Anesthesia

August 3, 2018

Pediatricians, with blast at FDA, warn of food additive and packaging risks to kids

Moms and dads who have tried to safeguard their kids’ health by emphasizing fresh fruits and vegetables in their diet may need to take yet more steps to protect youngsters from harms associated with chemicals found in common foods and their packaging.

The American Academy of Pediatrics has issued a formal, research-based caution to consumers about “colorings, flavorings, and chemicals deliberately added to food during processing (direct food additives) as well as substances in food contact materials, including adhesives, dyes, coatings, paper, paperboard, plastic, and other polymers, which may contaminate food as part of packaging or manufacturing equipment (indirect food additives).”

As the New York Times reported of the advisory from the group representing 67,000 doctors who care for kids:

June 26, 2018

Why are advance directives so key? Look at tough stats on ventilator survival

by Patrick A. Malone

Grown-ups with the least bit of gray on them may want to step up their thinking on how they want to receive medical care under tough circumstances, especially if they consider a new, clear-eyed and hard-nosed study that dispels any myths about possible life-sustaining “miracles” of artificial breathing machines.

A research team with experts from Boston, San Francisco, and Dallas studied 35,000 cases in which adults older than 65 had undergone intubation and use of mechanical ventilators at 262 hospitals nationwide between 2008 and 2015.

They found that a third of patients intubated died in the hospital.

July 17, 2017

Anesthesia residents offer eye-opening insights on drowsy MD perils

by Patrick A. Malone

Some of the very medical specialists who are supposed to put patients to sleep experience big problems themselves staying awake, with more than half of anesthetic trainees reporting in a new national survey in Britain that they had crashed their cars or nearly done so while headed home after long night shifts.

American doctors’ social media responses to this new research indicate that work weariness and drowsy driving are perils for practitioners on this side of the Atlantic, too.

The doctors’ complaints also underscores the irrationality of recent decisions by American medical educators to reinstate long shifts for interns and residents, trainees who play important—and sleep-deprived— front-line roles in providing medical services to too many patients in academic medical centers and hospitals nationwide.

June 11, 2017

Fla. justices reject keystones of partisans’ plan to undercut patients’ rights

by Patrick A. Malone

As congressional Republicans pursue their counter factual campaign this week to strip patients of their rights to pursue legal redress for harms they suffer while seeking medical services, the Florida Supreme Court has sent a powerful message to federal lawmakers about the wrongheadedness of some of their key notions.

The justices in Tallahassee have repudiated state lawmakers’ assertions of the existence of a “malpractice crisis,” in which dire action is needed to ensure doctors can get affordable liability insurance and be sufficiently protected to practice good medicine.

They also have rejected caps on patients’ claims for pain and suffering, finding that these limits on “non-economic” damages violate constitutional rights to equal protection under the law, and “arbitrarily reduce damage awards for plaintiffs who suffer the most drastic injuries.”

December 21, 2016

New cautions issued on babies and anesthesia, newborn screenings

by Patrick A. Malone

Some new cautions have been issued on some key aspects of children’s health care. The federal government is increasing its warnings on anesthetic use for children and expectant moms, while a newspaper investigation is raising issues with common newborn screenings and their inconsistency and inaccuracy. Meantime, a health news site is adding to questions about a much-touted program to reduce head trauma harms in kids’ athletics.

FDA warnings on anesthetics for babies, expectant moms

Let’s start with the federal Food and Drug Administration cautions on “repeated and lengthy use of general anesthetic and sedation drugs” with children younger than 3 and pregnant women. The agency says it has been studying potential harms of these powerful medications for these two groups since 1999, and will label almost a dozen common anesthetics and sedation drugs with new warnings.

February 3, 2016

Rationed care? MDs, hospitals say drug shortages are causing it

by Patrick A. Malone

When partisans want to terrify Americans about their access to health care, they use a code term: rationed care. It turns out that doctors and hospitals nationwide already have made that frightening prospect real: They tell the New York Times that drug shortages have forced them to make tough choices about limiting which patients get optimal treatment for serious conditions, including bladder and ovarian cancer, leukemia, Hodgkin’s lymphoma, myeloma, hemorrhages during heart surgery, and kidney disease.

