Talia is right here and says 'awful, I can’t breathe'
February 10, 2017 10:14 PM Subscribe
Quantity of Care Pt 1: A Lost Voice (Seattle Times investigative report) Talia Goldenberg emerged from the fog of anesthesia. The 23-year-old wiggled her toes. She wagged her feet. Good signs for a patient coming out of spinal surgery.
But as the anesthesia faded in Talia’s system, she realized that not everything was perfect, despite the confident assurances of her surgical team.
Quantity of Care Pt 2: High Volume, Big Dollars, Rising Tension
Internal records obtained by The Times, and interviews with current and former staffers, reveal an array of concerns communicated directly to the institution’s top administrators. The complaints include explicit warnings about inadequate patient care, inappropriate surgeries, poor documentation, a lack of accountability for postoperative complications and dubious decisions that resulted in patient harm and death.
But as the anesthesia faded in Talia’s system, she realized that not everything was perfect, despite the confident assurances of her surgical team.
Quantity of Care Pt 2: High Volume, Big Dollars, Rising Tension
Internal records obtained by The Times, and interviews with current and former staffers, reveal an array of concerns communicated directly to the institution’s top administrators. The complaints include explicit warnings about inadequate patient care, inappropriate surgeries, poor documentation, a lack of accountability for postoperative complications and dubious decisions that resulted in patient harm and death.
That's absolutely shattering to read. Great investigative journalism. Piss poor medical care. But we should run hospitals like businesses and big data and KPIs are going to save us all right? We should design the system based on efficiencies that incentivizes doctors to perform procedures as a high volume and nothing will possibly go wrong. Adopt a lean approach in our health care infrastructure because caring for people is just like running a factory, no? It's just the patients and staff who suffer, and they'll no doubt be reassured by the obscene amount of money the surgeons and hospitals are raking in.
posted by supercrayon at 3:07 AM on February 11, 2017 [12 favorites]
posted by supercrayon at 3:07 AM on February 11, 2017 [12 favorites]
Due to straight-up neglect and a stunning lack of respect for life, we have lost a vibrant young artist, an outstanding individual -- Talia Goldenberg. The reason that we know about the neglect and lack of respect shown in that institution is that Talia's father is a physician; while any loving parent would know that things aren't right, he knew exactly what was not right, and he demanded again and again that staff in that hospital help his daughter. Which they refused to do. This is a horrible thing. This organization is disgusting, their lack of care for their patients unconscionable, their ongoing determination to chase after money outrageous. This is criminal. These people are criminals, this is a criminal enterprise, all the way up into the administration and down to the physicians.
Had Talia been a poor person, without beauty, without artistic talent, had Talia not had a strong, educated family and been woven deeply into a core of people who cared deeply about her, we would not have read this story. Because it wouldn't have been written. The story of this hypothetical poor person would have slid through the cracks, though their families despair would have equaled that of the Goldenberg family, though their frustration and rage would equal that of the Goldenberg family.
This physician, this neurosurgeon, this Dr. Delashaw, he is The Teflon Doctor, the attempts to bring him to justice for the lives which he has ruined or taken have failed as surely as the attempts to bring John Gotti to justice for the lives which he ruined or had taken. And Delashaw is every bit as arrogant as was Gotti, every bit as confident that he is untouchable as was Gotti, every bit as smug, perhaps not as wealthy as Gotti was but we can safely bet that Delashaw is not driving a three year old Kia. I marveled at John Gotti and his crew and what they did. I marveled reading about Delashaw, also, another criminal, but while I was reasonably detached at Gotti's antics, I have not at all felt detachment reading about Delashaw but have felt instead a white-hot anger.
I'd like to meet him. I'd like to tell him hello. I'd like to spend a few minutes in his company.
~~~~~
If you'd like to know what a good neurosurgeon looks like, acts like, thinks like, then go read Do No Harm: Stories of Life, Death and Brain Surgery by Dr. Henry Marsh. I can't recommend it highly enough, one of the best "reads" (I listen to books more than read them nowadays) that I had last year, the book a fascinating look inside his world, inside his work, inside his life. He is not a coward as is Delashaw, he faces up to his mistakes, puts them out in front of the world. I sortof love him; I tend to really love docs and Marsh is as good as it gets. This 10 minute video -- excerpted from Your Life In Their Hands -- is just way too cool for school, give ten minutes of your life to it, watch Marsh and his team talking with a man whilst performing flippin' brain surgery on him, excising a tumor.
~~~~~
FIN -- Delashaw is human garbage. It would be wonderful if this exposé brings him and that organization to ruin.
Spectacular reportage -- thank you, Seattle Times.
posted by dancestoblue at 3:15 AM on February 11, 2017 [39 favorites]
Had Talia been a poor person, without beauty, without artistic talent, had Talia not had a strong, educated family and been woven deeply into a core of people who cared deeply about her, we would not have read this story. Because it wouldn't have been written. The story of this hypothetical poor person would have slid through the cracks, though their families despair would have equaled that of the Goldenberg family, though their frustration and rage would equal that of the Goldenberg family.
This physician, this neurosurgeon, this Dr. Delashaw, he is The Teflon Doctor, the attempts to bring him to justice for the lives which he has ruined or taken have failed as surely as the attempts to bring John Gotti to justice for the lives which he ruined or had taken. And Delashaw is every bit as arrogant as was Gotti, every bit as confident that he is untouchable as was Gotti, every bit as smug, perhaps not as wealthy as Gotti was but we can safely bet that Delashaw is not driving a three year old Kia. I marveled at John Gotti and his crew and what they did. I marveled reading about Delashaw, also, another criminal, but while I was reasonably detached at Gotti's antics, I have not at all felt detachment reading about Delashaw but have felt instead a white-hot anger.
I'd like to meet him. I'd like to tell him hello. I'd like to spend a few minutes in his company.
~~~~~
If you'd like to know what a good neurosurgeon looks like, acts like, thinks like, then go read Do No Harm: Stories of Life, Death and Brain Surgery by Dr. Henry Marsh. I can't recommend it highly enough, one of the best "reads" (I listen to books more than read them nowadays) that I had last year, the book a fascinating look inside his world, inside his work, inside his life. He is not a coward as is Delashaw, he faces up to his mistakes, puts them out in front of the world. I sortof love him; I tend to really love docs and Marsh is as good as it gets. This 10 minute video -- excerpted from Your Life In Their Hands -- is just way too cool for school, give ten minutes of your life to it, watch Marsh and his team talking with a man whilst performing flippin' brain surgery on him, excising a tumor.
~~~~~
FIN -- Delashaw is human garbage. It would be wonderful if this exposé brings him and that organization to ruin.
Spectacular reportage -- thank you, Seattle Times.
posted by dancestoblue at 3:15 AM on February 11, 2017 [39 favorites]
Ugh. This is the exact hospital I was in when my lung collapsed over five years ago. (Warning, medical triggers.)
In retrospect I've realized there were some pretty dodgy things that had happened, and I'm lucky I'm a stubborn pain in the ass and that I was able to advocate for myself as well as heal very fast to get the hell out of there in record time.
