Play Stupid Games, Win Stupid Prizes...

[epidural man]

its pretty hard to fry the cord with an RF. not sure what to make of that, but it is surprising that there was BOTH the cord damage AND the anoxic injury. regardless, the woman is dead and the care was awful. so much wrong here

The cord was not injured - according to the notes by expert witness.

The DURA had "focal hemorrhage" which would be expected if a needle punctured the dura. The dura was distended which means the local was probably injected into the spinal fluid - how much is unknown. The bradycardia points to this conclusion as well - basically she got a high-spinal.

I'm not surprised the outcome turned out this way, although the problem seemed to be recognized fairly early. She received positive pressure ventilation via mask until she was intubated (but apparently in the wrong spot) which was recognized and re-intubated. Perhaps it was during this time that actually killed her.

According to the expert witness, there was no fluoroscopy being used.

---

Members don't see this ad.

 

[Agast]

I think fluoro was used for the RFA, and when he had the brilliant idea to shoot her up with local at the end he either did it blind or instructed the Xray tech not to save that image

 

[gaseous_clay]

Straight up murder. WTF is up with the Texas Medical Board? THey need to get off their lazy butts and start cleaning up Pain in that state.

Those of you who have a TX medical license receive monthly emails from the board listing the numerous physicians they reprimand with slaps on the wrist. I have yet to see them go after big fish like this.

 

[clubdeac]

Hello friends, I am not a pain management doctor (but I guess neither is the owner lol ..). Are those procedures above buzz words to avoid that practice? Do those procedures work? are they taught to pain management doctors? What would your good/conscientious attendings teaching students say about a practice as above.

The reason I'm asking is because I'm trying to get a feel for the mindset and culture of a practice that lets CRNA pretend to be doctors and perhaps get innocent people killed like Mrs Ray. A practice that affiliates with Drs like Gallagher who ok infusions that got Ms Jenifer Cleveland killed in Wortham Tx.

To me this practice needs to be shut down and an investigation by the State Medical board should be started. The wild thing is that the CRNA Houghton continues to work there.

Pain Management Experts With Years Of Experience

Texas Partners Healthcare Group has cared for thousands of patients in the Dallas-Fort Worth (DFW) metropolitan area for years.

txphealthcare.com

Im afraid innocent people are being duped of their money and worse killed !

What can we do?

That ship sailed long ago. Needed to rein in mid level creep legislatively years ago. If you’re truly interested in getting involved by the book “Patients at Risk” and join the group physicians for patient protection

 

[futhermore204]

I found more details on Dallas County Civil Court’s website

https://courtsportal.dallascounty.org/DALLASPROD/Home/WorkspaceMode?p=0

The expert witness testimony fills in some of the details

https://courtsportal.dallascounty.org/DALLASPROD/DocumentViewer/Embedded/B_Hi9DxQXTDjJR72sZFRPLQP9zmNEzTharg9vh80P0elG1wBb73DzxzmR6PwK-4IFZNs1U0ZP795SynWNsd5mQ2?p=0

Basically, Houghton is under the supervision of Baber Younas, MD, who is an anesthesiologist who seems to have grandfathered himself into interventional pain without doing a fellowship. This might explain why he hired a CRNA to begin with, he didn’t get formal training himself so he has no respect for the process.

Autopsy showed focal hemorrhage and distension of the dura with CSF, so had she survived Mrs Ray would likely have been paralyzed.

However in a brilliant stroke of incompetence, the CRNA providing anesthesia, Molina, had a documented history of substance problems and impairment at work x2 (known to Texas nursing board). He straight up administered a whopping 200mg of propofol and 100mcg of fentanyl to Mrs Ray for the RFA at the beginning of the procedure. For the non-anesthesiologists, that’s an intubating dose for a big dude. No one breathes through that. (It’s such a mind-boggling dose that I’m wondering if our substance-abusing friend actually gave her less than that and squirreled away the rest for his own fun later? But that probably wouldn’t help his case to say he falsified the records to support his habit).

So poor Mrs. Ray got a one-two punch. The first CRNA suffocates her. The second CRNA spears her spinal cord.

This is actually a good case of greedy doctors supervising unqualified CRNAs to do procedures and make more money.

wow, looks like they are compelling the physician to disclose financials. Reasons cited. Apparently guardrails were not enforced to prevent the tragic death. And what's nuts is some anesthesia recording equipment data was erased ! looks like its going to trial. Does it remain malpractice or does it turn criminal? see attached. Start at page 5. Public domain.

