Imagine being that nurse extender in the room when Alien 2.0 occurs out of nowhere. Was probably a green nursing student. He or she will never forget that for as long as they live!!!
Feb 4, 2023·edited Feb 4, 2023Liked by Med Mal Reviewer
This is horrifying! The poor man was conscious with his heart outside of his chest and he was bleeding out. His family had to have been devastated. I know it would (if it was my dad) keep me awake for a very long time, and counseling would be required. What a terrible way to lose someone you loved, or even knew about. This convinces me, further, that everyone should have an advocate with them during a hospital stay, such as this had predicted for post-op.
There are many bad lawsuits and frivolous lawsuits. This....was not one of them. What a horrific ending for everyone involved. That poor young nurse extender is scarred for life.
As an intensivist I agree with most of what the expert witness stated, clearly someone deserving of the title of expert. It was a well written expert opinion with clear and well informed opinions
One of my pts had a sternal dehiscence after CABG, and the CTS gave multiple reasons of delaying sternal revision (fyi, not justifying this case or his, just sharing experience):
1. The tissue around sternum and grafts were friable.
2. Pt unstable (due to infection, pulm issues, CHF etc)
3. Just had surgery (some patients are so high risk, they can’t have back to back surgery)
4. Things popping out of the chest wall extremely rare
Etc…
Just sharing a scenario as a family med doc, and what CTS told me, I don’t know if any of it is true, or was just a matter of convenience/scheduling issue (as CTS work at many hospitals, traveling etc)
Again, not defending/attacking this doc, our CTS or otherwise, just sharing
Maybe it's just me, but I felt the expert witness really focused much more on the ICU docs rather than the surgeons, which bothered me. Ultimately, the fix was rewiring the chest, and why he wasn't taken emergently to the OR is wild. Dr. B saying he "wasn't made aware" of the patient's sedation issues is no excuse, because it sounds like the nursing staff documented that multiple times. That compounded with Dr L "telling" the intensivists to heavily sedate or paralyze if necessary... Why didn't they just put in the orders themselves? It seemed like the expert witness wasn't hard enough on his critique of the CT surgeons in general.
I think its mostly because the expert was a critical care doc, so he focused on the ICU. I suspect that there were actually multiple cardiothoracic experts for both sides, but since they settled before trial, their opinions were never disclosed in the court records. But I definitely agree with you that the responsibility was more in the CV surgery rather than the ICU docs.
although i am not CTS or ICU, the CT results were available in the record for all providers to review. It is part of ICU staff’s job to review & understand those findings. It’s hard to believe that sternal nonunion s/p CABG would not prompt a good ICU attg to have a direct conversation with the surgeon re plan of care & specific precautions....
Yep. Seems like the communication between the silos was limited. Also seems a little like a freak accident in some regards. 99.99% of the time probably nothing bad happens, but this time it went horribly wrong.
This is a crazy case. Thanks for sharing.
It blew my mind when I first read it, and I've seen literally thousands of med mal cases with also sorts of weird/bad outcomes. Thanks for reading!
Imagine being that nurse extender in the room when Alien 2.0 occurs out of nowhere. Was probably a green nursing student. He or she will never forget that for as long as they live!!!
Lol that’s what I was thinking!!
This is horrifying! The poor man was conscious with his heart outside of his chest and he was bleeding out. His family had to have been devastated. I know it would (if it was my dad) keep me awake for a very long time, and counseling would be required. What a terrible way to lose someone you loved, or even knew about. This convinces me, further, that everyone should have an advocate with them during a hospital stay, such as this had predicted for post-op.
I think a lot of people were very traumatized by this, such a sad case.
There are many bad lawsuits and frivolous lawsuits. This....was not one of them. What a horrific ending for everyone involved. That poor young nurse extender is scarred for life.
As an intensivist I agree with most of what the expert witness stated, clearly someone deserving of the title of expert. It was a well written expert opinion with clear and well informed opinions
One of my pts had a sternal dehiscence after CABG, and the CTS gave multiple reasons of delaying sternal revision (fyi, not justifying this case or his, just sharing experience):
1. The tissue around sternum and grafts were friable.
2. Pt unstable (due to infection, pulm issues, CHF etc)
3. Just had surgery (some patients are so high risk, they can’t have back to back surgery)
4. Things popping out of the chest wall extremely rare
Etc…
Just sharing a scenario as a family med doc, and what CTS told me, I don’t know if any of it is true, or was just a matter of convenience/scheduling issue (as CTS work at many hospitals, traveling etc)
Again, not defending/attacking this doc, our CTS or otherwise, just sharing
Thanks for sharing! Always interesting to hear a specialist's rationale for their decisions.
Wow.
Maybe it's just me, but I felt the expert witness really focused much more on the ICU docs rather than the surgeons, which bothered me. Ultimately, the fix was rewiring the chest, and why he wasn't taken emergently to the OR is wild. Dr. B saying he "wasn't made aware" of the patient's sedation issues is no excuse, because it sounds like the nursing staff documented that multiple times. That compounded with Dr L "telling" the intensivists to heavily sedate or paralyze if necessary... Why didn't they just put in the orders themselves? It seemed like the expert witness wasn't hard enough on his critique of the CT surgeons in general.
I think its mostly because the expert was a critical care doc, so he focused on the ICU. I suspect that there were actually multiple cardiothoracic experts for both sides, but since they settled before trial, their opinions were never disclosed in the court records. But I definitely agree with you that the responsibility was more in the CV surgery rather than the ICU docs.
although i am not CTS or ICU, the CT results were available in the record for all providers to review. It is part of ICU staff’s job to review & understand those findings. It’s hard to believe that sternal nonunion s/p CABG would not prompt a good ICU attg to have a direct conversation with the surgeon re plan of care & specific precautions....
the "silo" comment by one of the expert witnesses hit the nail on the head. good lord.
Yep. Seems like the communication between the silos was limited. Also seems a little like a freak accident in some regards. 99.99% of the time probably nothing bad happens, but this time it went horribly wrong.