Anesthesia Given Without Consent And Against Patient's Will

Quote:

---

Quoting deepsleep1975

---

Gigirle Thanks for the insult. Perhaps I didn't express my view how I wanted. I never ignore my patients concerns. What I was refering to is I hate when people come in with preconceived unwavering notions on what they should have me do inspite of the fact that their desires put them at increased risk for complications and I communicate this to them and they still insist and refuse to compromise.
I'll give you an example early in my practice -- when I could be bullied by these demands --- a patient was getting a diskectomy on their lower back ( a 1-2hr operation ). They insisted on local only -- I explained to them that this would be a very claustrophobic, uncomfortable position and to then sedate in this postition it could become dangerous for them. They still demanded local only. I accepted -- 30min into the operation they became uncomfortable and panicky. I gave some sedation the patient kept moving to the point the surgeon couldn't operate. So the question is what do I do now any more sedation and they could stop breathing effectively, yet to convert to general anesthesia we would have to roll them over on an open wound -- exposing them to infection. I vowed to never do this again; I would never allow myself to place a patient in danger by comprimising my standard of care because of their insistance. Now, I will discuss the issues but if the patient wants me to perform some anesthesia I feel could endanger themselves I have them refered to another anesthesiologist.

---

Then that is what you do.

Listen to the patient. If you can't agree on care, the answer is not to agree in words but digress in action but to simply refuse the patient care.

Lastly, I want the ability, like every other service, to refuse to pay my doctors if I don't get the quality of service that my dollars should command.

Oh no, you say.... we couldn't do that! Doctors must get paid even if the patient's condition worsens!!!

And then Vinnie wants to demand that we don't sue.

You get to pick. I either get to refuse payment for less than expected results or the ability to sue after the fact.

You choose.

Jeff, you mean well , but you are flat out wrong with this particular case. I understand your emotional take on having the input of the patient on your care. I want to have input on my care. But this really refers to a medical plan and decision making formed by you and a primary care physician, oncologist, surgeon etc. The field of anesthesiology is different. You can refuse certain procedures up front like spinals , epidurals, or the entire procedure. But don't ask me to take off the plane with only one out of 4 engines just because you want to but don't know how to fly. But once you are administered anesthetic agents of any kind, sedative etc. You pretty much give up your "personal " choices to the medical care of the anesthesiologist because you can not make decisions anymore. You are now at the mercy of your doctor to do what ever is medically necessary to get you through surgery safely. Patients think they are tough, want to be awake for the surgery, a very inexperienced anesthesiologist will let himself be talked into this. Then the patient moves, rips out the screws placed in the knee by the surgeon, the surgeon blames the anesthesiologist, the anesthesiologist blames the patient for honoring the patients request, the patient blames and sues the anesthesiologist for ruining his knee because even though he asked to be awake, the anesthesiologist " should have known better" and performed below the standard of care. Seen it. Also, most all malpractice suits come from non paying indigent patients to begin with, so give up on your doctor payment refusal crap.

Quote:

---

Quoting Vincent B

---

Jeff, you mean well , but you are flat out wrong with this particular case. I understand your emotional take on having the input of the patient on your care. I want to have input on my care. But this really refers to a medical plan and decision making formed by you and a primary care physician, oncologist, surgeon etc. The field of anesthesiology is different. You can refuse certain procedures up front like spinals , epidurals, or the entire procedure. But don't ask me to take off the plane with only one out of 4 engines just because you want to but don't know how to fly. But once you are administered anesthetic agents of any kind, sedative etc. You pretty much give up your "personal " choices to the medical care of the anesthesiologist because you can not make decisions anymore. You are now at the mercy of your doctor to do what ever is medically necessary to get you through surgery safely. Patients think they are tough, want to be awake for the surgery, a very inexperienced anesthesiologist will let himself be talked into this. Then the patient moves, rips out the screws placed in the knee by the surgeon, the surgeon blames the anesthesiologist, the anesthesiologist blames the patient for honoring the patients request, the patient blames and sues the anesthesiologist for ruining his knee because even though he asked to be awake, the anesthesiologist " should have known better" and performed below the standard of care. Seen it. Also, most all malpractice suits come from non paying indigent patients to begin with, so give up on your doctor payment refusal crap.

---

Wrong.

The minute we start saying, "you, mr. or mrs. patient must just accept blindly the treatment you are about to receive" we all lose.

Malpractice suits come from indigent patients mostly? Really?

I tell you what. I will look up the stats. You do the same.

Lastly, why are doctor's protected from the contract of service for pay? You wouldn't pay the kid up the street the $20 bucks you owe him if he screws up the lawn he was supposed to mow, but I am supposed to pay a doctor a hundred grand no matter the outcome?

