CRNAs once again defamed...

dynamiteRN · Jul 14, 2004

Since there is power in number, I think we should all write to MSNBC . Let them know that definitely there are circumstances surrounding the case that could have caused the death, and not to be concluded that the death is a result of having a nurse anesthetist as the anesthesia provider. They should inform the public that Dr. Kotler is WRONG, WRONG, WRONG!!!! We should clear the name of CRNAs being viewed as a liability before the public eye as a result of this TV show.

kdst · Jul 15, 2004

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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."

I've seen methemoglobinemia twice and in both cases the blood was brown, like cocoa, not crimson.

HawaiiRN · Jul 15, 2004

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....

http://newyorkmetro.com/nymetro/news/trends/columns/cityside/n_9981/

zrmorgan · Jul 15, 2004

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....
http://newyorkmetro.com/nymetro/news/trends/columns/cityside/n_9981/

they'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.

check it out...http://www.nursingadvocacy.org/news/news.html

kdst · Jul 15, 2004

DR. 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.

alansmith52 · Jul 15, 2004

someone post a link where I can do some educating.

nrsjo · Jul 16, 2004

The 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.

catcolalex · Jul 16, 2004

that guy's ignorant remarks make me sick.

jrvb · Jul 16, 2004

The 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.

deepz · Jul 16, 2004

someone post a link where I can do some educating.

This is from the NY Metro.com website

Struck Twice

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

in crisis.

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

into."

"I've had three patients cancel today," says one surgeon. "We're losing

business."

"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 . . .

EvelynRN-BSN · Jul 19, 2004

I 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!

Evelyn:rolleyes: