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Seeking medical and legal advice- Handling of daughter's outpatient surgery (1 Viewer)

odin33

Footballguy
First and foremost, my daughter is healthy and ok with no lingering issues from the below situation. Some of this is seeking advice and some of it is just getting it off my chest. A good bit of protective parenting, but something feels very off.

My 14 yo daughter broke and dislocated her ankle mid April. Plate, pins, and tight rope surgery for dislocation. ~10" incision. Surgery was a success and she was up alert and talking about an hour later.

After the surgery there was a small area that was open. Changed dressing daily and all, but a month later it just wasn't healing so last Friday she had another surgery to stitch the area up. There was a concern about having to do a 'wound vac' so they put her under. She ended up not needing it, half hour -45 minutes and the surgeon/ortho was talking to us saying all went well, cleaned it up a bit and 6 stitches total. That was at 4:45p. She said she's recovering in post op and should be back to the room in about an 45-hour. Phew!

5:30 rolls around and nothing, 6 nada- getting twitchy, nurses confirmed all good, 6:30- now we're getting pissed. 7- wife is climbing the walls, still no daughter. 7:15 (this hospital pretty much shuts down on the weekend so no one is around) I track down one of the few nurses in the wing and she said they don't have enough nurses to go get her. WTF! Offered to go get her myself, which must have been the trigger as she came back to the room about 15 minutes later. Wife is messaging/calling a good friend who's a doctor down in GA updating as we go through this.

So it's 7:30, 3 hours after surgery and she is still on another planet from the meds and looks washed out (very pale). She's wheelchair bound so she has to be alert enough to plant her good leg and pivot from bed/chair/toilet etc. So, we wait until she's back on earth. Nurses checking vitals every half hour, and actively trying to get us out the door. Anesthesiologist on call comes in and looks/reads her records. Fentanyl during surgery, plus deladid, then she says oxy during and another at 5:45. An hour after surgery when they said she was fine? We both look at the doc like you've got to be kidding. This was for 6 flipping stitches.

So 9:00 rolls around and she's on the space ship back to earth but barely. That wing of the hospital is shutting down and she's still not with it so we decide ok, admit her overnight because it's simply not safe to take her home. Had to convince the Anesthesiologist to call the surgeon to write the order. Back and forth between hospital and surgeon, she writes the order. Ok cool, I go take off to grab dinner. Get back and we're told the hospital can't admit her because she isn't 16. How in the hell is that possible? Our options are move her back to post op recovery where it's a giant room with curtains as 'rooms' or call the ambulance and transport her downtown to children's hospital only to sit in their generic ER for god knows how long to maybe, possibly, get a room. So we go back to post op.

Finally about 10:30 (6 full hours after surgery) she's awake and aware. End up rolling out of the hospital shortly after 11.

We're not the type to sue for the cash grab, and as I mentioned she's perfectly ok now, but this feels very wrong. Surgeon/Ortho stated they are looking into it when we had a follow-up this week. No S*** Sherlock. You can tell their all bracing for the lawsuit as the finger pointing and defenses have gone up. Had we not stood up for ourselves they'd have sent us home with a doped up kid who could and likely would have reinjured her leg from being out of it. We don't want this to happen to anyone else with possibly a much worse outcome so we feel we have to do something.

Put in for and received her medical records which confirmed the meds given. Doctor friend is reviewing it but this isn't her area of expertise. Hoping to tap the general knowledge here for both medical guidance if I'm making a mountain out of a mole hill or not, and any legal professional as to how/should we proceed with legal action.

TIA

TL/DR
So to total it all up:
- Anesthesiologist doing the surgery went IMO way overboard on the meds- google search states that combo of meds can be lethal!
- Hospital was not adequately staffed to tend to patients
- Nursing staff was pushing us to leave despite daughters condition
- Hospital would not admit her overnight because of age
- Hospital's solution was to send her to another hospital with no guarantee of getting a room
 
End of the day, you'll have a hard time proving "damages"

But I get how it's frustrating and I'd consider filing a complaint with the appropriate medical board.
 
