CRNAs once again defamed... - page 2
Hi everyone. I am new to the board but have been a long time follower of the different threads here in this forum. I could not be thankful enough for all the shared wealth of information and... Read More
Jul 14, '04[
If you read through the article, it makes reference to the surgeon noting that Olivia's blood was crimson. Does this sound like methemoglobinemia to anyone else? It would explain the appearance of the "normal numbers."[/QUOTE]
I've seen methemoglobinemia twice and in both cases the blood was brown, like cocoa, not crimson.
Jul 14, '04I found this site that discusses a 2nd plastic surgery death at the same facility one month after the highly publicized Olivia Goldsmith case. The 2nd case involves an MDA, not a CRNA but I wonder if it got the same scrutiny.. and I wonder what Dr Kotler and MSNBC have to say about it....
Jul 14, '04Quote from HawaiiRNthey'd probably blame the circulator, or the pre-op nurses, then there would be a "reliable" documentary sold to the public about angels of death or something...I don't blame the docs on this one, they are just flailing to protect their collegues... it is clearly the media selling yet another crap sandwich.I found this site that discusses a 2nd plastic surgery death at the same facility one month after the highly publicized Olivia Goldsmith case. The 2nd case involves an MDA, not a CRNA but I wonder if it got the same scrutiny.. and I wonder what Dr Kotler and MSNBC have to say about it....
check it out...http://www.nursingadvocacy.org/news/news.html
Jul 15, '04DR. ROBERT KOTLER, PLASTIC SURGEON: Well, Deborah, in cosmetic surgery, the risk is not in the cutting and the sewing, it is in the anesthetic. And unfortunately, that's what happened to Olivia. There were problems with the anesthetic which shouldn't have occurred.
Of course there is risk in cutting and sewing. What about bleeding and infection? What about when they accidentally perforate the abdominal wall with that liposuction wand? What ever happened to the informed part of consent? I wonder if that is what he tells his patients, that the only risk is from the anesthetic! Scary.
Jul 15, '04The NY Times published an article in June about the deaths of these women. One of them had a lethal dose of lidocaine in her system, I believe they questioned whether the clinic knew ACLS protocol. And from what I remember, neither of these women were monitored in any way during their surgery. No respirations, no pulse ox. The patient's were given high doses of drugs, and no one paid any attention to them. Everyone was asleep at the wheel. The article did not point any fingers at CRNA staff, but it sound like a real mess.
Jul 16, '04The first death occured when a plastic surgery fellow injected lidocaine into the trachea by accident. The blood levels on autopsy showed four times the lethal dose of lidocaine in the body.
Unfortunately (according to the NY Times) a nurse anesthetist was taking care of the second patient when they arrested on the table. The Times article said that during this case which was done under MAC, no precordial stethoscope was used and "proper oxygen monitoring was not used". Whether that means no pulse ox is hard to tell but can be inferred. Maybe this CRNA was at fault but they certainly do not represent all anesthetists.
Jul 16, '04Quote from alansmith52someone post a link where I can do some educating.
This is from the NY Metro.com website
Only a month after Olivia Goldsmith died at Manhattan Eye, Ear and
Throat, there's been another death during a face-lift. Inside a hospital
By Beth Landman
It had been the most difficult of months at Manhattan Eye, Ear and
Throat Hospital. The death of novelist Olivia Goldsmith, who had gone
there for elective facial surgery on January 7 and entered an
irreversible coma within hours, became national news. Figuring out which
of the well-known surgeons who work there had operated on her became a
dark guessing game from Tribeca to Scarsdale. And Goldsmith herself
would have been embarrassed to write an ending so baldly and tragically
ironic: checking in to look more youthful--and never checking out.
Just as it seemed the storm was about to subside, the situation got
worse. On February 16, a second woman, Susan Malitz, the 54-year-old
wife of Connecticut urologist Alan J. Malitz and daughter-in-law of
psychiatrist Sidney Malitz, died during a face-lift. And unlike in the
Goldsmith case, where the surgeon turned out to be Norman Pastorek, a
highly respected but relatively low-key otolaryngologist, Malitz's
doctor was Sherrell Aston, the hospital's plastic-surgery chairman,
widely considered to be one of the two or three most skilled facial
sculptors in New York (who worked in tandem with veteran
anesthesiologist Gary Mellen, a favorite with the hospital's doctors).
Aston has worked on some of the most famous faces in the world--Catherine
Deneuve, Anna Wintour, Pamela Harriman, and Tipper Gore are reportedly
four of his patients. In addition to being a fixture on Manhattan's
A-list social circuit with a much-photographed socialite wife of his
own, Muffie Potter Aston, he is considered one of the field's top
academicians. Aston is one of the only practicing aesthetic surgeons to
be a full professor of surgery--at NYU--and he runs the industry's annual
New York-based symposium. According to one doctor, "There's nothing more
humbling than surgery. You can be at the top of your game and performing
the simplest operation, and some freak accident or reaction can occur
that has nothing to do with you."
The hospital Aston heads is a cliquish place where most of the city's
top cosmetic doctors work--including Daniel Baker, Alan Matarasso, Gerald
Pitman, and Nicolas Tabbal--popping into each other's operating rooms on
a regular basis. But after Malitz's death, Aston's operating room was
taped over like a crime scene. State investigators--called in by the
hospital--were inside, local news crews were stationed outside, and
doctors from a peer group called the American Medical Foundation were
conducting their own explorations. Crisis-communications firm GCI Group,
which has worked on crises like Firestone's tire recall and the British
Tourist Authority's troubles with a foot-and-mouth disease scare, kicked
into gear. "It's a great hospital and a damn good brand. They are very
sad about this," says GCI's point man in the case, Ray Kerins. This was
not meeth's first crisis. Two years ago, the hospital was shut down for
a week during the anthrax scare when an exposed employee died there.