 

[Agast]

Wow, the run down at the end of who all is employed by that group is…spectacular

 

[futhermore204]

Wow, the run down at the end of who all is employed by that group is…spectacular

Loll.. sad. And the owner anesthesiologist made one of his cRNAs send him a breath analyzer test picture in the morning everyday before reporting to work. Was he just winging it to ensure safety or was that from the Texas State Medical Board? I suspect the former.

Question:
"For example, in this case the important data contained on the anesthesia machine used for Mrs. Ray was destroyed. This evidence would have shown exactly when Mrs. Ray first stopped breathing and when her vital signs first showed signs of trouble"

what machine is this guys? is it standard of care to keep this data ? who has access to delete it? That's gonna be key.

 

[thiswonthurtabit]

Holy ****, what kind of place employs that many people with significantly shady pasts? That's insane.

 

[futhermore204]

Holy ****, what kind of place employs that many people with significantly shady pasts? That's insane.

Makes me think that my peers must have shady pasts and I'm just unaware. Perhaps shadiness is more common than what we would surmise.

 

[Laryngospasm]

And here I am struggling to get unilateral rfa approved by Medicare.. maybe I should just add unnecessary MACs, neuromonitoring and a little ESI at the end to top it off and it would get approved. I’ve been doing it all wrong.

 

[SeniorWrangler]

Holy ****, what kind of place employs that many people with significantly shady pasts? That's insane.

They probably work for peanuts and don’t ask too many questions.

 

[futhermore204]

They probably work for peanuts and don’t ask too many questions.

Nah... Probably they are getting a lot of money being OK doing shady stuff the owner of the practice is peddling.

 

[futhermore204]

So here is the opinion of Dr. Christian who rips apart Integrity Wellness Center and the docs, nurses, and day time TV CRNA wanna be docs. See around page 20

"Dr. M prevented the EMS from attaching capnography because it would have clearly demonstrated that the intubation was not done properly" WTF

Owner Anesthesiologist Doctor hired at least 5 shady incompetent people to run the facility. Google reviews are still excellent though.
Besides us is the public unaware?

How is this place still treating people after the death of a mother who went in for a routine procedure and no checks and balances in place?

Seems like the case is going to trial in a month.

Integrity Wellness Center

iwcsurgery.com

Integrity Wellness Center
920 S Belt Line Rd #250, Coppell, TX

 

[futhermore204]

You can read all that transpired in this pdf.

I must say this Dr. Christian who is in practice for 30 + years shreds the defendants savagely.

https://tinyurl.com/2e3en4un

 

[Agast]

No capnography and also no pulse oximeter on an intubated patient. Amazing.

 

[futhermore204]

In my mind, we are churning out too many NPs, PAs and CRNAs. Why don't they open up new medical schools? Its impossible getting into medical school these days. You know why I think its not happening ? because its cheaper for folks like Dr. Baber Younas to hire CRNA's to do the procedures than doctors. And he did not even do a pain management fellowship !!

Of course patients are going to get hurt and die like in these cases. As you may recall Jenifer Cleveland died due to lack of supervision. A medspa death, an investigation and a license suspension - ClearHealthCosts

In regards to Ms. Kimberly Rays death, from the court documents Dr. Baber Younas, Houghton, and Molina settled. Dr. Mandava has not yet. It Should have gone to trial in my opinion. We need exposure to change some disturbing medical industry trends.

Exposing the ineptitude credentialing, made up monitoring for substance abuse within the clinic, deletion of monitoring data, nepotism with hiring, and as seen on TV doctors played by CRNA Houghton would have exposed the behind the scene dangers in outpatient surgical centers. Also we need to stop the out of network billing shenanigan's that make greedy doctors richer.

Dr. Baber Younas owns the outpatient surgical center where Ms. Kimberly Ray died ( Integrity Wellness Center )and is the hiring doctor of Dr. Mike Gallagher, CRNA Houghton, CRNA Molina and Dr. Mandava.

He owns Texas Partners Health Care Group Pain Management Experts With Years Of Experience where CRNA Houghton is proudly on the front page. He thinks hes a doctor. he told Kimberly Rays family he was ! Such BS. After all the training we do, we let CRNAs do doctor procedures and kill folks. Come on, open up new medical schools !

 

[RM38]

They are opening new schools. Since I started med school in 2008 the number of DO schools in the US has probably doubled. FL also opened 3 new MD schools, including 1 at a place where they already have a DO school.

 

[futhermore204]

They are opening new schools. Since I started med school in 2008 the number of DO schools in the US has probably doubled. FL also opened 3 new MD schools, including 1 at a place where they already have a DO school.

