgg]

The plaintiffs attorney should not settle this.

The attorneys don't care about fair, or protecting hypothetical future patients. It's just math to them. Hours invested and their cut of the payout. Settling a case drastically reduces their hours and effort and lets them move on to the next one.

They're not suing the government, or a huge medical conglomerate like Kaiser or Duke or one of the Baaahston hospitals with ultradeep pockets. It's a lone plastic surgeon, a surgicenter, and a (probably underinsured) nurse anesthetist who may never work again after this. There's only so much blood to squeeze from that stone. There's no $100 million whale of a jury award at the end of that rainbow. Why invest the time going to court when everyone wants to settle?

 

[coffeebythelake]

The attorneys don't care about fair, or protecting hypothetical future patients. It's just math to them. Hours invested and their cut of the payout. Settling a case drastically reduces their hours and effort and lets them move on to the next one.

They're not suing the government, or a huge medical conglomerate like Kaiser or Duke or one of the Baaahston hospitals with ultradeep pockets. It's a lone plastic surgeon, a surgicenter, and a (probably underinsured) nurse anesthetist who may never work again after this. There's only so much blood to squeeze from that stone. There's no $100 million whale of a jury award at the end of that rainbow. Why invest the time going to court when everyone wants to settle?

Of course, I agree w u. A two man show isnt ever going to pay up even a fraction of 100 million. All wishful thinking on my part. The lawyers goals do not exactly align with family's. It's sad that most of what actually happened in there will never be told. The public may never truly understand the danger of meeker. Tucked away by whatever confidentiality clause goes with the settlement.

 

[Crabbygas]

Kinda makes you wonder if those two went right back to work the next day and are still scheduling new cases.

 

[coffeebythelake]

Kinda makes you wonder if those two went right back to work the next day and are still scheduling new cases.

Yeah I thought about that too. Really ****ed up

 

[IlDestriero]

I think there was a case at Madigan where a child got burned during an ENT case for mac with nasal cannula and a simple cyst removal from around the eye...point being that it's probably not worth the potential slam dunk case for an airway/facial fire just to do a quick mac + open oxygen case.

yes. I believe the settlement was $11M.

 

[IlDestriero]

The plaintiff's attorney is in it for the money. Justice has nothing to do with this case or any other. The goal is to strip the defendants of everything they own in this world in order for the plaintiff's attorney to get rich. The process will then rinse and repeat without mercy.

For justice to occur in this case Mr. Meeker must be punished by the Board of Nursing which IMHO should include loss of license to practice as a CRNA.

That may happen. I know of a CRNA that had a DUI and had their license revoked. This is worse in my opinion as Meeker actually seems to practice incompetently and dangerously as evidenced by 2 catastrophic events.

 

[IlDestriero]

Kinda makes you wonder if those two went right back to work the next day and are still scheduling new cases.

I’m sure the surgeon did. They will blame the CRNA for everything, even if they knew about abandoning the patient, not transferring her, etc. He’s got 3 more implants and a couple tip rhinoplasties this week. “When I left he said she’d be fine. If I had any idea she needed to be transferred, I would have driven her myself if necessary.”
I’m sure he was also in total denial, perhaps surviving a few near misses without any long term complications.

 

[pgg]

yes. I believe the settlement was $11M.

$12M

Here's the anesthesiology forum thread about it from a few months back. Also discussed in a few other threads elsewhere on SDN.

$12 Million after Baby's Oxygen Mask Ignites and severely burns

A Baby's Oxygen Mask Ignited During Surgery I have never been involved in an airway fire. I never want to have one. From just the information in the newspaper article, I think that this airway fire was avoidable.

forums.studentdoctor.net

 

[Vandalia]

That may happen. I know of a CRNA that had a DUI and had their license revoked. This is worse in my opinion as Meeker actually seems to practice incompetently and dangerously as evidenced by 2 catastrophic events.

I did a quick check and if I got the right guy he is 68 years old. I doubt he cares about his license at this point.

 

[AdmiralChz]

This case hopefully has been referred to the state board of medicine, but at least in my state they don’t cover CRNAs. If this happened around me and what they are alleging actually happened both parties would probably have their licenses provisionally suspended, at least the anesthesiologist. No clue what the nursing board would do.

