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Attending Surgeries With Limited On Call: Who Will Have Your Back?

This month, we feature an article from the archives written by CAP’s former General Counsel Gordon Ownby

When attending to a weekend surgery at the hospital, make sure you don’t find yourself all alone with too much to do.

A 61-year-old patient was the only scheduled surgery on a Saturday morning, where he was to undergo an ERCP for suspected inflamed gallbladder/bile duct gallstones. The gentleman had Type 2 diabetes, major depressive disorder, essential hypertension, and a remote history of a CVA. Dr. A, the anesthesiologist for the surgery, classified the patient as ASA III and anticipated a difficult intubation.

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On the morning of the scheduled surgery, Dr. A — the only anesthesiologist on call at the hospital that weekend — learned that he was also to attend to a Cesarean section for a patient with failed labor.

The ERCP started at 8:15 that morning and after a difficult intubation, proceeded without incident. Surgery concluded at 9:25 but hospital staff notes at 9:35 showed the extubated, bag-masked patient in the PACU as unresponsive. Dr. A ordered new dosages of relaxant-reversals without improvement. Dr. A then re-administered a muscle relaxant and attempted to re-intubate the patient. When the reintubation failed, Dr. A was successful in placing a laryngeal mask airway. At 10 a.m. with the LMA in place and connected to a ventilator, Dr. A left the patient in the care of the nursing staff and respiratory therapists as he began general anesthesia for the Cesarean section in the OR next door.

With Dr. A at the Cesarean section, the GI patient desaturated and staff called the emergency room physician, who arrived at 10:05 a.m. According to his records, the ER physician noted no breath sounds or chest rise. The ER physician asked the staff to call Dr. A back to the PACU stat to re-establish an airway and to call any other available anesthesiologist – as well as a general surgeon in the event of a cricothyrotomy. The ER physician made several unsuccessful attempts to intubate the patient and began an emergency cricothyrotomy when Dr. A returned to the PACU. The ER physician asked Dr. A to assist in establishing an airway, but Dr. A stated he did not think he could do that successfully as he had previously been unable to re-intubate the patient and that he needed to return to the Cesarean delivery. The ER physician unsuccessfully attempted the cricothyrotomy and a Code Blue was called at 10:22 a.m. Another anesthesiologist arrived at 10:40 a.m. and successfully intubated the patient. The patient remained pulseless, however, and was declared dead at 11:07 a.m.

In a subsequent lawsuit, the family sued Dr. A for medical negligence and for patient abandonment. Dr. A and the family resolved the litigation without going to trial.

In his deposition, Dr. A testified that he advised the OB surgeon to speak to the GI surgeon regarding whether the Cesarean delivery could be performed first. No such change occurred. Dr. A also testified that staff was unable to get another anesthesiologist to take the Cesarean section or to get a surgeon for a possible cricothyrotomy.

Jurors expect physicians to make more than just technical medical decisions:  When a situation puts patient safety at risk, they will look for a physician’s assertiveness. These are the times for the “patient’s advocate” to be heard.