C'mon. You can't have it both ways.

I think you may have some anger issues, maybe you should go to canada and get your healthcare.

Quote:

---

Quoting BlueCrystal

---

I'm at stage III with Endometriosis. I am actively planning my funeral. I believe that when someone becomes ill in this fashion it's time to let god take control and accept fate.

---

I didn't read this thread until today. I, too, am sorry for your sickness. Take care and good luck.

Quote:

---

Quoting Vincent B

---

I think you may have some anger issues, maybe you should go to canada and get your healthcare.

---

Agreed. BMWs...big screen TVs....$100,000 procedure fee for an individual Physician (no, sorry, not even the premier pediatric neurosurgeon at Hopkins pulls that in for one surgical procedure).

cyjeff, no one expects patients to blindly accept treatment. Docs would just like the benefit of the doubt that they actually know what they're talking about. Your magazine articles and wikipedia info is welcome, and sometimes entertaining, but it doesn't replace the skill, education, and experience of your Physician. Just ask yours...you know, the one you consider a friend. ;)

Quote:

---

Quoting lealea1005

---

cyjeff, no one expects patients to blindly accept treatment. Docs would just like the benefit of the doubt that they actually know what they're talking about. Your magazine articles and wikipedia info is welcome, and sometimes entertaining, but it doesn't replace the skill, education, and experience of your Physician. Just ask yours...you know, the one you consider a friend. ;)

---

That is EXACTLY what you are asking.

Don't bother the nice doctor with your questions, sonny, you really shouldn't even be establishing eye contact.

I do trust my physician... to a point. Ultimately, it is MY decision, and no one else's, what happens to my body - because no one, OTHER THAN ME, pays for the mistakes made.

Vince, yes, there may be a monetary component, but you tell me... what is your sight worth? How about the ability to move without a cane? How about 9 months of PT hell?

What is that worth to you? What about a disfiguring facial injury? You know, the kind that is listed as "cosmetic" but will forever prevent you from walking down the street without children pointing and juries looking away?

How much is that worth? 25K? here's 25K... when can you show up?

Oh, and as for the 100K... I was using as a reference my grandfather's open heart surgery... cost of surgery was $125K. He didn't make it. The surgeon still got paid.

So... if I am your car mechanic and instead of fixing your car I blow it up. Make it unusable forever. Forever deprive your family of its use and any revenue it would help generate.

Would you still pay me for the repair?

As for the rest.... Are you honestly trying the "poor poor pitiful me" act?

The mean income for doctors in this country is as follows...

Physicians and Surgeons. Medical Group Management Association, Physician Compensation and Production Report, 2003.

Table 1. Total compensation of Physicians by Specialty; 2002

Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267

Are you really screaming poverty here?

Quote:

---

Quoting cyjeff

---

That is EXACTLY what you are asking.

Don't bother the nice doctor with your questions, sonny, you really shouldn't even be establishing eye contact.

I do trust my physician... to a point. Ultimately, it is MY decision, and no one else's, what happens to my body - because no one, OTHER THAN ME, pays for the mistakes made.

Vince, yes, there may be a monetary component, but you tell me... what is your sight worth? How about the ability to move without a cane? How about 9 months of PT hell?

What is that worth to you? What about a disfiguring facial injury? You know, the kind that is listed as "cosmetic" but will forever prevent you from walking down the street without children pointing and juries looking away?

How much is that worth? 25K? here's 25K... when can you show up?

Oh, and as for the 100K... I was using as a reference my grandfather's open heart surgery... cost of surgery was $125K. He didn't make it. The surgeon still got paid.

So... if I am your car mechanic and instead of fixing your car I blow it up. Make it unusable forever. Forever deprive your family of its use and any revenue it would help generate.

Would you still pay me for the repair?

As for the rest.... Are you honestly trying the "poor poor pitiful me" act?

The mean income for doctors in this country is as follows...

Physicians and Surgeons. Medical Group Management Association, Physician Compensation and Production Report, 2003.

Table 1. Total compensation of Physicians by Specialty; 2002

Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267

Are you really screaming poverty here?

---

Sorry about your grandfather, truly, I am. The amount you gave is the total cost of surgery. I see you ARE angry. It's a normal part of your grief process. That answers a lot of my questions.

BTW..your statistics are old. A recent (2007) study by MedChi found that Physician salaries have been overestimated for years and have continually dropped every year for the past 6 years. The figures you cited do not include $20,000+ in malpractice premiums, staff salaries, rent, health insurance, etc.
Salaries are not the issue here.