Like many of us I have worked in office environments with equipment less than the ASA standard - often its lack of ETCO2 monitoring, but I know of one location they doesn’t even monitor continuous SpO2 in the PACU after a general. I’ve also seen - dead/broken laryngoscopes, no sealed ETTs (including one place with only uncuffed tubes for adults?!), no NG/OG tubes, and used disposable LMAs that are washed off with soap and water then put into a common bin. Many places also buy used, refurbished ventilators which are often total crap.

It can be a scary wild, Wild West out there with a lack of regulatory agencies covering it. Beware before agreeing to cover and office - you must go and assess equipment first.

 

[PieOHmy]

Yup. Plastic surgeons are generally a pain in the ass. Gotta love the guy who thinks you can run a 10 hour anesthetic for a flap case with no pressors. I just nod my head, smile, and lie through my teeth as I lace the iv fluids with phenylephrine.

You actually CAN dannyboy.
So many people think you have to be running 2% sevo or the patient will get recall.
You can back off on your anesthetic A LOT and patient will still be anesthetize.
Match the surgical stimulation to level of anesthesia. If there is NO or very little surgical stimulation dial it down. 0.8, 0.7 sevo.. You WON'T get recall with that. One of my pet peeves is people leaving the dial on 2.5% and giving a **** ton of neo.. Dial that **** down...
Length of case should have zero to do with if you use pressors or not.
In fact when I trained a few of my attendings would throw out all pressors that i drew up.... Those are for amateurs they would say.

 

[dannyboy1]

You actually CAN dannyboy.
So many people think you have to be running 2% sevo or the patient will get recall.
You can back off on your anesthetic A LOT and patient will still be anesthetize.
Match the surgical stimulation to level of anesthesia. If there is NO or very little surgical stimulation dial it down. 0.8, 0.7 sevo.. You WON'T get recall with that. One of my pet peeves is people leaving the dial on 2.5% and giving a **** ton of neo.. Dial that **** down...
Length of case should have zero to do with if you use pressors or not.
In fact when I trained a few of my attendings would throw out all pressors that i drew up.... Those are for amateurs they would say.

In long cases, especially in the bad hypertensives or the elderly the BP goes to ****. Usually happens around hour 8 or so. Even with 1/2 MAC of gas and minimal narcotic. With adequate fluid replacement and perfect labs. I look at it at the patients way of saying “this case has gone on to fu(king long”
I hate having to work harder just because the surgeon is slow as hell. Neo works just fine.

 

[coffeebythelake]

You actually CAN dannyboy.
So many people think you have to be running 2% sevo or the patient will get recall.
You can back off on your anesthetic A LOT and patient will still be anesthetize.
Match the surgical stimulation to level of anesthesia. If there is NO or very little surgical stimulation dial it down. 0.8, 0.7 sevo.. You WON'T get recall with that. One of my pet peeves is people leaving the dial on 2.5% and giving a **** ton of neo.. Dial that **** down...
Length of case should have zero to do with if you use pressors or not.
In fact when I trained a few of my attendings would throw out all pressors that i drew up.... Those are for amateurs they would say.

Your attendings must have never taken care of sick patients?? What you are talking about is anesthesia 101.

 

[deleted697535]

You actually CAN dannyboy.
So many people think you have to be running 2% sevo or the patient will get recall.
You can back off on your anesthetic A LOT and patient will still be anesthetize.
Match the surgical stimulation to level of anesthesia. If there is NO or very little surgical stimulation dial it down. 0.8, 0.7 sevo.. You WON'T get recall with that. One of my pet peeves is people leaving the dial on 2.5% and giving a **** ton of neo.. Dial that **** down...
Length of case should have zero to do with if you use pressors or not.
In fact when I trained a few of my attendings would throw out all pressors that i drew up.... Those are for amateurs they would say.

I agree run most people at 0.8 Mac or so but...

Mac changes neither with duration of surgery nor stimulus.

What is Mac?

 

[PieOHmy]

I agree run most people at 0.8 Mac or so but...

Mac changes neither with duration of surgery nor stimulus.

What is Mac?

Your attendings must have never taken care of sick patients?? What you are talking about is anesthesia 101.

Dial that **** down... you will find magically you dont need neo as much!!
If you are that worried slap a BIS on

 

[WholeLottaGame7]

I agree run most people at 0.8 Mac or so but...

Mac changes neither with duration of surgery nor stimulus.

What is Mac?

He's not saying 0.8 MAC sevo, he's saying 0.8% sevo, so like 0.3-0.4 MAC. That's cutting it awfully fine to some awareness and/or movement unless you're redosing midaz (not a great option for all those 60+ yo flaps we do) or a remi gtt (for 10 hours? yikes). Maybe a nice sufentanil infusion?

I agree with the sentiment, though. Hate seeing a patient hypotensive on 2.5% sevo. C'mon, bro/bro-ette.

 

[deleted697535]

He's not saying 0.8 MAC sevo, he's saying 0.8% sevo, so like 0.3-0.4 MAC.

He's not is he? Omg I hope not.

Please post some evidence for this being safe?

Bis? Bis? Seriously? Am I reading this correctly? I don't know what to say...

 

[WholeLottaGame7]

I do LMA for my endoscopic DCR and MAC for most of my other cases (eyelids, browlift, facelift) which can be anywhere from 1-4 hours. Why is MAC such a bad idea if the anesthesiologist can manage it?

It helps if you're "doing" something or requesting somebody else to do something for you, to know what you're asking for. Whenever a surgeon asks for "MAC," I immediately know they have no clue what they're talking about, and instead just ask them what their goals/needs for the procedure are.

Since you seem to be here to learn, let me explain.

If I put monitors on your patient and watch his vital signs for 15 minutes while we do nothing but chat about the weather for 15 minutes, that's monitored anesthesia care.

If I intubate, place an a-line, central line, PA catheter, and epidural, and constantly give blood/titrate pressors, that's monitored anesthesia care.

There are 4 levels of sedation: anxiolysis, moderate, deep, and general. If you want the patient to cooperate, they are getting anxiolysis or maybe moderate sedation. If you want them to be asleep and not remember a portion of the procedure, regardless of whether they have an ETT, an LMA, or a nasal cannula, they are getting deep sedation or a GA.

Just google "ASA sedation scale," and read the chart. Every proceduralist who writes for sedation or works with anesthesiologists should be familiar with that chart. Sadly, if you do read it, you will be ahead of 99% of your colleagues, and even more sadly, probably 30% of anesthesiologists.

 

[dpmd]

It helps if you're "doing" something or requesting somebody else to do something for you, to know what you're asking for. Whenever a surgeon asks for "MAC," I immediately know they have no clue what they're talking about, and instead just ask them what their goals/needs for the procedure are.

Since you seem to be here to learn, let me explain.

If I put monitors on your patient and watch his vital signs for 15 minutes while we do nothing but chat about the weather for 15 minutes, that's monitored anesthesia care.

If I intubate, place an a-line, central line, PA catheter, and epidural, and constantly give blood/titrate pressors, that's monitored anesthesia care.

There are 4 levels of sedation: anxiolysis, moderate, deep, and general. If you want the patient to cooperate, they are getting anxiolysis or maybe moderate sedation. If you want them to be asleep and not remember a portion of the procedure, regardless of whether they have an ETT, an LMA, or a nasal cannula, they are getting deep sedation or a GA.

Just google "ASA sedation scale," and read the chart. Every proceduralist who writes for sedation or works with anesthesiologists should be familiar with that chart. Sadly, if you do read it, you will be ahead of 99% of your colleagues, and even more sadly, probably 30% of anesthesiologists.

That and more is on the quiz we have to take if we want moderate sedation privileges so guess i am a 1%er. As a general surgeon most of what i do requires general so I don't usually discuss an anesthesia plan except for my smaller cases when I tell them what I plan to do and how long I think it will take (knowing that surgeon's mental clocks tend to move slower in the or and I have on occasion looked up thinking only an hour has passed but in fact it has been longer so I try to account for that in my estimate) and what position I need them in then let them decide how to best accomplish it all. If I know something that leans one way or another (like the patient is super stoic and cooperative, versus they are big druggies needing high doses just for applying a dressing over their abscess) I will share that but ultimately as long as I can get in the room with minimal MAFAT (mandatory anesthesia f*cking around time, mostly a joke but there are a couple of super methodical docs who take at least twice as long as their colleagues to start induction) I am fine with whatever they choose. Though I do appreciate knowing when i should be careful what i say if patients are not deeply sedated (which everyone I have worked with so far tends to do)

