Stepped In It by Pat Conrad MD

manure

Looks like we can file this one under “Oops”…or aw sh….

A Fairfax County, Virginia jury ordered a local anesthesiologist and her practice to pay $500,000 to a patient for defamation and medical malpractice. While being prepped for his colonoscopy, “the plaintiff apparently told the anesthesiologist that he had passed out previously while having blood drawn and that he was taking medication for a mild rash on his genitals.” Fearing that he would be too doped to remember the doctor’s instructions following his April, 2013 colonoscopy, the plaintiff pushed “record” on his smartphone mic to get the post-procedure instructions. “The man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show.” And when he got home, the man got to hear all of the nasty OR banter:
– “After five minutes of talking to you in pre-op,” the anesthesiologist Tiffany M. Ingham, MD told the sedated patient, “I wanted to punch you in the face and man you up a little bit.”
– The recording captured Ingham mocking the amount of anesthetic needed to sedate the man.

– In referring to a rash on the man’s penis, Ingham was recorded warning a medical assistant not to touch it, “saying she might get “some syphilis on your arm or something,” then added, “It’s probably tuberculosis in the penis, so you’ll be all right.””

– The doctors then discussed “misleading and avoiding” the man after he awoke, and Soloman Shah, the gastroenterologist, reportedly told an assistant to convince the patient that “he had spoken with Shah and “you just don’t remember it.” Ingham suggested Shah receive an urgent “fake page” and said, “I’ve done the fake page before,” the complaint states. “Round and round we go. Wheel of annoying patients we go. Where it’ll land, nobody knows,” Ingham reportedly said.”
– ” Court documents state Shah also made some insulting remarks — “As long as it’s not Ebola, you’re okay.” (Insulting?).

– “Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states.”
– “The anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.”

– After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.” Shah replied, “I call it the Northern Virginia syndrome,” according to the suit.

The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a “one-party consent” state, meaning only one person involved in a conversation need agree to the recording. The doctors argued that the patient did not suffer any physical injury or miss any days of work. The plaintiff complained that he was “verbally brutalized” and suffered anxiety, embarrassment and loss of sleep for several months.
The anesthesiologist has since moved to Florida; the gastroenterologist was dropped from the case.
One of the jurors commenting on the requested $1.75 million judgment, said that the $500,000 award was a compromise because “we have to give him something, just to make sure that this doesn’t happen again.”
“These types of conversations,” testified Kathryn E. McGoldrick, former president of the Academy of Anesthesiology, “are not only offensive but frankly stupid because we can never be certain that our patients are asleep and wouldn’t have recall.”
A few observations:
– Dr. McGoldrick is of course correct, and – let’s be honest – we all know she is protecting the party line.

– The docs in this case were over the line and neither shall I defend their stupidity. But…

– Let’s not get on our high horse: Physicians should not say many of the off-color things that they routinely say in the OR. And the first one of you, who actually completed a residency, who claims you never heard or said such, and never thought it was funny, is a damn liar.

– What kind of patient records the audio of his entire colonoscopy? This smells. I’m not sure how thorough the colonoscopy prep was, because my gut tells me this plaintiff is full of used groceries.

– It is often a sad truth in medicine that speaking the truth is NOT the way to go. The truth is that North Virginia Syndrome is a very real and prevalent neurosis among the tight-twisted pretension addicts in that region. And up until 1970, Mary Washington was an all-girls school. I’d have made fun of that too.

– Doctors steel themselves, along with the traditional methods of dissociation, denial, rage, and alcohol, with coarse humor to laugh at the fallibilities in others, and often pray not to find at some point those same failings in themselves. For all the stupid TV dramas about medicine, patients don’t want to know what it’s really like, and they raise hell when they find out.

– Doctors can be dicks.

– So can patients.