I'm also probably very lucky I had a bunch of local mefites visiting regularly, including one local doctor. I distinctly remember the attention, promptness and general care improving slightly after Slarty visited, like they realized "Shit, this random weirdo has doctors visiting from other hospitals."
What was dodgy?
For starters I kept managing to eject my chest vacuum tube and launch it across the room. This apparently isn't supposed to happen, and they didn't believe me until I demonstrated that it was indeed happening.
It's also probably not supposed to get shoved back into the surgical hole cut in my chest between ribs without so much as a sanitizing wipe down. I probably shouldn't have been crawling out of bed to go get that tube and shove it back in on my own, either, but if I waited for a nurse every time it happened I wouldn't have spent much time on vacuum at all.
I also learned that the aftercare that I didn't receive was basically non-existent and I probably shouldn't have been discharged so early, and that I probably should have had at least one follow up appointment and set of chest X-rays to make sure everything was still in the right place.
The sutures I got for hole in my chest were haphazardly sloppy and dodgy as hell, too. They weren't just ugly, but a couple of them pulled out in the first days after discharge and were showing the initial signs of infection for a week afterwards. I was never given antibiotics at any point, which seemed odd considering I'd spent over half a month walking around with an intentional open chest wound.
There was nothing dodgy about the bill, though. According to the bill I received nearly 250k in medical aid in less than 15 days. Some of the line items on that bill were multi thousand dollar "consultations" that couldn't have been more than a doctor popping his head in, saying hello, looking at my latest X-ray and popping back out fifteen seconds later, deftly avoiding any questions I might have had.
And to be fair - I'm glad of what care I did receive there. And I'm glad they dismissed that ridiculous bill and either wrote it off or put me on temporary insurance.
Thankfully I haven't really been in hospitals enough to make any comparison. But everything I've read about Swedish Cherry Hill and what I've figured out in retrospect about how a collapsed lung recovery is supposed to go - I'm even more thankful that something fucked up didn't happen while I was there.
And all that said - there's something really screwy about the fact that the most profitable year of my entire life was the one where I nearly died in an ER and it earned a for-profit hospital a quarter of a million dollar tax write off.
posted by loquacious at 4:28 AM on February 11, 2017 [45 favorites]
In retrospect I've realized there were some pretty dodgy things that had happened, and I'm lucky I'm a stubborn pain in the ass and that I was able to advocate for myself as well as heal very fast to get the hell out of there in record time.
I'm also probably very lucky I had a bunch of local mefites visiting regularly, including one local doctor. I distinctly remember the attention, promptness and general care improving slightly after Slarty visited, like they realized "Shit, this random weirdo has doctors visiting from other hospitals."
What was dodgy?
For starters I kept managing to eject my chest vacuum tube and launch it across the room. This apparently isn't supposed to happen, and they didn't believe me until I demonstrated that it was indeed happening.
It's also probably not supposed to get shoved back into the surgical hole cut in my chest between ribs without so much as a sanitizing wipe down. I probably shouldn't have been crawling out of bed to go get that tube and shove it back in on my own, either, but if I waited for a nurse every time it happened I wouldn't have spent much time on vacuum at all.
I also learned that the aftercare that I didn't receive was basically non-existent and I probably shouldn't have been discharged so early, and that I probably should have had at least one follow up appointment and set of chest X-rays to make sure everything was still in the right place.
The sutures I got for hole in my chest were haphazardly sloppy and dodgy as hell, too. They weren't just ugly, but a couple of them pulled out in the first days after discharge and were showing the initial signs of infection for a week afterwards. I was never given antibiotics at any point, which seemed odd considering I'd spent over half a month walking around with an intentional open chest wound.
There was nothing dodgy about the bill, though. According to the bill I received nearly 250k in medical aid in less than 15 days. Some of the line items on that bill were multi thousand dollar "consultations" that couldn't have been more than a doctor popping his head in, saying hello, looking at my latest X-ray and popping back out fifteen seconds later, deftly avoiding any questions I might have had.
And to be fair - I'm glad of what care I did receive there. And I'm glad they dismissed that ridiculous bill and either wrote it off or put me on temporary insurance.
Thankfully I haven't really been in hospitals enough to make any comparison. But everything I've read about Swedish Cherry Hill and what I've figured out in retrospect about how a collapsed lung recovery is supposed to go - I'm even more thankful that something fucked up didn't happen while I was there.
And all that said - there's something really screwy about the fact that the most profitable year of my entire life was the one where I nearly died in an ER and it earned a for-profit hospital a quarter of a million dollar tax write off.
posted by loquacious at 4:28 AM on February 11, 2017 [45 favorites]
“I wanted all my faculty — as I said to them many times — I want them to be rich,” Delashaw testified, according to records in the case.
This man makes over 2 million dollars annually ruining people's lives, torturing them with unnecessarily invasive procedures, and occasionally murdering them. Capitalism is a sick fucking system.
posted by sockermom at 5:53 AM on February 11, 2017 [34 favorites]
This man makes over 2 million dollars annually ruining people's lives, torturing them with unnecessarily invasive procedures, and occasionally murdering them. Capitalism is a sick fucking system.
posted by sockermom at 5:53 AM on February 11, 2017 [34 favorites]
The business of medicine is a fucking meat grinder, particularly the wretched production based RVU compensation system. When I walked away from my old job getting reimbursed by RVU and took a salaried position, overnight I became a much better physician, free to make decisions based on my best sound medical judgement alone. Not coincidentally, my salary dropped by more than a third. For me it was worth it.
Prior to this, I'd get my paycheck and pour over the monthly summary of RVUs. For a time, I was keeping a running total of my RVUs. Did I make decisions based solely on what it meant for my production totals? You bet. More EKGs, more procedures, longer chart notes justifying higher medical complexity. Was any of it unjustified? I don't know. In my mind, it was ok because I figured there were armies of people at insurance companies doing the same kind of shenanigans to make sure they weaseling out of paying whenever they could and if you didn't play the game you'd get screwed. But eventually I quit, because that's what it is -- a game -- and I have more important things to do besides play Capitalism The Game: Medicine Edition.
Unfortunately, we've taken Medicare and Medicaid and privatized them and I'm starting to see the same pressures for productivity but I'm still salaried. When I get talked to by bean counters in my organization about my productivity I politely explain to them the number of hours that I work far exceeds those that I'm contracted to work and far exceeds those that any administrator works and no physician in America ever has been told "You are producing enough now, we can ease up on your schedule" and this will never ever happen in the current reimbursement model. What are you going to do, fire me? One day they probably will and that's the day I leave clinical practice entirely to be a full time activist for single payer health care.
I happen to be on staff at Swedish and although I'm far removed from these cases, I know some of the people in the article and I work with residents and fellows. There's a major rift in the staff over the tension between making money and the culture of safety. At my last re-credentialling, I was required to attend a 2 day safety seminar as part of a "We're rolling out a major change in how we're dealing with safety" program. 2 days of getting paid to sit and drink coffee in a lecture hall instead of seeing patients? Sure, sign me up. I'm sure many of my colleagues (particularly non salaried production based physicians) blew this off without repercussions. But every employee is required to go through this , many thousands of nurses, lab techs, kitchen staff, everyone. These classes are held every month over a 2 year period. The chief medical officer and CEO and COO show up personally and give speeches about how important safety is. None of it was new to me -- the typical forward thinking culture of safety, importance of reporting, root cause analysis, and continuous quality improvement that's finally arriving in medicine. But I suspect this is the first time many of the ancillary staff have heard this stuff and the fact that the medical director is speaking directly to the janitors about this is significant and fires up the staff. There are posters and reminders everywhere now. Some of the powers that be at the hospital have invested significantly in this.