 

[Mikkel]

He's not saying 0.8 MAC sevo, he's saying 0.8% sevo, so like 0.3-0.4 MAC. That's cutting it awfully fine to some awareness and/or movement unless you're redosing midaz (not a great option for all those 60+ yo flaps we do) or a remi gtt (for 10 hours? yikes). Maybe a nice sufentanil infusion?

I agree with the sentiment, though. Hate seeing a patient hypotensive on 2.5% sevo. C'mon, bro/bro-ette.

I run MAC 1.5+ on most patients, with usually no need for neo or ephedrine. That's the power of single-drug anesthesia (no narcotic or benzodiazepine).

 

[caligas]

I run MAC 1.5+ on most patients, with usually no need for neo or ephedrine. That's the power of single-drug anesthesia (no narcotic or benzodiazepine).

PACU called, they’re running out of Zofran.

 

[dhb]

PACU called, they’re running out of Zofran.

Gases alone are not very emetic. Most PONV is caused par opiates.

 

[deleted697535]

I run MAC 1.5+ on most patients, with usually no need for neo or ephedrine. That's the power of single-drug anesthesia (no narcotic or benzodiazepine).

Is that also a joke? Wtf is going on around here these days

 

[deleted697535]

Gases alone are not very emetic. Most PONV is caused par opiates.

Wtf? Seriously is someone having a laugh here today? Do you guys practice on mars or something?

 

[dhb]

Wtf? Seriously is someone having a laugh here today? Do you guys practice on mars or something?

The good thing about this forum is that everybody practices the same cookie cutter anesthesia and we can all pat ourselves on the back for a job well done!
Merry Chirstmas and happy Brexit

 

[deleted697535]

1.5 Mac probably isn't good for people's brain man. And totally unnecessary.

 

[BLADEMDA]

FWIW, I typically see mid levels do run 1.5 MAC in terms of Inhalational agent. I prefer 1.5 MAC over 0.5 MAC but do agree there is room to improve.

I do think that on the margins use of opioids and excessive inhalational agent May increase post op nausea/vomiting but with our typical prophylaxis To prevent N/V the incidence is low.

This type of stuff really isn’t a big deal on your ASA1 or 2 patient.

 

[Noyac]

You make good points and I appreciate your input. Some surgeons are very pompous and elite ish towards us and that creates the problem. Maybe if we both understood where each other was coming from it would be easier.

We certainly do get some requests from surgeons that make no physiologic or pharmacologic sense and that irks us. Just last week I had a plastic surgeon request prone, in an obese guy with a huge beard and recently reversed trache. She said she would cancel the case if we used any form of paralytic incl sux, mag, cis, roc ever. Not even demonstrable tof after suggamadex would do. (she didn't know what suggamadex was)

well I can work with just about anyone but this surgeon described here would have to find another anesthesiologist.

 

[Noyac]

For justice to occur in this case Mr. Meeker must be punished by the Board of Nursing which IMHO should include loss of license to practice as a CRNA.

This is were the state medical board and the ASA need to come together and focus their efforts. The board of nursing is running amuck. This guy has a prior event on his record. We don’t know the details of it but now he has struck again. It is possible that the prior event was an unavoidable misadventure but this one seems to point in another direction. The state nursing boards need less autonomy since they are not qualified to make sound medical decisions and have proven to have an agenda.

 

[deleted697535]

well I can work with just about anyone but this surgeon described here would have to find another anesthesiologist.

Yeah it bugged me a bit too but I told her if I'm in any bother with the airway we're paralyzing. It went fine in the end and I was just in a mood to play around. Had a resident too who wanted to learn

 

[AnesRunner]

Similar story.

Chula Vista Cosmetic Surgeon Sued Over Patient's Death

It was supposed to be a routine breast augmentation surgery, but it went horribly wrong and left a 35-year-old wife dead and her two young children motherless.

www.google.com

Ouch. I knew Carlos from residency. His wife is listed as the practice's NP on his website.