Not fast enough for the growth in population. I think the intention is to have less doctors and off load to midlevels. That hurts patients and saves money for the hospitals and greedy doctors.

 

[MitchLevi]

Med school slots are irrelevant if there aren’t a proportional increase in PGY spots.

 

[bedrock]

Med school slots are irrelevant if there aren’t a proportional increase in PGY spots.

I’d rather we have more US grads and less IMG practicing in america.

I do agree some increase in residency slots makes sense but not a proportional increase. Too many weak IMG candidates.

We need the vast majority of American physicians to have completed all of
their medical education in America.

 

[buddababa]

I’d rather we have more US grads and less IMG practicing in america.

I do agree some increase in residency slots makes sense but not a proportional increase. Too many weak IMG candidates.

We need the vast majority of American physicians to have completed all of
their medical education in America.

I usually agree with most of your statements. But this one is not backed by data. I’ve seen plenty of IMG who are loads smarter, stronger and better than plenty of US grads

 

[Agast]

It really depends on the country of origin. Medical training is really different and if there is less culture of meritocracy…well, they’re not sending their best.

 

[futhermore204]

It really depends on the country of origin. Medical training is really different and if there is less culture of meritocracy…well, they’re not sending their best.

That's so not true. Its extremely competitive getting into medical school in other countries as well. At the end of the day we all know how hard Step 1 is etc etc. To get through that you got what it takes at least academically to be a doctor. But there is so much more to it as you know. Academics, Affability and Availability come to mind. And don't forget not having a lex luthor like temperament helps.

 

[futhermore204]

Suspended Wortham med spa doctor linked to North Texas medical facility being sued over Arlington mother's death

Recently suspended Frisco doctor, Michael P. Gallagher, was chief anesthesiologist at Integrity Medical Center where Kimberly Ray was treated, per family attorney.

www.kcentv.com

Attorney General getting involved. News just yesterday. Good.

MSN

 

[MitchLevi]

I’d rather we have more US grads and less IMG practicing in america.

I do agree some increase in residency slots makes sense but not a proportional increase. Too many weak IMG candidates.

We need the vast majority of American physicians to have completed all of
their medical education in America.

Proportional shouldn’t be taken literally, and instead more figuratively.

If we increase the number of med school seats by a lot, we need a lot more residency spots.

Not all programs fill obviously.

If we have 50k med school spots and 40k residency spots, what exactly are we doing?

 

[clubdeac]

In my mind, we are churning out too many NPs, PAs and CRNAs. Why don't they open up new medical schools? Its impossible getting into medical school these days. You know why I think its not happening ? because its cheaper for folks like Dr. Baber Younas to hire CRNA's to do the procedures than doctors. And he did not even do a pain management fellowship !!

Of course patients are going to get hurt and die like in these cases. As you may recall Jenifer Cleveland died due to lack of supervision. A medspa death, an investigation and a license suspension - ClearHealthCosts

In regards to Ms. Kimberly Rays death, from the court documents Dr. Baber Younas, Houghton, and Molina settled. Dr. Mandava has not yet. It Should have gone to trial in my opinion. We need exposure to change some disturbing medical industry trends.

Exposing the ineptitude credentialing, made up monitoring for substance abuse within the clinic, deletion of monitoring data, nepotism with hiring, and as seen on TV doctors played by CRNA Houghton would have exposed the behind the scene dangers in outpatient surgical centers. Also we need to stop the out of network billing shenanigan's that make greedy doctors richer.

Dr. Baber Younas owns the outpatient surgical center where Ms. Kimberly Ray died ( Integrity Wellness Center )and is the hiring doctor of Dr. Mike Gallagher, CRNA Houghton, CRNA Molina and Dr. Mandava.

He owns Texas Partners Health Care Group Pain Management Experts With Years Of Experience where CRNA Houghton is proudly on the front page. He thinks hes a doctor. he told Kimberly Rays family he was ! Such BS. After all the training we do, we let CRNAs do doctor procedures and kill folks. Come on, open up new medical schools !

Agree but we also need to limit independent practice by these noctors and stop scope creep

 

[futhermore204]

Agree but we also need to limit independent practice by these noctors and stop scope creep

Whats scope creep?

 

[clubdeac]

Whats scope creep?

Are you kidding or being serious? There are numerous nurse anesthetist schools with pain fellowships cranking out “pain providers”

I feel bad for the young pain docs. Probably have maybe 10 years before the specialty is overrun by mid levels. Most PCPs already in my area are NPs

 

[MitchLevi]

The difference in education is so vast it’s hard to put into words. There are a bunch of PAs in my group, and I’ve had several myself. It’s just not the same. Not even the same sport.