The fact that you have others in the organization really pushing the limits of safety and reaping huge financial rewards for themselves and the hospital must be creating enormous political tension at the top and I suspect this is how a reporter at the Seattle Times got tipped off on a potential story. Should be interesting to see how it all shakes out.
I'm just glad to be a humble doc focused on just doing the best I can and somewhat insulated from the shit show of the business of medicine.
posted by Slarty Bartfast at 6:57 AM on February 11, 2017 [78 favorites]
Prior to this, I'd get my paycheck and pour over the monthly summary of RVUs. For a time, I was keeping a running total of my RVUs. Did I make decisions based solely on what it meant for my production totals? You bet. More EKGs, more procedures, longer chart notes justifying higher medical complexity. Was any of it unjustified? I don't know. In my mind, it was ok because I figured there were armies of people at insurance companies doing the same kind of shenanigans to make sure they weaseling out of paying whenever they could and if you didn't play the game you'd get screwed. But eventually I quit, because that's what it is -- a game -- and I have more important things to do besides play Capitalism The Game: Medicine Edition.
Unfortunately, we've taken Medicare and Medicaid and privatized them and I'm starting to see the same pressures for productivity but I'm still salaried. When I get talked to by bean counters in my organization about my productivity I politely explain to them the number of hours that I work far exceeds those that I'm contracted to work and far exceeds those that any administrator works and no physician in America ever has been told "You are producing enough now, we can ease up on your schedule" and this will never ever happen in the current reimbursement model. What are you going to do, fire me? One day they probably will and that's the day I leave clinical practice entirely to be a full time activist for single payer health care.
I happen to be on staff at Swedish and although I'm far removed from these cases, I know some of the people in the article and I work with residents and fellows. There's a major rift in the staff over the tension between making money and the culture of safety. At my last re-credentialling, I was required to attend a 2 day safety seminar as part of a "We're rolling out a major change in how we're dealing with safety" program. 2 days of getting paid to sit and drink coffee in a lecture hall instead of seeing patients? Sure, sign me up. I'm sure many of my colleagues (particularly non salaried production based physicians) blew this off without repercussions. But every employee is required to go through this , many thousands of nurses, lab techs, kitchen staff, everyone. These classes are held every month over a 2 year period. The chief medical officer and CEO and COO show up personally and give speeches about how important safety is. None of it was new to me -- the typical forward thinking culture of safety, importance of reporting, root cause analysis, and continuous quality improvement that's finally arriving in medicine. But I suspect this is the first time many of the ancillary staff have heard this stuff and the fact that the medical director is speaking directly to the janitors about this is significant and fires up the staff. There are posters and reminders everywhere now. Some of the powers that be at the hospital have invested significantly in this.
The fact that you have others in the organization really pushing the limits of safety and reaping huge financial rewards for themselves and the hospital must be creating enormous political tension at the top and I suspect this is how a reporter at the Seattle Times got tipped off on a potential story. Should be interesting to see how it all shakes out.
I'm just glad to be a humble doc focused on just doing the best I can and somewhat insulated from the shit show of the business of medicine.
posted by Slarty Bartfast at 6:57 AM on February 11, 2017 [78 favorites]
The posters and omnipresent hand san dispensers caught my eye as a patient and visitor too, for what it's worth.
posted by wotsac at 7:12 AM on February 11, 2017
posted by wotsac at 7:12 AM on February 11, 2017
I distinctly remember the attention, promptness and general care improving slightly after Slarty visited, like they realized "Shit, this random weirdo has doctors visiting from other hospitals."
I have had friends tell me similar stories after I drop by to see them; I know people from all walks of life and so the nurses are sometimes surprised when they turn out to be friends of one the attending physicians. So if any mefites are hospitalized in the Augusta, GA area, let me know and I will drop by to let the staff know you are a VIP. It sucks that that has to be the case (every patient should be a VIP), but that's the way it is.
posted by TedW at 7:26 AM on February 11, 2017 [23 favorites]
I have had friends tell me similar stories after I drop by to see them; I know people from all walks of life and so the nurses are sometimes surprised when they turn out to be friends of one the attending physicians. So if any mefites are hospitalized in the Augusta, GA area, let me know and I will drop by to let the staff know you are a VIP. It sucks that that has to be the case (every patient should be a VIP), but that's the way it is.
posted by TedW at 7:26 AM on February 11, 2017 [23 favorites]
Responses from the Swedish and Delashaw tout how "empowered" caregiver's are to raise patient safety concerns. But Delashaw in particular seems to dismiss criticism of him as based solely on jealousy. That doesn't really instill confidence in their evaluation process.
Also, even if we give him the benefit of the doubt (not that he deserves it), he's working on complex patients so of course shit goes wrong/there are disagreements as to what the best course of action is blah blah blah, that's still no fucking excuse to not have a properly staffed ICU. Mandating long work hours for non-urgent matters is shitty to both the staff (contributing to higher turnover) and importantly the patients (poorer care and more errors). If he's not directly responsible for staffing (it sounds like maybe he is? I'm not clear), he sure as hell has enough clout to insist on better staffing on behalf of his patients. He'd just have to cut back on the number of surgeries until the ICU was adequately staffed. But nope, apparently post-operative care isn't his problem. Or it's just another way for him to earn a bonus.
posted by ghost phoneme at 7:34 AM on February 11, 2017 [2 favorites]
Also, even if we give him the benefit of the doubt (not that he deserves it), he's working on complex patients so of course shit goes wrong/there are disagreements as to what the best course of action is blah blah blah, that's still no fucking excuse to not have a properly staffed ICU. Mandating long work hours for non-urgent matters is shitty to both the staff (contributing to higher turnover) and importantly the patients (poorer care and more errors). If he's not directly responsible for staffing (it sounds like maybe he is? I'm not clear), he sure as hell has enough clout to insist on better staffing on behalf of his patients. He'd just have to cut back on the number of surgeries until the ICU was adequately staffed. But nope, apparently post-operative care isn't his problem. Or it's just another way for him to earn a bonus.
posted by ghost phoneme at 7:34 AM on February 11, 2017 [2 favorites]
I compare this man to my local spine surgeon, the main earner for our local hospital, who recently retired.
His salary went up every year in line with inflation and at the top he would have earned about £100,000. Same as all the other surgeons & anaesthesiologists, physicians and pathologists
He didn't do a lot of private work because the focus of his life to the detriment of his income was training the next generation of surgeons. As such he served without remuneration as the training programme director, examiner (he got travel expenses reimbursed), he taught in the medical school, did peer review, guided research and contributed nationally and internationally to Spinal surgery. Gave talks all over the world, developed a piece of kit but gave the patent to a trainee of his.