Cynics then predicted the institution's demise. But within weeks, the
schedule was full.
"I've had three patients cancel today," sighs one surgeon. "We're losing
business. If you are sitting around with your family this week, and your
mother says, 'I'm going to Manhattan Eye and Ear to have my eyes done,'
you're going to want to lock her in the house."
"It's scary," says another doctor. "Everyone is very concerned about
what happened. Absolutely everything you can imagine is being looked
"I've had three patients cancel today," says one surgeon. "We're losing
"We can't even play our radios," reports a third. "They want to make
sure nothing is interfering with the electrical equipment."
Olivia Goldsmith was allegedly taking mood stabilizers as well as
homeopathic products, either of which could potentially be problematic
during an operation, and there is the possibility that the local
anesthetic could in and of itself have caused complications. The crucial
question is not only why or if she had an adverse reaction to anesthesia
but why, with all the medical resources at the hospital's disposal,
couldn't she be saved? "It's one thing when you arrest on a tennis court
or in a store," says one doctor. "But when your breathing stops on an
operating table, you can often be resuscitated." One theory of what
happened in Goldsmith's operating room currently making the rounds at
the hospital is that Pastorek noticed that the color of Goldsmith's
blood wasn't bright crimson, and asked the nurse anesthetist about it.
She checked, and the readings looked fine. But in fact, it was a
situation known as electromechanical dissociation, or PEA (pulseless
electrical activity): Even though her heart had stopped contracting, it
was still conducting electrical impulses. They were able to give her
CPR, but her brain had been deprived of oxygen for too long, and she
lapsed into a coma.
Susan Malitz had myasthenia gravis, a neurological disease, which some
doctors say may have created problems. "It's quite complicated in terms
of anesthesia; certain drugs that are used can have peculiar or
prolonged effects. If somebody is given sedation with myasthenia and the
airway is not closely monitored, breathing can be severely compromised,"
explains Mark Sivak, a doctor at Mount Sinai and one of the country's
foremost experts in the disease. "But generally when this happens, the
patient is intubated immediately and breathing is regulated."
But Malitz was well aware of her condition and had been cleared by her
doctors for this operation. "She was from a family of top doctors. They
never would have allowed her to do this if they didn't feel she was
completely safe," says a family friend.
Over the past five years, there have been more than 13,500 cosmetic
procedures performed at the hospital, but meeth spokesmen will not
confirm the number of fatalities, and doctors have cited the medical
privacy laws passed last April as a reason to withhold details about the
cases and the doctors involved. Overall, a patient's chances of dying
during surgery are a relatively reassuring 1 in 90,000, according to the
National Safety Council. By comparison, a person's chances of dying in a
car accident in any given year are about 1 in 18,000. It's hard to
overstate Manhattan Eye, Ear and Throat's reputation among both
cosmetic-surgery doctors and patients. "I've worked at Manhattan Eye and
Ear for over 25 years, and it's probably the best plastic-surgery
hospital and the best group of surgeons in the world," says Daniel
Baker, who is widely perceived to be one of the city's top two or three
cosmetic doctors. "Other surgeons come to that hospital from all over
the world to watch the doctors work."
In recent years, however, an increasing number of the institutions'
surgeons have been following the national trend and choosing to operate
out of the accredited rooms in their own offices. "Some people prefer
the privacy of an office where they know the staff and it doesn't feel
as foreign," says Baker.
Plastic surgeon David Hidalgo agrees. "I used to do all my operations
there," he says. "Now I go there two or three times a month. In my own
office, I feel I have better control of the variables."
Twenty-five-year Manhattan Eye, Ear and Throat veteran Gerald Pitman has
his own accredited operating room but prefers the hospital atmosphere.
"I actually like operating there, because if anything happens you have
more back-up. Patients forget that surgery has risks, but meeth actually
has a better track record than any other hospital I know of." Manhattan
Eye and Ear had no reported deaths in the years 1999 to 2001, and there
are no cited violations or judgments against the institution over the
last ten years listed on the Board of Health's Website.
"My commitment is to make sure the tradition of Manhattan Eye and Ear
continues," says the hospital's executive director, Philip P.
Rosenthal. "These two deaths appear to be just an unfortunate
coincidence, but we are taking the matter very, very seriously."
"There is no plastic surgeon in the U.S. who is not thinking of this as
we speak," says Dr. Robert W. Bernard, president of the American Society
for Aesthetic Plastic Surgery, the field's most prestigious
organization. "We all think, there but for the grace of God . . .
Jul 19, '04I cannot believe Dr. Kotler would say such a thing! I don't know who he is, but still. He is ignorant in saying such a thing. CRNA's have to go to school just as a Anesthesiologist do. Heck, CRNA's probably get more hands experience than anesthesiologists do. They probably have a ton of book work with some hands on experience.
Our CRNA is wonderful. I work for Dr. Hakki, a cosmetic surgeon in the state of Maryland and we do our surgeries in our cosmetic surgery center. He glorifies over our CRNA. He would not have anyone else working for him. Luckily not all doctors think that way. He is very knowledgable and knows just as much, if not more than some anesthesiologist. Some people are just plain ignorant. It sounds like this doctor has too big of a head on his shoulders and he feels that M.D.s are superior to all!