Thursday, July 26, 2007

I got sued part 2

Actually maybe things didn't go that well. As the case wore on, she required more oxygen to keep her saturation up. In retrospect, the rotten food I should have sucked up was probably getting past my et cuff.

So I decided to keep her intubated, get a chest X-ray and call ICU.

I took her out to recovery and put her on a ventillator there and called ICU who sent their fellow over right away. As it turned out her oxygenation got worse in the next few minutes and her CXR was gross.

To make a long story short, she spent several months in the ICU, a few more in hospital but was actually discharged with no new deficits. Not that spending a few months in ICU is necesartily a good thing.

I had a somewhat unpleasant meeting with my chief, (who you may recall was the individual who was able to see the patient in a relaxed un-hurried fashion in the preassessment clinic and failed to document the patient's achalasia) and called the Canadian Medical Protective Association.

Several months later the patient's father called me up and asked to meet with me regarding what had happened to his daughter. I called up the local lawyer on my case who advised me to only meet with a lawyer present. I phoned the father back and told him, this. His response was, "Is this how you doctors handle things?" I often think if I had just met with him I might have avoided legal action (or least shifted blame onto the surgeon and my chief). A few weeks later he called me up and asked if he could photocopy the chart. As patient charts are legally the property of the patient, I told him to go ahead. Unfortunately the hospital refused to let him photocopy the chart which lead to me receiving a letter from his lawyer. Strike two.

Time passed. In my province at that time you had only one year to file a lawsuit. As eleven months rolled by, I began to feel good about myself again. At eleven months and two weeks I got served! Along with the surgeon, and the hospital. Curiously my chief managed to escape.

About 2 years later I had what is called an examination for discovery. This is a process in civil suits where you sit down and the other lawyer questions you. Your lawyer is present, but does not ask questions; he may interupt to clarify and he may by hand or eye signals caution you on answering a question. The plaintiff is usually present, although there is no requirment that she be there.

This of course involves taking a day off work although in anaesthesia one can do this by working around the call schedule. The other side of course cancelled the first session on short notice and we had to reschedule.

Now as I have said, there were mitigating factors; the bottom line is that I screwed up. I could have and should have dug deeper asked more questions of the surgeon and patient. I should have got the chart back from the surgery resident. I should have cancelled the case after the induction. I should have checked for a suction. Blah, blah, blah. I should have done all these not so I wouldn't get sued, but rather to prevent a patient would was told she was coming for a simple short stay surgery that would solve her problems forever from spending months in the ICU, a fate I would wish on no-one (even my chief).

The other lawyer of course missed all this in his two hour interogation. The examination ended with the curious question, "Did you give her chlorine" to which I answered no.

Now there were a few other problems. As I mentioned the patient was deaf-mute. She also had a variety of pre-existing neurological problems which of course nobody bother documenting pre-operatively. Also in the ICU as they began to wean her off her sedatives, she developed twitching, which the neurologist said was due to "anoxic brain damage". Although the patient required high concentrations of oxygen and other ventillatory support she was never even hypoxic, let alone anoxic.

Eventually the case was settled out of court for a low six figure amount.

The only consolation when something bad happens to one of your patients, is that you learn something that will help future patients, and the institution may make changes that may prevent future events. I have done achalasia patients since uneventfully and I now know what a "Heller's Myotomy" is. I can even google it now:

Years later I was talking to the scrub nurse in that case and I learned why I had a student nurse helping me. At that time, in the Centre of Excellent, each service had its own head nurse in the OR. Some of the head nurses actually helped out. The head nurse in this case usually didn't. On that particular day because they were behind and were busy setting up for this laparoscopic procedure, they asked the head nurse if she could help me get the case started. Her response was to send the student nurse in to "help" me. I gather that when her bosses in the OR asked her why she didn't help me, she said it was because she didn't like me. At that time I had worked at the CofE for 3 months and had never worked in her room so I must have managed to piss her off in the first couple of hours that day. She retired a couple of months later. This says something about the institutional culture at the Centre of Excellence. Normally when you give an excuse like "I didn't help him because I don't like him", the usual response would be "I don't care whether or not you like him...your job is to help him". As it was one of the items discussed with my chief at the unpleasant meeting I mentioned above was the fact that according to my chief after 3 months all the nurses hated me. Well I certainly wasn't too impressed with the nurses around that time.

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