I remember one time learning that he did something 'iffy' financially, a really complicated little scam, get this, donating his salary from teaching on a Masters programmer & encouraging the other lecturers to donate theirs into a pot, from which the fees were paid for the trainees. I believe he got his knuckles rapped for that one.
I know our NHS system is groaning at the seams and under huge pressure to change and become more like the US system. Ideologically it would fit more with a Nordic model but that's not the way the main political powers here think.
This story was an horrific read for me from a number of levels, the torture of being a physician and knowing your child could be saved by a piece of kit you told them needed to be in the room....I fear for this father's mental health, I really do.
But secondly, knowing we are heading down this ugly route where the values and behaviours we prized for so long are being chipped away in favour of market forces, leading to an existential threat.
thank you for posting this, I'm sending it onto all the senior UK surgeons I know.
posted by Wilder at 7:43 AM on February 11, 2017 [26 favorites]
His salary went up every year in line with inflation and at the top he would have earned about £100,000. Same as all the other surgeons & anaesthesiologists, physicians and pathologists
He didn't do a lot of private work because the focus of his life to the detriment of his income was training the next generation of surgeons. As such he served without remuneration as the training programme director, examiner (he got travel expenses reimbursed), he taught in the medical school, did peer review, guided research and contributed nationally and internationally to Spinal surgery. Gave talks all over the world, developed a piece of kit but gave the patent to a trainee of his.
I remember one time learning that he did something 'iffy' financially, a really complicated little scam, get this, donating his salary from teaching on a Masters programmer & encouraging the other lecturers to donate theirs into a pot, from which the fees were paid for the trainees. I believe he got his knuckles rapped for that one.
I know our NHS system is groaning at the seams and under huge pressure to change and become more like the US system. Ideologically it would fit more with a Nordic model but that's not the way the main political powers here think.
This story was an horrific read for me from a number of levels, the torture of being a physician and knowing your child could be saved by a piece of kit you told them needed to be in the room....I fear for this father's mental health, I really do.
But secondly, knowing we are heading down this ugly route where the values and behaviours we prized for so long are being chipped away in favour of market forces, leading to an existential threat.
thank you for posting this, I'm sending it onto all the senior UK surgeons I know.
posted by Wilder at 7:43 AM on February 11, 2017 [26 favorites]
So happy to see this hit the public eye.
I've had a rocky relationship with Swedish Cherry Hill for a while now, but many of my clients still seek treatment and surgery there. It's not really ethically or professionally my place to advise or refer them elsewhere, though, so I leave it alone and work with them when they get out.
However, my partner struggles with severe neck pain. Last year her primary physician asked her to speak with a spinal surgeon to explore her options. My mother works at the upper levels of medicine in Seattle, and we asked her for a referral. She gave us a good one, along with one specific piece of advise: "Not Delashaw."
My partner's pain has since retreated, and she hasn't had surgery. But if and when she does, I'll be damned if I don't bring the full might of my mother and employers to bear to make sure that surgery and recovery are properly staffed.
posted by skookumsaurus rex at 10:14 AM on February 11, 2017 [12 favorites]
I've had a rocky relationship with Swedish Cherry Hill for a while now, but many of my clients still seek treatment and surgery there. It's not really ethically or professionally my place to advise or refer them elsewhere, though, so I leave it alone and work with them when they get out.
However, my partner struggles with severe neck pain. Last year her primary physician asked her to speak with a spinal surgeon to explore her options. My mother works at the upper levels of medicine in Seattle, and we asked her for a referral. She gave us a good one, along with one specific piece of advise: "Not Delashaw."
My partner's pain has since retreated, and she hasn't had surgery. But if and when she does, I'll be damned if I don't bring the full might of my mother and employers to bear to make sure that surgery and recovery are properly staffed.
posted by skookumsaurus rex at 10:14 AM on February 11, 2017 [12 favorites]
"When there is a change in culture it is commonplace for individuals to complain"
I believe what they meant to say was, "We made changes but do not intend to take responsibility for them. We'll dismiss any warnings as baseless whining, rather than assess whether our changes are doing more harm than good."
posted by evidenceofabsence at 1:09 PM on February 11, 2017 [3 favorites]
I believe what they meant to say was, "We made changes but do not intend to take responsibility for them. We'll dismiss any warnings as baseless whining, rather than assess whether our changes are doing more harm than good."
posted by evidenceofabsence at 1:09 PM on February 11, 2017 [3 favorites]
To doctors here: what would have happened if Talia's dad had gone ahead and don the crik procedure himself?
I was also surprised to read that surgeons were in up to SIX ORs at a time. That sounds terrifying to me!
Would a possible solution to the "how long are doctors in a certain OR" question be to give the doctor some kind of GPS device whose data could be subpoenaed in cases where there's debate about how long the doctor spent in each room?
posted by bendy at 4:25 PM on February 11, 2017
I was also surprised to read that surgeons were in up to SIX ORs at a time. That sounds terrifying to me!
Would a possible solution to the "how long are doctors in a certain OR" question be to give the doctor some kind of GPS device whose data could be subpoenaed in cases where there's debate about how long the doctor spent in each room?
posted by bendy at 4:25 PM on February 11, 2017
God damnit, I was really hoping that part 1 wasn't going to end the way it did. That poor poor girl. And her poor parents. I feel like I've just watched Dear Zachary again. Only instead of being pissed off at lawyers and judges, I'm pissed off at nurses and doctors. 20 minutes to get a damn crike kit after they had repeatedly told them to be ready for it. That is criminally negligent, the kind of thing that should get medical licenses revoked. If you're choosing money over patients maybe you shouldn't be a damn doctor.
posted by Hazelsmrf at 5:16 PM on February 11, 2017 [7 favorites]
posted by Hazelsmrf at 5:16 PM on February 11, 2017 [7 favorites]
(The very very small silver lining here is that anytime a potential patient looks up this doctor they will get to see this article. And hopefully pick someone that isn't putting the almighty dollar ahead of his patients lives.)
posted by Hazelsmrf at 5:18 PM on February 11, 2017 [3 favorites]
posted by Hazelsmrf at 5:18 PM on February 11, 2017 [3 favorites]
To doctors here: what would have happened if Talia's dad had gone ahead and don the crik procedure himself?
This post has been on my mind ever since I read it and shot off my brief, kind of snarky comment above, but now that I have a little time, I can flesh out my thoughts a little. Your question is exactly one that crossed my mind, and without hesitation I thought "If my daughter were in that situation I would have jumped in and managed her airway, up to and including a cricothyroidotomy, consequences be damned." Then again, my specialty is one where airway management is a core skill, so I am comfortable doing things other physicians might not be (although I have never personally done a crike). What would happen is anyone's guess. It would depend on whether you were on staff in the hospital, your reputation and connections in the community, what kind of lawyer you can afford, and so on. Not to mention whether the procedure was successful or not; you can easily kill a patient if you try to manage their airway unsuccessfully. So, basically, anything between nothing and criminal charges that probably wouldn't result in jail time but would ruin your career. To answer your last question, there are RFID enabled ID badges that can track physician presence in ORs, but they are used more with anesthesiologists as far as I know, and not very widely at that.