Quote:

---

Quoting lealea1005

---

Sorry about your grandfather, truly, I am. The amount you gave is the total cost of surgery. I see you ARE angry. It's a normal part of your grief process. That answers a lot of my questions.

BTW..your statistics are old. A recent (2007) study by MedChi found that Physician salaries have been overestimated for years and have continually dropped every year for the past 6 years. The figures you cited do not include $20,000+ in malpractice premiums, staff salaries, rent, health insurance, etc.
Salaries are not the issue here.

---

My salary does not include my costs of doing business either.

My grandfather died over 20 years ago. My grieving process ended years ago.

However, whenever ANYONE tells me that I should just pay and trust that the people I am paying are going to do a stellar job, I worry.

Again... you wouldn't give the same level of trust to a mechanic, a carpenter, a landscaper or any other skilled trade.... but I am demanded to stop asking my medical "partner" all those darned questions.

Jeff, I hope your insurance plan pays for a psychiatrist because you need one asap. You did not provide us with that average and medium income figure. What happens when you leave your psychiatrist's office and you are still just as messed up and delusional as you are now ? Do you sue him ?? Let me answer for you, yes. Its got to be somebodies fault i'm so messed up, but not my own.
Just to update are stats department put together by you, anesthesiologist malpractice premiums are $80-$85K per year with no incedents.

Quote:

---

Quoting lealea1005

---

Sorry about your grandfather, truly, I am. The amount you gave is the total cost of surgery. I see you ARE angry. It's a normal part of your grief process. That answers a lot of my questions.

BTW..your statistics are old. A recent (2007) study by MedChi found that Physician salaries have been overestimated for years and have continually dropped every year for the past 6 years. The figures you cited do not include $20,000+ in malpractice premiums, staff salaries, rent, health insurance, etc.
Salaries are not the issue here.

---

Please post that link. I have researched MedChi and I did not see anything describing the statistics and/or results you found.

I did find, however, the annual Mardi Gras bash information and the information about how patients should lobby to be more a part of the process.... but nothing on your stats.

Quote:

---

Quoting Vincent B

---

Jeff, I hope your insurance plan pays for a psychiatrist because you need one asap. You did not provide us with that average and medium income figure. What happens when you leave your psychiatrist's office and you are still just as messed up and delusional as you are now ? Do you sue him ?? Let me answer for you, yes. Its got to be somebodies fault i'm so messed up, but not my own.
Just to update are stats department put together by you, anesthesiologist malpractice premiums are $80-$85K per year with no incedents.

---

Wow. So now you are practicing medicine? Nice.

And a payment of 85K in premiums still means he takes in over 225K a year.

I am not insane. I do not believe it is illogical to be able to question my health care.

Let's not forget how this started. The OP stated specifically that she did not want a specific procedure.

The doctor assured her it wouldn't be done... and then did it anyway.

You are saying that is correct because doctors know best and patients really don't deserve to have their questions and concerns taken into account.

I guess we will let the court decide who is correct. Want to place a side bet?

Quote:

---

Quoting cyjeff

---

My salary does not include my costs of doing business either.

My grandfather died over 20 years ago. My grieving process ended years ago.

However, whenever ANYONE tells me that I should just pay and trust that the people I am paying are going to do a stellar job, I worry.

Again... you wouldn't give the same level of trust to a mechanic, a carpenter, a landscaper or any other skilled trade.... but I am demanded to stop asking my medical "partner" all those darned questions.

---

The problem with comparing a medical situation where the doctor only gets paid if there is a positive outcome to something like a mechanic is that, economically speaking, there would be a tendency for doctors not to take difficult cases, which would require an elevated level of skill and labor, when the odds were against them going into the proceedure.

My personal experience with doctors has been pretty dismal. I have not found any that seem very skilled or who can even muster a facade of enthusiasm about medicine. I spend a lot of time on website such as "ask a patient" because I can get a wide variety of experience that is more likely to accurately forcast how a particular treatment is going to affect me.

Anyway, enough of this...

Quote:

---

Quoting donnabert

---

The problem with comparing a medical situation where the doctor only gets paid if there is a positive outcome to something like a mechanic is that, economically speaking, there would be a tendency for doctors not to take difficult cases, which would require an elevated level of skill and labor, when the odds were against them going into the proceedure.

My personal experience with doctors has been pretty dismal. I have not found any that seem very skilled or who can even muster a facade of enthusiasm about medicine. I spend a lot of time on website such as "ask a patient" because I can get a wide variety of experience that is more likely to accurately forcast how a particular treatment is going to affect me.

