Garbage
Have you ever had a patient unexpectedly arrest and then die while you were working to resuscitate them? A lot of us have and if there is a worse feeling, I don’t want to experience it. I know that when it happens, things go from tense to worried, to frantic, and I can’t imagine just casually going through the motions. I also can’t imagine not pulling every stop, screaming for every possible assistance, and putting pride aside to get whatever help one can to recover someone. I’ve done that too, more than once.
Out in Colorado, Dr. Geoffrey Kim was found “not guilty of negligent homicide in the death of 19-year-old patient Emmalyn Nguyen, but [found] guilty of attempted reckless manslaughter and guilty of obstructing a telephone after he failed to call for help for hours after Nguyen suffered cardiac arrest.” Huh?
The then-18-year-old patient went to Kim for breast augmentation, arrested, and was resuscitated enough to remain in a coma before dying 14 months later. The patient arrested at the doctor’s outpatient surgery center, and the prosecution charges that the surgeon “failed to call for help for five hours after her cardiac arrest, even though she needed immediate care at a hospital.” The defense tried to hang it on the nurse anesthetist for pushing too much fentanyl: “Investigators later determined that Meeker (the NA) had administered seven times the necessary amount of fentanyl to the teen, per court documents.” The defense also stated that the surgeon was waiting down the hall while the nurse anesthetist was preparing the patient, during which time she arrested.
“Rex Meeker, the former anesthetist at the Greenwood, Colorado, clinic, faced charges of criminally negligent homicide and reckless manslaughter. Those charges were dismissed in September 2022, and Meeker would go on to testify against Kim.” If the overdose charge was correct, why was the anesthetist allowed to walk? Was this a plea deal to go after the higher-profile surgeon?
Nurses at the surgery center also testified against Dr. Kim, stating that after he resuscitated the patient with CPR, they were told they could not call 911. Per the prosecutor, “Not only does he not call 911 himself, but [Kim] tells every other staff member in the operating room that they cannot call 911 either.” Huh?? The plaintiff’s attorney asserted that the surgical center is in a parking lot shared by a fire department, and the EMTs could have been there in 45 seconds to a minute.” Were there paramedics at the fire station? If the surgical center had anywhere close to a competent staff – apparently an open question – then paramedics should not have been able to offer anything additional in terms of stabilization, except for transport. And this patient clearly needed to be transported to an ICU immediately, at a minimum for a stat cardiology consult, never mind whatever other drips would be indicated.
“The information and evidence either discovered during the case or presented at trial established that …”
- Dr. Kim “made material misrepresentations to at least one other medical provider during the course of Patient A’s care”
- Dr. Kim did not “reflect accurately the number of times CPR was initiated on Patient A, the timing of CPR efforts at Respondent’s practice, Patient A’s response to such efforts, and the absence of improvement in Patient A’s condition … failed to advise the patient’s mother that he had to perform CPR efforts on Patient A prior to transfer.”
- Dr. Kim “obstructed emergency efforts to assist Patient A for hours while he both failed to contact emergency services himself, and while acting with a criminal mental state, prevented others from contacting emergency services to transport Patient A to the hospital.”
- Dr. Kim attempted to “conceal his conduct in the events leading to Patient A’s death and the Panel has gained greater understanding about (Dr. Kim’s) efforts to down- play the injuries incurred by Patient A during the medical procedure when he reported details to family and other medical providers.”
In August the Colorado Medical Board told Kim he could continue practicing, provided he disclosed his conviction to prospective clients. Last week the board suspended his license. But he was found guilty in June of reckless manslaughter and obstructing emergency medical care. Why the delay? Why the change of heart by the medical board? Was this a regular appeals sequence, or was this delayed political pressure?
Kim was sentenced last week to 15 days in jail, and two year’s probation, and will have to pay $70,000 in fines and serve 120 hours of community service in a facility for those who have suffered brain injuries.
Yeah, I understand how the perverse economics of health care have driven the rise of both outpatient surgery centers and nurse anesthetists, and I philosophically don’t like either. Don’t get me wrong, I have worked with some excellent anesthetists. I just don’t think they represent the best possible care. Years ago, the hospital in my hometown rebuilt a larger, more modern facility. The engineering required a more stable building site for a markedly heavier building, and the hospital moved to the north side of town. Shortly thereafter, an affiliated outpatient surgery center was built…on the opposite side of town. Which is not a problem for “routine, minor” surgeries so long as there are no pesky complications like arrests, strokes, or exsanguinations. Again, does this represent the best possible care?
This whole mess has so many rotten components. A shitty doctor. An incompetent NA. A shady medical board. And again, a true dirtbag surgeon. Possibly a corrupt prosecutor willing to let some bad actors walk in order to get a flashier target.
There are a lot of places, most actually, where everyone during and after the fact does their best for the patient. But not in this part of Colorado, where all we’re left with is a healthy young woman, dead.
This case causes me to have a visceral reaction. This is what happens when outpatient surgery centers use CRNAs to save a buck and increase profits. Same old story. Not prepared for emergencies and the surgeon is not an airway expert. Meeker had a history of another patient dying under his care. Pretty sure he did not disclose that to the surgeon and the surgeon probably didn’t ask or properly vet him. Meeker got a plea deal if he testified against the surgeon. He relinquished his CRNA license; however, he is still able to work as a RN. From what I understand, Meeker had left the room briefly, after sedating her. When he or some other staff member re-entered the room, she was blue. What bothers me most is that anyone could have walked outside and called 911 on their cell phone. Or run over to the fire department in the same lot. F**k the surgeon. All of this was so avoidable. They all ultimately went home to their families. Emmalyn ultimately went to the morgue. So, so wrong.
A shame that nobody else stood up and called 911. Twice during a long career I had to call 911 from a clinic for a patient needing a higher level of care, each time over the very vocal protestations of those in charge. The first time, early in my career, the Director yelled at me, “They already paid!” I lost that job. The second time, later in my career, I was able to improve the systems in the second clinic. I lost another job because the hospital would not order a fracture table for the OR. They didn’t have one but some fracture cases can’t be properly treated without one, and I transferred a few fracture patients to another hospital rather than agreeing to provide substandard surgical treatment without it. As a surgeon I was fortunate to be able to stand up to that type of pressure, confident that I would find more work, and able to tolerate the sudden loss of income. What a sad story