The article really touches on a lot of problems with healthcare in this country, along with some red herrings and detours along the way. It could easily have been expanded into a book and still not deal thoroughly with the issues raised.
As for the poor patient in part 1, I wish the autopsy would have been more conclusive (and the fact that it wasn't is puzzling). It is always hard to judge medical issues from a distance, but it seems quite possible that the airway issues that apparently resulted in Talia's death could have been anesthesia related rather than the result of anything the surgeon did or did not do. In any event, surgery on the neck carries a small but definite risk of airway complications due to both anesthesia and surgery, and the risk would be increased in a patient with EDS. Putting her in the ICU was very reasonable, but the whole point of that is to allow for early detection and intervention in life-threatening situations, and it seems like that wasn't done. Was the ICU inadequately staffed with physicians? Nurses? Respiratory therapists? Was the training and/or experience of those people appropriate? There is really too little information here to know what really happened, but speaking as someone who has sent many a patient to the ICU because I didn't like the way they were breathing (most recently last Thursday), it looks like the holes in the Swiss cheese really lined up in this case.
Having said that, even though Dr. Delashaw might not bear all the responsibilty for Talia Goldenberg's death, the second part of the article makes a lot of good points. Dr. Bartfast is spot on when it comes to one of the most insidious forces in medicine in the US, fee for service. Given that there are any number of forces decreasing reimbursement for any given procedure, the only way to make up for decreasing income is to do more procedures. And tell people you are doing them because of the threat of lawsuits. In some cases this is to generate profits for the parent corporation, but in others (rural hospitals, those that serve a high percentage of uninsured patients), that income is needed just to keep the business afloat.
As for the use of fellows to do much of the procedure, that is really less of an issue than the article makes it out to be. There really are some surgeries where out of several hours there are only a few critical minutes where you need the most expertise possible. And often fellows have had multiple courses of training before the fellowship they are currently doing, especially if they came from overseas. (A fully trained and highly experienced physician from most other countries has to start over as an intern if they wish to practice medicine here.) In my own experience there have been surgeons in training that I would be happy to let operate on me or my family, even above their supervising physicians. On the other hand, in the quarter of a century or so I have been in the OR, I have seen physicians like Delashaw wreak havoc in hospitals. The statistics regarding malpractice are skewed by a few docs who are responsible for far more than their share of lawsuits, and he seems like a good example. And perhaps my perspective is skewed because our neurosurgery chair is an expert in coiling vessels, but we do very few open procedures any more. 57% clipping versus coiling seems way out of line. But he was bringing in money, so that made up for a lot of other things.
I am really glad I am on a salary. Even though the amount of work I do is almost entirely driven by other physicians, I still like not having a personal stake in the finances of any given procedure. That's not to say I don't strive to be cost-effective, but I am not interested in looking for ways to pad a given patient's bill. Too bad every physician can't (or won't) practice medicine that way.
posted by TedW at 5:52 PM on February 11, 2017 [17 favorites]
This post has been on my mind ever since I read it and shot off my brief, kind of snarky comment above, but now that I have a little time, I can flesh out my thoughts a little. Your question is exactly one that crossed my mind, and without hesitation I thought "If my daughter were in that situation I would have jumped in and managed her airway, up to and including a cricothyroidotomy, consequences be damned." Then again, my specialty is one where airway management is a core skill, so I am comfortable doing things other physicians might not be (although I have never personally done a crike). What would happen is anyone's guess. It would depend on whether you were on staff in the hospital, your reputation and connections in the community, what kind of lawyer you can afford, and so on. Not to mention whether the procedure was successful or not; you can easily kill a patient if you try to manage their airway unsuccessfully. So, basically, anything between nothing and criminal charges that probably wouldn't result in jail time but would ruin your career. To answer your last question, there are RFID enabled ID badges that can track physician presence in ORs, but they are used more with anesthesiologists as far as I know, and not very widely at that.
The article really touches on a lot of problems with healthcare in this country, along with some red herrings and detours along the way. It could easily have been expanded into a book and still not deal thoroughly with the issues raised.
As for the poor patient in part 1, I wish the autopsy would have been more conclusive (and the fact that it wasn't is puzzling). It is always hard to judge medical issues from a distance, but it seems quite possible that the airway issues that apparently resulted in Talia's death could have been anesthesia related rather than the result of anything the surgeon did or did not do. In any event, surgery on the neck carries a small but definite risk of airway complications due to both anesthesia and surgery, and the risk would be increased in a patient with EDS. Putting her in the ICU was very reasonable, but the whole point of that is to allow for early detection and intervention in life-threatening situations, and it seems like that wasn't done. Was the ICU inadequately staffed with physicians? Nurses? Respiratory therapists? Was the training and/or experience of those people appropriate? There is really too little information here to know what really happened, but speaking as someone who has sent many a patient to the ICU because I didn't like the way they were breathing (most recently last Thursday), it looks like the holes in the Swiss cheese really lined up in this case.
Having said that, even though Dr. Delashaw might not bear all the responsibilty for Talia Goldenberg's death, the second part of the article makes a lot of good points. Dr. Bartfast is spot on when it comes to one of the most insidious forces in medicine in the US, fee for service. Given that there are any number of forces decreasing reimbursement for any given procedure, the only way to make up for decreasing income is to do more procedures. And tell people you are doing them because of the threat of lawsuits. In some cases this is to generate profits for the parent corporation, but in others (rural hospitals, those that serve a high percentage of uninsured patients), that income is needed just to keep the business afloat.
As for the use of fellows to do much of the procedure, that is really less of an issue than the article makes it out to be. There really are some surgeries where out of several hours there are only a few critical minutes where you need the most expertise possible. And often fellows have had multiple courses of training before the fellowship they are currently doing, especially if they came from overseas. (A fully trained and highly experienced physician from most other countries has to start over as an intern if they wish to practice medicine here.) In my own experience there have been surgeons in training that I would be happy to let operate on me or my family, even above their supervising physicians. On the other hand, in the quarter of a century or so I have been in the OR, I have seen physicians like Delashaw wreak havoc in hospitals. The statistics regarding malpractice are skewed by a few docs who are responsible for far more than their share of lawsuits, and he seems like a good example. And perhaps my perspective is skewed because our neurosurgery chair is an expert in coiling vessels, but we do very few open procedures any more. 57% clipping versus coiling seems way out of line. But he was bringing in money, so that made up for a lot of other things.
I am really glad I am on a salary. Even though the amount of work I do is almost entirely driven by other physicians, I still like not having a personal stake in the finances of any given procedure. That's not to say I don't strive to be cost-effective, but I am not interested in looking for ways to pad a given patient's bill. Too bad every physician can't (or won't) practice medicine that way.
posted by TedW at 5:52 PM on February 11, 2017 [17 favorites]
Thanks TedW. FWIW I didn't see your comment as snarky but totally indicative of what I would hope that any doctor of mine would say.
The article said that the dad was a family doctor, but no mention of whether he was associated with that hospital.
I still can't imagine any scenario where a dad wouldn't do anything - whether it led to infection or a lawsuit - to save his young daughter's life. I've never had kids, but had a dad who I know indisputably would have done that if he were a doctor.