Anyway, enough of this...

---

You are, of course, correct. We have all had mechanics that refused work because they didn't think they could do it.

But, wouldn't this also lend itself to a natural selection process... where only the best doctors would take the most difficult cases and then, by extrapolation, could charge a premium for their services?

Economics abhores a vacuum. If there is someone willing to pay top dollar for a service, someone will provide that service.

Where this thread has gotten off track is surrounding the simple question "How much input should a patient have in his/her own care?"

A patient's answer is - A LOT!
Apparently, a doctor's answer is - only until that input crosses over into medicine.

Would you use a mechanic that had a sign over their desk that said, "Questions about what we are doing to your car will not be tolerated. The mechanic went to extensive training to be able to do this. Unless you went to mechanic's training, you should be quiet. We will provide you a bill for what you needed at the end. Payment is required before you get in the car and test the repairs."

Quote:

---

Quoting deepsleep1975

---

Dear Caring4U
I am an anesthesiologist and reading your post greatly offended me. Your attitude that you can order up the type of anesthesia like you are at McDonalds is one of my most hated areas of my job. The idea that you tell the anesthesiologist the type of anesthesia you want is akin to telling the surgeon I want only a partial meniscectomy, no chondroplasty and leave my synovium intact. You need years of expertise to understand the nuances of each surgery and the anesthesia for each. For you to get this surgery completely awake you would have needed a spinal or a combination block femoral and sciatic block, with this you would have had no pain but you would have felt movement and things happening in your knee. With the spinal you would have had a 5 min period where 30 % of people vomit and then you would have waited in the RR 90+min for your leg and bladder function to return. With the nerve block you would have had two injections mild - mod pain with injection -- taking 5-15min to perform each block and then you would have had a 'dead' leg for 6-18hrs. Also you would have gotten near toxic levels of local anesthetic to combine both blocks. So don't feel so hurt nobody intentionally tried to harm you it was in your best interest and next time there can be less nauseating anesthetics. Understand that you are not an expert and that dictating care like you are doing is putting you at risk for complications.

---

Versed was given to me in 1991 and it totally destroyed my life. Why this drug is used on people I'll never know. I woke up 5 times during an endoscopy to break up a gall stone and was given more and more and more versed. I woke up unable to move my head and neck and was covered in bruises, mostly on my arms and upper body. I was scared to death and totally freaked out from this. I knew something happened to me when I was "under" this evil poison, and that I was abused....but what happened? All i felt was fear and dread. I later found out from one of the nurses that I became extremely violent. I sat up on the table, lunged at the Dr, put my hands around his throat and tried to strangle him!! Four orderlies came in and literally beat the crap out of me to get me off of him, yanking and pulling and punching me. This drug leaves a HUGE margin for patient abuse....I'm living proof of that.
I've been under a doctor's care for PTSD ever since this incident. I used to be a productive member of society...now I'm fearful of everything and everyone....(it also didn't help matters that I was molested about month after this happened by an old pervert gynecologist in Brandon FL. I asked him why a nurse wasn't present in the room, and he stated "oh she'll be in shortly." When he started fondling me, I screamed out at the top of my lungs "Dear GOD, Someone please help me!!!!!" I was in hysterics, sweating, crying and shaking in disbelief of what happened.)

Cyjeff is right. He is correct in shooting down the idea that the patient should have -zero- say in their treatment. Additionally, the pilot analogy is completely irrelevant to the discussion.

It is also a fact that there are often choices that a patient may have for anesthesia and sedation, especially when a local is involved. But, as happened to me, the choices are sometimes not presented completely or truthfully. Fact is, many anesthesiologists are deceitful or forceful about using Versed. I was maneuvered into having Versed.

You want to talk about offended or angry anesthesiologists? When I told one doctor about my experience he was red faced angry that I was treated this way. I will use this person in the future.

I honestly don't see why Versed is EVER used - unless the patient knows exactly what it is and requests it - and, of course, the attending doctors agree to it's use.