 

[ShockIndex]

There was a comment about not working for an attorney for less than $1M/hr. To that I will tell you that there are people that practice far below what everyone would consider the standard of care. I’ve seen the records. I’ve read the reports. These people deserve to be sued, sanctioned, and potentially lose their license. They cause avoidable harm and destroy lives. I’m not talking about bad luck, surgical misadventures, etc. I’m referring to gross malpractice.
Completely negligent care obvious to everyone in the field.
It happens. It likely happened above if 1/2 the facts are true.
The legal system is appropriate for that and there is no reason to not support those cases. This family should receive compensation for their damages, ongoing care for their neurologically devastated child, etc. If any of the allegations are true it’s indefensible and avoidable harm. Which is why it will settle and the details never known.
Perhaps the patient got “sedation” for the block and then the CRNA left during set up for lunch or a dump or whatever. That’s difficult to defend as anything less than abandonment and malpractice, if not criminal negligence.

This is very true. Here is just a sampling of the really, really depressing stuff that as come across my desk for expert witness testimony:

1) A 30ish year old patient given 1 mg of IV 1:10,000 epi for their rash resulting in MI. Nurse told the MD she was uncomfortable pushing the med; MD tells nurse not to worry, they do it all the time.

2) 40ish year old patient who was narcotic naive discharged from the ED with a 100 mcg/hr Duragesic Patch on her arm for acute pain. Plaintiff’s attorney found multiple emails from hospital admin informing the ED physician group of the Black Box warning as other patients at the institution had complications from the drug being applied in the ED, and the drug was taken out of the ED Omnicells. Patient found dead in bed the next day with the patch still on...

3) Late 40s executive with a Type A dissection seen on multiple imaging modalities over a 12-hour period, each with a progressively enlarging pericardial effusion. No attempt at shear stress control over the 12-hr period while awaiting CT surgery consult and patient arrested in front of the anesthesiologists during pre-op.

There are plenty others that are ongoing cases that would blow your mind.

 

[PieOHmy]

This is were the state medical board and the ASA need to come together and focus their efforts. The board of nursing is running amuck. This guy has a prior event on his record. We don’t know the details of it but now he has struck again. It is possible that the prior event was an unavoidable misadventure but this one seems to point in another direction. The state nursing boards need less autonomy since they are not qualified to make sound medical decisions and have proven to have an agenda.

this is a political debate that the AMA cant even tackle.. or does not WANT to tackle

 

[Ronin786]

Hey can u link some references regarding this? We deal w this problem all the time. It's like all these plastic surgeons are trained by the same person. I ofyen work in some neo because it is the best thing for the patient. Next time my residents ask me about this I can show them...

Intraoperative Use of Vasopressors Does Not Increase the Risk of Free Flap Compromise and Failure in Cancer Patients

Objective:To examine the effects of vasopressors on free flap outcomes.Background:Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistica

insights.ovid.com

 

[Noyac]

this is a political debate that the AMA cant even tackle.. or does not WANT to tackle

I don’t know anything about the AMA. Haven’t given a ****e about them in over 15 yrs.
But the ASA is slowly paying attention. They are still a pushover for the nurses because they lack cojones.
However, the pressure from front line anesthesiologists is starting weigh on them. Keep It up.
It amazes me how quickly and fervently they get the message out to our base when the revenue (opt out legislation) is jeopardize. But they act like they are walking on thin ice when dealing with the AANA.

 

[pgg]

I don’t know anything about the AMA. Haven’t given a ****e about them in over 15 yrs.
But the ASA is slowly paying attention. They are still a pushover for the nurses because they lack cojones.
However, the pressure from front line anesthesiologists is starting weigh on them. Keep It up.
It amazes me how quickly and fervently they get the message out to our base when the revenue (opt out legislation) is jeopardize. But they act like they are walking on thin ice when dealing with the AANA.

It's not that the ASA lacks cojones, it's that they're beholden to all of their members who are making cash off 3:1 and 4:1 schemes. Let's be honest, the ASA does what its members tell it to do, and its members are clearly still telling it not to rock the boat and upset the nurses. Every single MGMA 75+ ACT practice in North America, regardless of how well controlled and well behaved they assure us their CRNAs are, is happy with the status quo.

