[HSF] "Easier to let pts suffer than to do what is right"

CardiacNse at aol.com CardiacNse at aol.com
Wed Feb 6 22:11:58 EST 2008 

Peer review for medical errors should first be the RCA (root cause  analysis) 
to determine if possible causes that can be corrected by improving  deficient 
processes. If during the RCA it is determined that peer review is  indicated, 
part of the corrective action may include peer review. A lot depends  on the 
pattern of decisions and practice.
 
Did the MD who removed the "good" kidney on a patient with very compromised  
anatomical structure go to peer review? Yes, but that was because there were  
other things indicating that there might be decision/practice issues. But also 
 it was found that radiology dictation was not specific enough and a process 
that  was improved was the specificity with which the reading of films was  
reported.
 
I know I'm not describing cardiothoracic incidents, but the idea is the  same.
 
 
In a message dated 2/6/2008 4:00:21 P.M. Pacific Standard Time,  
msfirst at gmail.com writes:

But if  the purpose of these "peer reviews" is to make sure that your re-op
for  bleeding is not 2x the STS average, is that a bad thing?  Oh my, I  am
starting to sound like an administator - Hal, quick, shoot  me......

Oh, by the way - what is the peer review process for "medical  errors" and
how are they defined?   and by  whom?

-michael


On 2/6/08, John Schor  <johnschor at mac.com> wrote:
>
> I have worked with people who  would not admit their own errors. I have
> seen many pt's "buried" due  to surgeons not doing the right thing, ie
> reoperating on a pt like  Hal's while under close scrutiny. I no longer
> work with those  people.
>
> I am now alone in practice in a rural area of Northern  Arizona. When a
> pt has any complication, the whole medical staff  immediately knows
> about it. If a surgeon reoperates, read "unplanned  procedure", a flag
> is raised on the chart and it is automatically  reviewed by a member of
> the "peer review committee".
>
>  It's usually a primary care doc, pediatrician, radiologist, or other
>  "peer" who has to figure out whether the Board Certified CT Surgeon
>  knows what he's doing and has provided standard of care.
>
> I  have had a couple of "unplanned procedures" because I am very
>  conservative and will reexplore pt's if things "just don't look
>  right". Any one on the HSF would understand and even commend such
>  behavior, but small town medical politics are very  interesting.
>
> On the other hand, I do have a monopoly for a 60  mile (100km) radius.
>
> John
>
>
> John Schor,  MD
> Verde Valley Medical Center
> Cottonwood, AZ 86326
>  Tel: 928-649-2584
>
> On Feb 6, 2008, at 2:20 PM, Nasser F.  Abou'Seada wrote:
>
> > "a place that keeps tabs on which pt's  go back to the
> > OR; then secret tribunals are held in order to  "educate" the medical
> > staff. It takes guts to take on cases like  that. It's a lot easier to
> > let pt's suffer than to do what is  right."
> >
> > Dear John
> > please elaborate more  ....
> > sounds the same everywhere !!!!
> >
> >  NFA
> >
> >
> >
> > On Feb 6, 2008 3:06  PM, John Schor <johnschor at mac.com> wrote:
> >
> >>  Hal:
> >> Great job!
> >> You prove the point that we  can only know so much without operating.
> >> Pontificating is the  worst place to be. It is clear you are a Jedi
> >> Master; "May  the force be with you".
> >>
> >> I am currently at a  place that keeps tabs on which pt's go back to
> >> the
>  >> OR; then secret tribunals are held in order to "educate" the  medical
> >> staff. It takes guts to take on cases like that. It's  a lot easier to
> >> let pt's suffer than to do what is  right.
> >> I admire your efforts.
> >> John
>  >>
> >>
> >> John Schor, MD
> >>  Verde Valley Medical Center
> >> Cottonwood, AZ 86326
>  >>
> >>
> >> On Feb 6, 2008, at 10:03 AM,  Hgrmd at aol.com wrote:
> >>
> >>>
>  >>> Prasanna,
> >>>
> >>> ?  Thanks.
> >>>
> >>>
> >>>
>  >>> Hal
> >>>
> >>>
>  >>> -----Original Message-----
> >>> From: Prasanna  Simha M <prasannasimha at gmail.com>
> >>> To:  OpenHeart-L at lists.hsforum.com
> >>> Sent: Wed, 6 Feb 2008 11:55  am
> >>> Subject: Re: [HSF] (no subject)
>  >>>
> >>>
> >>>
>  >>>
> >>> Gut instinct pays.
> >>>  Prasanna
> >>>
> >>> On Feb 6, 2008 10:17 PM,  <hgrmd at aol.com> wrote:
> >>>
>  >>>>
> >>>> Ahmed,
>  >>>>
> >>>> ? Thanks for your words.?  Parenthetically, all of my partners
> >>>> advised  me
> >>>> not to operate.
> >>>>
>  >>>>
> >>>>
> >>>> Hal
>  >>>>
> >>>>
> >>>>  -----Original Message-----
> >>>> From: alsadd  <alsadd at ksu.edu.sa>
> >>>> To:  OpenHeart-L at lists.hsforum.com
> >>>> Sent: Wed, 6 Feb 2008  5:33 pm
> >>>> Subject: RE: [HSF] (no subject)
>  >>>>
> >>>>
> >>>>
>  >>>>
> >>>> Congratulations Hal a job well done.  It is the thing to do bite the
> >>>> bullet.
>  >>>>
> >>>>
> >>>>  Ahmed
> >>>>
> >>>> -----Original  Message-----
> >>>> From:  openheart-l-bounces at lists.hsforum.com
> >>>>  [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
> >>  hgrmd at aol.com
> >>>> Sent: Wednesday, February 06, 2008 3:21  AM
> >>>> To: OpenHeart-L at lists.hsforum.com
>  >>>> Subject: [HSF] (no subject)
> >>>>
>  >>>> Dear Members,
> >>>> ? Two days ago, I  reoperated on the gentleman with the stenotic and
> >>>>  thrombosed SVC.? I'm glad I did.? I femorally cannulated and went
>  >>>> on pump
> >>>> prior to splitting the chest  (he was 3 weeks postop).? I only
> >>>> dissected
>  >>>> the
> >>>> right atrium.? The adhesions  were torture.? The tip of the femoral
> >>>> cannula
>  >>>> was advanced only into the IVC.? No effort was made to  control
> >>>> either
> >>>>  cava.?
> >>>> The heart stayed warm and beating.? A right  atriotomy was made and
> >>>> extended
>  >>>> across the RA-SVC junction.? It was tightly stenotic.? A  large
> >>>> amount of
> >>>> clot was  retrieved with a 6mm Fogarty.? A large patch of bovine
>  >>>> pericardium
> >>>> was placed.? The whole  operation took less than 3 hours.?
> >>>> Yesterday,  it
> >>>> was
> >>>> evident that his  facial and forearm edema were markedly improved.?
> >>>>  He's
> >>>> already on Lovenox and Coumadin.
>  >>>>
> >>>> Hal
> >>>>
>  >>
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