If Versed went away, the earth would continue to turn on it's axis and surgery would continue just fine. I will never use it again.


http://versedbusters.blogspot.com/

This thread would be amusing, if it wasn't so tragic. With all the laws about patient rights, "informed consent" documents and such, patients REALLY have no rights at all do they? The enumerated rights that a patient has to refuse treatment at any time, the right to veto any treatment they find offensive, risky or just plain unwanted, the right to be informed of side effects, plans of anesthesia, and the right to sign an informed consent after being given all pertinent information, all of this appears to be just a means of deceiving the patient into signing a "hold harmless" agreement for the Doctors' benefit.
Doctor's have no intention of allowing a patient to have input or to refuse drugs or treatment, and yet at the same time, these same Doctors will whine about the high cost of malpractice insurance. They want tort reform, they want immunity from lawsuits. Doctors wish to remove all risk from themselves, but want to continue putting patients at risk with complete disregard for their patients' personal safety and desires. Note the sanctimonious arguments against "McDonald's" or "cafeteria" style anesthesia.
Fraud ( having this patient sign an "informed consent" without necessary information), deceit ( not telling the patient of the true intentions of the anesthetist), and most egregious, chemical coercion with Midazolam, are all part of medical personnels' arsenal against the patient. Hospital staff are getting more and more sloppy as to patient consent as they get away with assaults on patients with the amnesia and patient control drug Versed/Midazolam.
We need some enforceable laws with teeth in them to prevent this kind of chemical abuse. Any lawyers out there having any luck using spoliation or res ipsa loquitur in patient abuse cases such as this?

I know this will seem absolutely unbelievable to you Doctor types, but I actually know more about my body and how it responds to anesthesia than you do! I have had 2 open reductions on my femur, along with a bone graft, knee surgery, and another of the same to take out all the pins and plates. I had an epidural with Morphine. No Versed, no GA, as a result of my very poor response to GA drugs and the mental effects of such. Wide awake and happy about it! Just as a "good" mechanic asks questions about what is happening with the car that would lead you to seek his expertise, so should a good Doctor converse with their patient about what has worked for them in the past and have them be an active participant in the plan. Some patients will be like the person who tells the mechanic "my car won't start" and some will be like a person who informs his mechanic that "the car turns over fast, but won't start, it seems like its not getting any gas, and its not backfiring through the carbourator. The battery and all fluids are fine." You doctors are no better than sophisticated auto technicians. The difference between a "real Doctor" and a fake one is the difference between a "real mechanic' who can trouble shoot and repair a car, and an "auto tech," who can only do what a computer (standard of care) tells them to do. With all your education you are acting like simple technicians who just cannot fathom or take into account that people are different, and that different people need different anesthesia. Or maybe its more sinister than that! Maybe it's the lure of all the extra money to be made by sedating patients... Maybe its one of those problems like we read about all over the internet where sedated, zombie like patients are so much fun to toy with, as in they are entertaining. Perhaps it's just so much quicker and easier to simply inject a patient with an amnesia and control drug like Versed, rather than taking the time to educate the patient. At the very least medical care has suffered immeasurably since the advent of Versed/Midazolam. No more is the patient entitled to respect, information, the absence of pain, etc. All that matters is disconnecting their brain at the earliest possible moment and then torturing amnestic patients, or using their screams as an excuse for more intrusive and costly general anesthetics. I am personally working with my state government to get "informed consent" laws strengthened. Guess whose favor those changes will be in????? hint; Patients and trial lawyers. You asked for it!

Quote:

---

Quoting Vincent B

---

No, I'm not a doctor, but when we have a crashing, hypotensive patient, the modern technology is to place a TEE in the OR (lawyers, please get the updated copy of standard of care for idiot lawyers) to obtain real time imaging of the LV function, systolic function, AV Mv TV function. Volume and segmental wall motion abnormalities, all to save the poor sole that will be brain dead and have his relatives be your clients and sue for 50 million dollars. Your a F++cking idiot !!@! Sue everyone , then complain that your health insurance is too high. You dont understand, every suit that is won or settled is paid by insurance, so really you, the idiot are paying for your own corruptive practices by paying extraordinary health insurance premiums. Think about it, your slashing your own throats!!!!

---

So you are saying no matter what people should not sue their doc's because it makes our insurance rates go sky high... So i guess I should not be suing the doctor I had for my last pregnacy? I guess it isn't hs fault that he neglected to deliver me when my liver enzymes were sky high and my blood pressure was so high I could have stroked out and my daughter was not getting sufficent oxygen? Well and let's not forget the part where when he did decide I needed an emergancy c-section he waited 6 1/2 hours while my daughters heartbeat was getting weaker and weaker. I guess I shouldn't make him pay for all of the therapy's that are now needed for my daughter or all of the specialists she has to see for various problems? Or for the fact because of his negligance she will never walk like a "normal kid" or go to prom like her sisters or hell maybe she won't even be able to ever talk but, I guess that is not his fault right? People like you make me crazy... I bet if you brought your vehicle in to get the engine repaired and it was done all half assed you would complain then if no action was taken to correct the problem I put money on it that you would have that shop in small claims for damages with a week. A doctor should be held just as accountable if not more accountable for there negligence as any other professional.