Ethical/Legal question

[Sis123]

Hi,

Here's a hypothetical question:

Patient A comes in for elective surgery (TAH BSO) and is in pre-op. Anesthesiologist sees patient and does the normal pre-anesthesia talk. Patient refuses Versed, is willing to have anything else instead, but refuses Versed verbally as well as writing this refusal on the consent form. Anesthesiologist says ok, fine. Anesthesiologist comes back with the pre-op sedative and injects it into IV. Patient starts to calm down a bit, and then asks the Anesthesiologist (who is wheeling her off to the OR) What was the drug she was given, A-man answers Midazolam, very quickly, mumbling. Patient is heard saying, "But, but, but" then she's out.

Is this legal? Is this ethical? Is it a patient's right to refuse a particular drug? I always thought that it was.....

[yoga crna]

It is both illegal and unethical. The patient could sue for civil (as opposed to criminal) battery as well as negligence if she had an adverse reaction to the versed.

There are plenty of other combinations of medications that can be used for pre-medication. Most of my patients get oral valium and do very well.

Yoga CRNA

[louloubell1]

Originally posted by deepz

There have been cases where failure to follow the patient's wishes have resulted in criminal charges. Some years ago in Oklahoma an MDA suggested to the patient that he should have a spinal anesthetic, and the patient refused. The patient wanted general. The MDA gave a sleep dose of Pentothal, then turned the patient on his side and gave him a SPINAL.

Assault and Battery was the resulting charge.

deepz

I was thinking that exact same thing re: an assault charge.

[J. B.]

When I had Versed I didnt come to my sences until I was fully dressed and i the loby of the Dr. Office. My wife said she knew I was coming out of it because I quite asking the God allful question over and over.

I had not recollection at all.

JB

BTY MY wife will never tell me what that question was so cant answer that one for you.

[athomas91]

i have had surg twice...once was oral surg...my surg. gave me versed and propofol only - no narcs...

apparently i was dancing and singing post-op and entertaining the entire surgical suite..i don't remember any of it...but my husband tells me i was hilarious...

[J. B.]

grinning

[BarbPick]

this hits home

When my mom was alive she went for a D&C, they were unable to do it, she was put on some steroid and returned a month later to complete it. The first time she had versed, she woke up, got in the car and went out almost home, we had to carry her in. We were told it was the versed. Who knows what they gave her the second time, they kept her for 23 hours and she was out cold 22 out of the 23 hours.

Any chance your friend told you why she did not want versed?

[gaspassah]

sounds like a simple case of assault and battery to me.

d

[Sis123]

Hi all, and thanks for all the thoughtful and insightful replies.

Well, lots of folks "really like versed", and this person had it previously along with dilaudid. She had a bad reaction to it (not an allergic reaction, a abusive and combative reaction - she was wired and wild)and she remembered some of the nasty fighting pre-op and post-op, even trying to hit nurses(eek!). She is a big control freak about her life, and the amnesia part of versed is unnerving to her, as well as knowing she flipped out. She was terrified of being so out of control of herself (she is a "church lady" and is honorable and decent as the day is long, never drinks alcohol because she always wants to be in total control of herself.)

She was terrified of amnesia, and being out of control. She felt that she had control of what drugs she was given, as she thought she knew what "patient's rights" are/were. She was totally unnerved entering the OR with someone that she trusted, and that someone had basically said by his actions, "TO HELL WITH what you want, I'm doing what I want with you, and you can't argue about it because you are soon to be unconscious". She has continuing nightmares about the surgery, the anesthesiologist, and generalized anxiety over this whole thing.

She wouldn't want to sue this dr. (she thinks folks are wayyyy to litigious) but she'd like to slap this man, and leave a red mark on his face for a while. Of course patients don't have any recourse if the surgery turned out well, and she is fine physically.

She'd also rather die than have surgery ever again, as well, as a result of this A-man.

[BarbPick]

wow, sounds like an atropine / robinal reaction. Wild as a hare.

[BarbPick]

she'd like to slap this man, and leave a red mark on his face for a while.

I will gladly go with her and hold her coat. I don't like the nightmares.

[yoga crna]

If I were her, I would write a letter to the hospital administrator with copies to the head of the medical staff and anesthesia departments. I would also send the letter to the ASA and the State Medical Board. The most important thing she can do is make sure the anesthesiologist gets a copy of the letter and to whom it has been sent. Also, she shouldn't pay her anesthesia bill or tell her insurance company not to pay it and why. That should get his attention.

YogaCRNA

"when they say it's not about the money, it is"

[versatile_kat]

I absolutely agree with yoga's suggestion. There's no better way to hit a point home than with money (or lack thereof). The medical staff should definitely be aware...