Isn't this procedure - or tracheotomy which is the one I'm familiar with - med school 2 or 301?
posted by bendy at 6:31 PM on February 11, 2017
The article said that the dad was a family doctor, but no mention of whether he was associated with that hospital.
I still can't imagine any scenario where a dad wouldn't do anything - whether it led to infection or a lawsuit - to save his young daughter's life. I've never had kids, but had a dad who I know indisputably would have done that if he were a doctor.
Isn't this procedure - or tracheotomy which is the one I'm familiar with - med school 2 or 301?
posted by bendy at 6:31 PM on February 11, 2017
I don't think the issue is that fellows are performing surgeries. I live in Montreal where we have several teaching hospitals, so I'm used to having a resident do the initial consults and procedures (under supervision), but they've ALWAYS divulged that information beforehand.
But doing unnecessary procedures to generate more revenue, doing higher risk procedures, not adequately staffing post-op and the ICU, not being ready for common post-op operations. I mean 20 minutes for an airway seems ridiculous, I'm not a doctor but shouldn't something like "difficulty breathing" already have a plan in place with all of the resources on hand and ready to go? Especially since the patients are just coming out of anesthesia? I mean, even if she had just suddenly stopped breathing I would hope they wouldn't just stand around for 15 minutes before looking to see if they even have a crike kit on hand. But she had been complaining of breathing issues for hours, so it's not like they didn't have notice. Her father is a doctor and he as well told them to have it ready, and they ignored him. There is no way that I can read this without jumping to nasty conclusions, I don't see how they can spin that one as anything other than gross negligence and carelessness.
I keep wondering how I'd react if that were my kid there. I would probably have been screaming at them to do something and I'd probably have gotten kicked out, but I definitely don't think I could have sat down and watched them a whole lot of nothing. Those poor parents. So hoping you guys eventually get to have a healthcare system that isn't run to make people rich but instead run to help people get better or manage their pain.
posted by Hazelsmrf at 7:28 PM on February 11, 2017 [3 favorites]
But doing unnecessary procedures to generate more revenue, doing higher risk procedures, not adequately staffing post-op and the ICU, not being ready for common post-op operations. I mean 20 minutes for an airway seems ridiculous, I'm not a doctor but shouldn't something like "difficulty breathing" already have a plan in place with all of the resources on hand and ready to go? Especially since the patients are just coming out of anesthesia? I mean, even if she had just suddenly stopped breathing I would hope they wouldn't just stand around for 15 minutes before looking to see if they even have a crike kit on hand. But she had been complaining of breathing issues for hours, so it's not like they didn't have notice. Her father is a doctor and he as well told them to have it ready, and they ignored him. There is no way that I can read this without jumping to nasty conclusions, I don't see how they can spin that one as anything other than gross negligence and carelessness.
I keep wondering how I'd react if that were my kid there. I would probably have been screaming at them to do something and I'd probably have gotten kicked out, but I definitely don't think I could have sat down and watched them a whole lot of nothing. Those poor parents. So hoping you guys eventually get to have a healthcare system that isn't run to make people rich but instead run to help people get better or manage their pain.
posted by Hazelsmrf at 7:28 PM on February 11, 2017 [3 favorites]
Isn't this procedure - or tracheotomy which is the one I'm familiar with - med school 2 or 301?
In movies they make it out to be as simple as grabbing a knife and a pen. I wonder how complicated it is for real as movies aren't really striving for medical realism, but shouldn't it be as simple as make hole/protect hole? If I couldn't breathe I probably wouldn't care if you did it with a dirty steak knife, deal with complications and infections later when I'm still alive to deal with them.
posted by Hazelsmrf at 7:32 PM on February 11, 2017 [1 favorite]
In movies they make it out to be as simple as grabbing a knife and a pen. I wonder how complicated it is for real as movies aren't really striving for medical realism, but shouldn't it be as simple as make hole/protect hole? If I couldn't breathe I probably wouldn't care if you did it with a dirty steak knife, deal with complications and infections later when I'm still alive to deal with them.
posted by Hazelsmrf at 7:32 PM on February 11, 2017 [1 favorite]
Isn't this procedure - or tracheotomy which is the one I'm familiar with - med school 2 or 301?
Many, perhaps most, physicians get a chance to practice a surgical airway on a mannequin or (if they're lucky) a cadaver at some point in their training, but that may have been decades ago. In real life emergencies things are never ideal (for instance, the patient may be so swollen that the anatomical landmarks are hard to find) and coupled with the knowledge that you can kill someone if you don't do it right it's easy to see why someone wouldn't jump right in and try for a surgical airway, especially in a hospital where there are presumably highly qualified people available.
posted by TedW at 7:42 PM on February 11, 2017 [8 favorites]
Many, perhaps most, physicians get a chance to practice a surgical airway on a mannequin or (if they're lucky) a cadaver at some point in their training, but that may have been decades ago. In real life emergencies things are never ideal (for instance, the patient may be so swollen that the anatomical landmarks are hard to find) and coupled with the knowledge that you can kill someone if you don't do it right it's easy to see why someone wouldn't jump right in and try for a surgical airway, especially in a hospital where there are presumably highly qualified people available.
posted by TedW at 7:42 PM on February 11, 2017 [8 favorites]
Isn't this procedure - or tracheotomy which is the one I'm familiar with - med school 2 or 301?
Not at all. Only some surgeons, intensive care physicians, anesthesia, maybe some ER docs are trained and comfortable doing that. The dad here is a family medicine doc and likely has never ever even see one done in real life. So I completely understand why he didn't step in, especially this is in a ICU where people trained to do this kind of thing are suppose to be only steps away. If he had tried and his daughter died anyway, he probably would be blamed for her death. I agree with TedW, something systemically failed here. I also wonder if the violent manipulation of her neck as they tried to intubate her right after cervical surgery could have had something with her death.
posted by Pantalaimon at 7:46 PM on February 11, 2017 [5 favorites]
Not at all. Only some surgeons, intensive care physicians, anesthesia, maybe some ER docs are trained and comfortable doing that. The dad here is a family medicine doc and likely has never ever even see one done in real life. So I completely understand why he didn't step in, especially this is in a ICU where people trained to do this kind of thing are suppose to be only steps away. If he had tried and his daughter died anyway, he probably would be blamed for her death. I agree with TedW, something systemically failed here. I also wonder if the violent manipulation of her neck as they tried to intubate her right after cervical surgery could have had something with her death.
posted by Pantalaimon at 7:46 PM on February 11, 2017 [5 favorites]
In movies they make it out to be as simple as grabbing a knife and a pen. I wonder how complicated it is for real as movies aren't really striving for medical realism, but shouldn't it be as simple as make hole/protect hole?
