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A tube misconnection and a death: a medical whodunit

A tube misconnection and a death: a medical whodunit

Here’s what we know. In September 2016, a 72-year-old former member of the Australian national soccer team suffered what must have been an extremely painful death when his oxygen supply was somehow connected to his urinary catheter. The oxygen filled his bladder until it burst, and then the gas expanded his abdomen so much that his diaphragm was pushed up causing his lungs to collapse. The flow of blood returning to his heart was also obstructed. What we don’t know is how this could have happened. Some have speculated that it was caused by a system problem. For example, the design of the connections on the urinary catheter and oxygen tubing might be similar and easily confused. Although this would be a simple explanation and might lessen the degree of human error involved, I’m not buying it. The types of connections used for urinary catheters and oxygen tubing are quite different. The end of a urinary catheter is a female connection with a relatively wide diameter to accommodate the male end of the tubing leading to the drainage bag. See figure below. The oxygen administration tubing is usually a combination of tube and nasal prongs as a single unit. See figure below. Considering the incompatible tubing, it is difficult to imagine how the oxygen could have been connected to the urinary catheter by the elderly patient. Yet it is also inconceivable that any hospital staffer could think that oxygen should be given via the bladder. At the coroner’s inquest, which is still in progress, one account says a nurse recalled seeing a white connector between the green oxygen tube...
Parking lot needlestick yields $4.6 million payout

Parking lot needlestick yields $4.6 million payout

A jury awarded a woman $4,618,500 for a needlestick injury she sustained in the parking lot of Target. Skeptical Scalpel shares his opinions. A South Carolina jury awarded a woman $4,618,500 for a needlestick injury she sustained in the parking lot of a Target store. She had parked her car and while walking to the store, her daughter picked up a hypodermic needle. As she swatted the needle out of the child’s hand, it punctured the woman’s palm. She went into the store and notified an employee. HIV post-exposure prophylaxis medications were prescribed which she said rendered her sick and bedridden. Her husband had to take time off from work to care for her. Hepatitis and HIV testing proved negative. Her lawyer asked Target for $12,000 to compensate her, but the store offered $750. The plaintiff’s attorney said, “When we started this, we were just trying to get Target to make my client whole, to pay for her medical bills and the time that her husband had to take off work. We tried to be reasonable and not take this to trial. But Target took a really hard stance on it … and I think the jury sent a message.” Not surprisingly, Target is considering appealing the verdict. I have some problems with this. If the verdict stands, does it mean a store is responsible for anything left in its parking lot at any time? Should stores hire people to comb the premises 24/7? That seems overly burdensome. There is an issue of possible negligence on the part of the plaintiff. Is swatting a needle out of the hand...
Shocker: Hospitalists’ “Unprofessional” Behavior Is Normal

Shocker: Hospitalists’ “Unprofessional” Behavior Is Normal

By their own admission, medical hospitalists are guilty of many types of unprofessional behavior, says a paper published a in the Journal of Hospital Medicine. A group of researchers from the University of Chicago surveyed medical hospitalists from three major Chicago area teaching institutions. The respondents themselves rated each listed behavior on a professionalism scale. There were 77 responses from a pool of 101 hospitalists who were sent the questionnaires. The study asked respondents to state whether they had either engaged in and/or observed unprofessional conduct. The key findings were as follows: Most of the respondents had engaged in at least one unprofessional behavior. The most common unprofessional behavior was (I hope you are sitting down) having non-medical/personal conversations, such as discussing plans for the evening, in hospital corridors. [Gasp!] Over 60% of these doctors admitted that they ordered a routine test as “urgent” as a way of obtaining results more quickly. (Can you believe it?) My favorite is that 40% confessed that they had made fun of or disparaged the emergency department team for missing findings. (Unreported but very likely true is that 60% of those questioned committed another unprofessional act, which was lying by claiming they had never made fun of or disparaged any ED MDs. The only physicians I know who do not routinely make fun of the ED staff are pathologists because they never deal directly with the ED. Before all you ED docs get your panties in a knot, I am certain all of you disparage all of us too.) Other alleged unprofessional behaviors were celebrating a blocked admission, going to work when ill,...
Patient Dies 90 Min After Live Broadcast Surgery

Patient Dies 90 Min After Live Broadcast Surgery

“In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate? A major complication was inevitably to occur during a live broadcast.” As I predicted last year, it had to happen sooner or later. In that post, I wrote “A major complication will inevitably occur during a live broadcast. No matter the reason, it will be blamed on the live video surgery.” Of the many stories in the Indian media about this tragic case, most brought up the debate about the ethics of showing surgery to an audience in real time. One article featured the response of a senior physician at the All India Institute of Medical Sciences (AIIMS) in Delhi, where the tragic event took place, who said, “Live surgery has nothing to do with the death; the whole world is moving from open to laparoscopic procedure for its safety rate. He succumbed because of his disease, and there were several experts present who did whatever was possible to save his life.” Right. I’m not so sure about that. Here’s what happened. A 62-year-old man who was having a laparoscopic resection for a liver cancer began bleeding during the procedure, which was being televised live to surgeons at a seminar. A Japanese liver surgeon was performing the operation assisted by a surgeon from the AIIMS, India’s most prestigious medical school. Reports say members of the audience encouraged the surgeons to switch to an open operation after bleeding could not be controlled laparoscopically, but the conversion did not occur until several hours had elapsed. The patient died in an intensive care unit about 90...
The Opioid Epidemic: What Was the Joint Commission’s Role?

The Opioid Epidemic: What Was the Joint Commission’s Role?

Last month the Joint Commission issued a statement written by its Executive VP for Healthcare Quality Evaluation Dr. David W. Baker explaining why it was not to blame for the opioid epidemic. If you haven’t already read it, you should. Here is the first paragraph of that document: “In the environment of today’s prescription opioid epidemic, everyone is looking for someone to blame. Often, The Joint Commission’s pain standards take that blame. We are encouraging our critics to look at our exact standards, along with the historical context of our standards, to fully understand what our accredited organizations are required to do with regard to pain.” With the help of an anonymous colleague, I looked at some of the historical context. In December 2001, the Joint Commission and the National Pharmaceutical Council (founded in 1953 and supported by the nation’s major research-based biopharmaceutical companies) combined to issue a 101-page monograph entitled “Pain: Current understanding of assessment, management, and treatments.” Here in italics are some excerpts from it. My emphasis is added in bold. Page 4: In 1968, McCaffery defined pain as “whatever the experiencing person says it is, existing whenever s/he says it does. This definition emphasizes that pain is a subjective experience with no objective measures. It also stresses that the patient, not clinician, is the authority on the pain and that his or her self-report is the most reliable indicator of pain. This set the tone for clinicians—i.e., patients are always to be trusted to report pain accurately. Page 16: For example, some clinicians incorrectly assume that exposure to an addictive drug usually results in addiction. Table...
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