What do healthcare professional owe when a patient is injured in our care?

This was prompted by an article/news story that I heard listening to NPR while cleaning the kitchen.

In the story, the patient had received a small abrasion on his forehead during a cataract procedure. After napping at home post procedure, he woke up to a bloody pillow case as his forehead was bleeding. His surgeon did not mention the abrasion at his post-op appointment. Upon further investigation, he discovered that was no mention of the abrasion in his chart. Not under the post-op documentation, not under anesthesia notes.

He did not appreciate that much. The entire episode was thought by him to be a reaction to the anesthesia medication.

Wait, let me back up.

This patient was undergoing cataract surgery at a cataract center. While in the procedure, the CRNA asked if he was in pain. He wasn’t, just felt some pressure to the side of the head. They increased his sedation.

The next thing the patient recalled was a bit of a commotion, and the surgeon yelling at him to stay still. In a later appointment the surgeon told him that he had a “adverse impact from the anesthesia.”

He thought to ask for a rebate in recompense for the injury.

The article uses phrases like the jig was up, in ascribing guilt to the surgeon for not mentioning it before. But the surgeon should absolutely have mentioned it when talking to the wife at the end of the procedure.

Oh, this makes me so mad.

Yes, adverse reactions to anesthesia happen. They do. And can run the gamut from allergic reactions to the anesthesia to death. That is quite the range of possibilities.

What I think is that he got a little frisky under deeper sedation.

I see it happen ALL the time in my role as an operating room nurse.

Especially the surgeon shouting at him to keep still while attached to the eye equipment. If the surgeon hadn’t shouted at him, he could very well have been blinded.

And the surgeon should have told the wife immediately. And the circulating nurse should have filled out an internal quality assurance form. That he would not have access to as the patient.

I tell patients after the case when they get belligerent under sedation and their family member. I also warn teenagers, especially boys to age 25, not to wake up like a brat (not the actual word I use). Because teenagers do.

I’ve been slugged, and scratched, and kicked more times than I can count. While patients are emerging from anesthesia. Oh, can’t forget the pinching. That also happens.

Do I think it was a medication reaction like they are purporting it to be? Nope. I bet he got belligerent under deeper sedation. This happens. But this is not an allergy. This is a reaction, probably a one time one..

This makes me wonder if he bothered to ask for and read the nurse’s notes as well. Instead of relying on the doctor’s notes.

The circulator should have note the abrasion on the operative record.

Do you think he even looked there?

I don’t think that this is the whole story. But enough of a story that an article was written and a news story broadcast.

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