As the world increasingly shifts to AMC- or hospital-employed models where the doctors aren't getting a piece of the CRNA-leveraged profits, maybe ... maybe ... enough of the ASA membership will demand meaningful action.

I honestly don't expect that to happen in the remaining 10-15 years of my working career. I have to admit I'm left wondering exactly why I have ever been an ASA member, or why I was a chairman's council level ASAPAC donor for a while (on my .mil salary, no less).

I feel like a chump that I was ever an AMA member - that organization clearly hates doctors who work for a living. I quit giving those wankers money about 10 years ago. But I can't but help feel like a superchump for giving the ASA and ASAPAC money.

 

[caligas]

It's not that the ASA lacks cojones, it's that they're beholden to all of their members who are making cash off 3:1 and 4:1 schemes. Let's be honest, the ASA does what its members tell it to do, and its members are clearly still telling it not to rock the boat and upset the nurses. Every single MGMA 75+ ACT practice in North America, regardless of how well controlled and well behaved they assure us their CRNAs are, is happy with the status quo.

As the world increasingly shifts to AMC- or hospital-employed models where the doctors aren't getting a piece of the CRNA-leveraged profits, maybe ... maybe ... enough of the ASA membership will demand meaningful action.

I honestly don't expect that to happen in the remaining 10-15 years of my working career. I have to admit I'm left wondering exactly why I have ever been an ASA member, or why I was a chairman's council level ASAPAC donor for a while (on my .mil salary, no less).

I feel like a chump that I was ever an AMA member - that organization clearly hates doctors who work for a living. I quit giving those wankers money about 10 years ago. But I can't but help feel like a superchump for giving the ASA and ASAPAC money.

ASA is far from perfect, but their advocacy efforts against anti anesthesiologist legislation make them better than nothing.

I appreciate you giving. I think many people talk about the ASA being weak as an excuse not to give.

 

[AdmiralChz]

Please, don’t waste your time with the AMA. They lost a tremendous amount of membership when they backed the deeply-flawed Obamacare/ACA legislation. They have spent the better part of 10 years defending that decision and focusing on increasing insurance rates... while completely missing the mid level uprisings in primary care and elsewhere. The AMA had next to nothing to say with the VA independent practice rules. I don’t know who they cater to (certainly not PCPs, or anesthesiologists). Say what you will about the ASA, but the balanced billing legislation problem showed they can be effective when pressed. My group pays for both memberships as a courtesy, but myself and several others refuse to be AMA members.

One useful thing the AMA does is give a big CME certificate for board certification. It cost like $20 or something, and satisfied my biannual state requirement.

 

[caligas]

Does anyone else get, like, daily dues statements from the AMA?

They must just shower the world with the dues statements and from time to time someone just pays it without thinking, probably by office staff.

 

[dpmd]

Does anyone else get, like, daily dues statements from the AMA?

They must just shower the world with the dues statements and from time to time someone just pays it without thinking, probably by office staff.

They purposefully make it look like just a routine renewal to something you are already a member of hoping someone else is paying your bills and doesn't know better.

 

[caligas]

They purposefully make it look like just a routine renewal to something you are already a member of hoping someone else is paying your bills and doesn't know better.

...like any legitimate organization

 

[DrZzZz]

Does anyone else get, like, daily dues statements from the AMA?

They must just shower the world with the dues statements and from time to time someone just pays it without thinking, probably by office staff.

I happily stick the prepaid return envelope in the mail, empty, every time I get one. The postage fee they eat is small, but it doesn't cost me any effort to stick the envelope in my mailbox and keeps the USPS workers employed

 

[dpmd]

I happily stick the prepaid return envelope in the mail, empty, every time I get one. The postage fee they eat is small, but it doesn't cost me any effort to stick the envelope in my mailbox and keeps the USPS workers employed

You could stuff the envelope full of trash to increase the fee supposedly

 

[VA Hopeful Dr]

I happily stick the prepaid return envelope in the mail, empty, every time I get one. The postage fee they eat is small, but it doesn't cost me any effort to stick the envelope in my mailbox and keeps the USPS workers employed

That's clever, I am stealing that idea