In an ideal setting it isn't too hard, but emergencies are never ideal settings. And while the basic idea of making a hole isn't wrong, you have to know where to make it to avoid, say, the thyroid artery among other structures.
posted by TedW at 7:50 PM on February 11, 2017 [3 favorites]
In an ideal setting it isn't too hard, but emergencies are never ideal settings. And while the basic idea of making a hole isn't wrong, you have to know where to make it to avoid, say, the thyroid artery among other structures.
posted by TedW at 7:50 PM on February 11, 2017 [3 favorites]
I have a lot of thoughts on this (so many) but all I can elaborate on is the "cult" sense I have had from working in a couple of big hospitals. I worked at the #1-2 hospital in America for a couple years and orientation felt like a brainwashing session. "Everything is fine here, everything is great." "We listen to complaints, we care about patients, we care about staff" These are absolutely sincere and complete lies at the same time, somehow. The Hospital doesn't care. The Hospital is a corporate entity. The staff there does care, except for those burnt out souls who can't put forth another care in the world.
If there is any upside in this horrible story, (which, no, there probably isn't), I guarantee the people involved in her case are scarred from it. The nurses, the aides, the residents, the 20 people in the room, they won't forget. They'll have the crike tray there the next time.
(again, so many more thoughts but I can't right now)
Also, spine surgery? Do everything in your power to avoid it.
posted by bobobox at 8:13 PM on February 11, 2017 [6 favorites]
If there is any upside in this horrible story, (which, no, there probably isn't), I guarantee the people involved in her case are scarred from it. The nurses, the aides, the residents, the 20 people in the room, they won't forget. They'll have the crike tray there the next time.
(again, so many more thoughts but I can't right now)
Also, spine surgery? Do everything in your power to avoid it.
posted by bobobox at 8:13 PM on February 11, 2017 [6 favorites]
OK, that all sounds (sort of) logical - I guess the main tragedy here is that even once she was placed in the ICU they never took ANY steps to help her breathing.
posted by bendy at 8:26 PM on February 11, 2017
posted by bendy at 8:26 PM on February 11, 2017
Isn't this procedure - or tracheotomy which is the one I'm familiar with - med school 2 or 301?
I did one on a goat neck shortly before graduating from medical school in 2005; haven't even seen one done since. There is zero chance that I would try to get a surgical airway in someone else's ICU, even on someone I loved very much. I would be shouting from the corner though.
I cannot help but mentally contrast this poor girl's experience with something that happened when I was a medical intern. We had a patient with ankylosing spondylitis whose neck vertebrae had sort of fused together as a complication of his disease, and he had very limited neck motion. When I was getting ready to sign out to the night team I asked my attending what I should tell them to do if he had respiratory distress and they couldn't extend his neck to intubate him. (He had no respiratory symptoms, I should add; he was in the hospital for something GI related). My attending physician immediately went to his room personally, spoke in detail with the patient and discovered that the guy had failed several awake/upright attempts at fiber optic intubation. He immediately made sure that there was a crike kit available on the floor and insisted that every time we changed shifts we had to instruct the incoming group that if he had respiratory distress he would need anesthesia or ENT to perform an emergency tracheostomy ASAP. (Again, the guy had zero breathing issues at the time; this was all just in case).
I do think that the issue seems to be less with the surgery itself than with her subsequent breathing problem being downplayed and the total lack of preparation for a foreseeable complication despite being warned. That speaks really poorly of the culture in that SICU.
posted by The Elusive Architeuthis at 8:26 PM on February 11, 2017 [18 favorites]
I did one on a goat neck shortly before graduating from medical school in 2005; haven't even seen one done since. There is zero chance that I would try to get a surgical airway in someone else's ICU, even on someone I loved very much. I would be shouting from the corner though.
I cannot help but mentally contrast this poor girl's experience with something that happened when I was a medical intern. We had a patient with ankylosing spondylitis whose neck vertebrae had sort of fused together as a complication of his disease, and he had very limited neck motion. When I was getting ready to sign out to the night team I asked my attending what I should tell them to do if he had respiratory distress and they couldn't extend his neck to intubate him. (He had no respiratory symptoms, I should add; he was in the hospital for something GI related). My attending physician immediately went to his room personally, spoke in detail with the patient and discovered that the guy had failed several awake/upright attempts at fiber optic intubation. He immediately made sure that there was a crike kit available on the floor and insisted that every time we changed shifts we had to instruct the incoming group that if he had respiratory distress he would need anesthesia or ENT to perform an emergency tracheostomy ASAP. (Again, the guy had zero breathing issues at the time; this was all just in case).
I do think that the issue seems to be less with the surgery itself than with her subsequent breathing problem being downplayed and the total lack of preparation for a foreseeable complication despite being warned. That speaks really poorly of the culture in that SICU.
posted by The Elusive Architeuthis at 8:26 PM on February 11, 2017 [18 favorites]
In movies they make it out to be as simple as grabbing a knife and a pen.
Honestly I'm thinking of the scene in L&O SVU where Melinda gets shot and coaches Benson to fix her by stabbing a scalpel into her ribcage. Total medical ignorance here.
posted by bendy at 8:33 PM on February 11, 2017
Honestly I'm thinking of the scene in L&O SVU where Melinda gets shot and coaches Benson to fix her by stabbing a scalpel into her ribcage. Total medical ignorance here.
posted by bendy at 8:33 PM on February 11, 2017
Thank you to everyone in this thread. To most people, medical care is a mystery in so many ways. I appreciate all of your comments.
posted by bendy at 9:01 PM on February 11, 2017 [1 favorite]
posted by bendy at 9:01 PM on February 11, 2017 [1 favorite]
It would depend on whether you were on staff in the hospital, your reputation and connections in the community, what kind of lawyer you can afford, and so on. Not to mention whether the procedure was successful or not; you can easily kill a patient if you try to manage their airway unsuccessfully. So, basically, anything between nothing and criminal charges that probably wouldn't result in jail time but would ruin your career.
Still, as a parent debating whether to save your child or not, would any of these be important?
posted by bendy at 9:09 PM on February 11, 2017
Still, as a parent debating whether to save your child or not, would any of these be important?
posted by bendy at 9:09 PM on February 11, 2017
Still, as a parent debating whether to save your child or not, would any of these be important?
Bendy, as a physican myself, I am sure the poor dad has been replaying those final hours in his head ever since. Asking himself what else he could have done, torturing himself with thousands of "what ifs".
But no, I don't think a fear of losing his license or facing charges were factors here. More the fear of doing more harm than good.
First of all, he had no equipment. Second, he might not have been trained how. Depending on type of practice, many physicians might not even have seen one in their practice, or years ago. You have to know where, you have to know how. And there were people in the room who were qualified to do it.
posted by M. at 11:29 PM on February 11, 2017 [7 favorites]
Bendy, as a physican myself, I am sure the poor dad has been replaying those final hours in his head ever since. Asking himself what else he could have done, torturing himself with thousands of "what ifs".
But no, I don't think a fear of losing his license or facing charges were factors here. More the fear of doing more harm than good.
First of all, he had no equipment. Second, he might not have been trained how. Depending on type of practice, many physicians might not even have seen one in their practice, or years ago. You have to know where, you have to know how. And there were people in the room who were qualified to do it.
posted by M. at 11:29 PM on February 11, 2017 [7 favorites]
Cricothyrotomy. (warning: blood etc.)
Tools needed: scalpel, bougie (plastic rod), endotracheal tube.