Most practitioners and institutions don’t inform patients about drug shortages or curtailed care. Some hospitals and doctors say the whole situation puts them in a major ethical quandary.

It’s curious, though: the story doesn’t address as much as it might, in my view, a more fundamental issue: Big Pharma greed.

December 21, 2015

At least 1,000 patients died in U.S. dental care in last 5 years

by Patrick A. Malone

Let the patient beware is an adage that may need to be extended to yet another realm of healthcare: dentistry. Kudos to a reporting team in Texas for their recently published investigation, disclosing that dentists all too frequently are involved in procedures in which their patients die and that ineffectual regulators fail to halt dodgy practices and feckless practitioners, some of whom hopscotch across the country with impunity.

The seven-part Dallas Morning News series finds that at least 1,000 dental patients have died in the last five years due to questionable oral healthcare. The report says the numbers may be greater but that regulatory laissez-faire prevents the public from understanding the severity of the issue.

Patients who go to dental practices for issues as minor as tooth decay and as significant as oral surgery all have ended up dead, often after undergoing poorly supervised anesthesia, the paper says.

June 26, 2015

When Malpractice Starts with a Doctor’s Mouth

by Patrick A. Malone

A northern Virginia man successfully sued a doctor for defamation and medical malpractice, earlier this month receiving a judgment of $500,000 for the serious – and, frankly, weird – ethical and medical harm he suffered during a colonoscopy.

The case is weird because “defamation” is something plaintiffs who are medically harmed don’t often claim, and also because the proof of both the defamation and the malpractice was recorded by the man’s phone. During the procedure, he was under general anesthetic and dressed only in the standard hospital gown.

As the Washington Post explained,

“Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a ‘one-party consent’ state, meaning that only one person involved in a conversation need agree to the recording.”

June 11, 2014

“Distracted Doctoring” Puts Patients at Risk and Practitioners in Trouble

by Patrick A. Malone

When you’re anesthetized and under the knife in an operating room, you assume your surgical team is concentrating on you, not texting on an iPad. For one heart patient, however, that assumption was wrong.

Pacific Standard Magazine’s unsettling review of distractions during medical procedures described the circumstances of a malpractice case in Texas when a 61-year-old woman died after a relatively low-risk cardiac procedure to correct her irregular heartbeat.

Dr. Christopher Spillers, the anesthesiologist, had been using his iPad throughout the operation. In his deposition in a subsequent malpractice lawsuit, the surgeon testified that the anesthesiologist hadn’t noticed the patient’s dangerously low blood-oxygen levels until “15 or 20 minutes” after she “turned blue.”

November 7, 2011

Doctor’s Conviction Goes Far Beyond Mere Malpractice

by Patrick A. Malone

Propofol is a surgical anesthetic safely used only in a hospital operating room or a comparably equipped medical facility with continuous monitoring of the patient’s heart rate and breathing. The idea of using propofol as a sleep aid in a private home, with a doctor occasionally looking in? Unthinkable, before Michael Jackson’s death.

Now Dr. Conrad Murray has been convicted of manslaughter for his role in Jackson’s death. Murray was supposed to be Jackson’s personal doctor, a unique physician with only one patient, who was paid $150,000 a month by Jackson’s concert agency to keep the singer healthy.

Medical malpractice occurs when a doctor violates basic patient safety rules and causes harm to a patient. But this was much worse. Dr. Murray was guilty not just of breaking rules, but of a fundamental conflict of interest. Apparently seduced by his large monthly salary, he threw his medical judgment out the window and let Michael Jackson wheedle him into dangerous and ultimately fatal behavior with powerful prescription drugs. If he had “just said no,” like any ethical, responsible physician would have done, Jackson presumably would have shopped for some other doctor to supply him drugs. But then Jackson’s death would have been on some other hands, and Murray would not be facing prison and loss of his medical license.