Elapsed time: two minutes.
posted by v-tach at 12:29 AM on February 12, 2017 [2 favorites]
Tools needed: scalpel, bougie (plastic rod), endotracheal tube.
Elapsed time: two minutes.
posted by v-tach at 12:29 AM on February 12, 2017 [2 favorites]
As a doctor who has had a little bit of airway training but is basically on a general practice training pathway, my medical knowledge just makes me all the more aware of what else I will probably cut before I get to the trachea and how I could make it worse.
posted by chiquitita at 2:10 AM on February 12, 2017 [5 favorites]
ghost phoneme, when I read your comment, Tom Lehrer's "Werner Von Braun" came to mind, with the line, "Once the rockets go up, who cares where they come down, that's not my department, says Werner Von Braun".
This epitomizes capitalism for me, in which all these bidniz grads learn how to compartmentalize their tawdry little schemes and insulate themselves from blowback.
I get health care overseas. It's adecuate, cheap and the medicos seem to actually give a damn about me, although I realize they also have their limitations and I am, after all, probably one of the few gringos they've ever encountered. Nevertheless, I get some feedback from others who rely on such health care and field questions on America from locals about similarities and differences. I can't say the world is universally impressed with how greedy American doctors have shown themselves to be, outside of the fact that the means for making money is impressive.
This particular story is appallingly tragic, considering the young woman's dad intervened and still, she died. I have a really good notion of how he feels, since a friend lost his daughter to a routine appendectomy.
The doctors have clearly forgotten, "First, do no harm".
Psychopaths. Toss 'em on the fire. There are plenty of physicians out there whose humanity makes them far more qualified. That is, if we all truly want to continue addressing ourselves as civilized.
posted by girdyerloins at 4:52 AM on February 12, 2017 [3 favorites]
This epitomizes capitalism for me, in which all these bidniz grads learn how to compartmentalize their tawdry little schemes and insulate themselves from blowback.
I get health care overseas. It's adecuate, cheap and the medicos seem to actually give a damn about me, although I realize they also have their limitations and I am, after all, probably one of the few gringos they've ever encountered. Nevertheless, I get some feedback from others who rely on such health care and field questions on America from locals about similarities and differences. I can't say the world is universally impressed with how greedy American doctors have shown themselves to be, outside of the fact that the means for making money is impressive.
This particular story is appallingly tragic, considering the young woman's dad intervened and still, she died. I have a really good notion of how he feels, since a friend lost his daughter to a routine appendectomy.
The doctors have clearly forgotten, "First, do no harm".
Psychopaths. Toss 'em on the fire. There are plenty of physicians out there whose humanity makes them far more qualified. That is, if we all truly want to continue addressing ourselves as civilized.
posted by girdyerloins at 4:52 AM on February 12, 2017 [3 favorites]
Tools needed: scalpel, bougie (plastic rod), endotracheal tube.
Thanks for the link, v-tach.
However, I'd also add SKILL (to know what the heck you are doing) and a willing and competent assistant. Plus, depending on how alert she still was - sedation and analgesia.
posted by M. at 4:54 AM on February 12, 2017 [3 favorites]
Thanks for the link, v-tach.
However, I'd also add SKILL (to know what the heck you are doing) and a willing and competent assistant. Plus, depending on how alert she still was - sedation and analgesia.
posted by M. at 4:54 AM on February 12, 2017 [3 favorites]
The Elusive Architeuthis: I have AS, although I currently don't have neck fusion. Folks who do are encouraged to wear medic alert bracelets, as even paramedics/EMTs could do damage trying to help someone with a fused neck who stops breathing. The Spondylitis Association of America also runs first responder training focused on this. The idea that even in a hospital where they surgically fused someone's neck they couldn't properly manage her airway is absolutely terrifying.
posted by hydropsyche at 4:57 AM on February 12, 2017 [4 favorites]
posted by hydropsyche at 4:57 AM on February 12, 2017 [4 favorites]
I wonder if her father being a physician as well didn't in the end actually work against her. It seems like her medical team transferred her to the ICU almost as a favor for someone "in the club" without thinking she had a serious indication for that degree in escalation in care. There is nothing in the article that suggests the ICU team took her seriously about finding it difficult to breath (no one did a CT or a bronchoscopy, at least not that's revealed to us). It all seems like a pat on the back to her father's anxieties to put her in the ICU.
I would save my wrath for the ICU doctor instead of the neurosurgeon though. He's probably right that nothing he did should have caused her trouble breathing and it was the ICU team's fault that they didn't investigate it more and were so wildly unprepared when she did go into respiratory failure.
posted by half life at 9:55 PM on February 12, 2017
I would save my wrath for the ICU doctor instead of the neurosurgeon though. He's probably right that nothing he did should have caused her trouble breathing and it was the ICU team's fault that they didn't investigate it more and were so wildly unprepared when she did go into respiratory failure.
posted by half life at 9:55 PM on February 12, 2017
All of this is horrifying, but the eeriest thing about part two for me is the way that Delashaw sounds just like Trump in almost every one of his responses. People criticize him? They must be jealous. Patient care? We make the most money. Higher rate of complications? You're imagining it. Hostile workplace? I'm the best boss.
Always a deflection and a brag or an attack on those who question him. It's the best. If you don't think it is the best, then YOU must be inadequate in some way. The banality of evil indeed.
posted by a fiendish thingy at 10:12 AM on February 13, 2017 [5 favorites]
Always a deflection and a brag or an attack on those who question him. It's the best. If you don't think it is the best, then YOU must be inadequate in some way. The banality of evil indeed.
posted by a fiendish thingy at 10:12 AM on February 13, 2017 [5 favorites]
The Washington State Department of Health is now investigating Swedish Cherry Hill and Delashaw. Also there were two complaints filed against Delashaw with the state Medical Commission in the last year, which the Commission is in the process of investigating.
posted by creepygirl at 8:21 PM on February 16, 2017 [2 favorites]
posted by creepygirl at 8:21 PM on February 16, 2017 [2 favorites]
Followup: The CEO of Swedish has resigned
posted by CrystalDave at 1:13 AM on February 22, 2017 [2 favorites]
posted by CrystalDave at 1:13 AM on February 22, 2017 [2 favorites]
"We believe it's an important time to return to physician leadership."
Well, yeah, it sure looks like it. And they didn't decide to return to physician leadership because of the horrible patient outcomes, or because many of its own doctors expressed concerns about how Swedish had lost its way. This happened because the Seattle Times publicly shamed Swedish with a high-profile article.
I am not a fan of everything the Times does, but they've done good work here.
posted by creepygirl at 7:46 PM on February 22, 2017
Well, yeah, it sure looks like it. And they didn't decide to return to physician leadership because of the horrible patient outcomes, or because many of its own doctors expressed concerns about how Swedish had lost its way. This happened because the Seattle Times publicly shamed Swedish with a high-profile article.
I am not a fan of everything the Times does, but they've done good work here.
posted by creepygirl at 7:46 PM on February 22, 2017
« Older One cannot think well, love well, sleep well, if... | Meatspace Newer »
This thread has been archived and is closed to new comments
posted by greermahoney at 12:28 AM on February 11, 2017 [5 favorites]