There's a lot to unpack here:

Keep in mind that these thoughts are based just on what you provided and there's some "guessing" as to the actual details

1) To start, this is almost certainly more than "Just 6 stitches". If they were considering a wound vac and it's still open after a month, they likely didn't just stitch it closed. They had to explore the area, probably clean it out, adjust edges/tissues in order to close. Not something to just do in the office. That's why anesthesiology was involved.

2) It sounds like she got procedural sedation. This isn't really the same as general anesthesia ("going under"). I'm guessing they didn't put any kind of airway in. They basically give meds/combo of meds to get her moderately/deeply sedated in order to tolerate what they needed to do.

Assuming that's the case, every kid reacts to the medications differently. They may have started with one medicine and it wasn't getting her where it needed to and they either gave more, gave another medication, etc. Similarly to that, not every kid wakes up the same from these medications. Some simply take longer than others even if it's not the usual course.

I would not assume the anesthesiologist went "way overboard". While it does sound like a lot of medicines (and not sure why oxy was added so quickly afterward), there may have been adequate reasons for it in order to allow the procedure to take place properly and/or control her pain/discomfort afterward.

3) So, if that happens, it will take longer for her to get back to her baseline. And on a Friday, late afternoon evening, that can turn into an issue. They may not have had a nurse to bring her back to you because she was having to stay there longer than anticipated and they need to remain with her and attend to her.

4) Nursing was pushing her to leave likely because they don't have staffing there after hours. That is an issue and I would think there's a contingency plan in place for if that happens. I'm glad you advocated for her to stay if she wasn't awake enough to go home.

5) Not every hospital has capabilities to admit pediatric patients. There are different age cutoffs and it depends on the hospital and the staffing. Plus, depending on staffing, it might be available one day and not another if you don't have any/enough pediatric trained nurses at a certain time. There's nothing that can be done about that. Not much different than having a procedure done at any outpatient center. If something goes awry, they can't just admit. It's simply not possible.

6) The only option in that scenario is to transfer her to another hospital if they don't have a place to safely monitor her with appropriate staffing. And since it's unplanned, yes, there's never going to be a guarantee of another room without going to the emergency department.

I get this is incredibly frustrating. In the end, keeping her safe is the priority and it sounds like that's what they did, keeping her there until 11pm until it was ok for her to go home. Not planned, but in this scenario, seems like the best option and other than the delays and frustration, it worked out. I understand the desire to place blame somewhere and I'm not saying it was ideal, but assuming the sedation she received was appropriate for what was going on and knowing that some kids just take a lot longer to recover than others, then this may have just been a cascade of unfortunate events that you can't really prevent. And without an understanding of what goes in with this stuff, I certainly can understand why you guys are upset. I think the biggest fault may end up being the communication throughout all this (and really lack thereof).

Just my $.02.
 
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There's a lot to unpack here:

Keep in mind that these thoughts are based just on what you provided and there's some "guessing" as to the actual details

1) To start, this is almost certainly more than "Just 6 stitches". If they were considering a wound vac and it's still open after a month, they likely didn't just stitch it closed. They had to explore the area, probably clean it out, adjust edges/tissues in order to close. Not something to just do in the office. That's why anesthesiology was involved.

2) It sounds like she got procedural sedation. This isn't really the same as general anesthesia ("going under"). I'm guessing they didn't put any kind of airway in. They basically give meds/combo of meds to get her moderately/deeply sedated in order to tolerate what they needed to do.

Assuming that's the case, every kid reacts to the medications differently. They may have started with one medicine and it wasn't getting her where it needed to and they either gave more, gave another medication, etc. Similarly to that, not every kid wakes up the same from these medications. Some simply take longer than others even if it's not the usual course.

I would not assume the anesthesiologist went "way overboard". While it does sound like a lot of medicines (and not sure why oxy was added so quickly afterward), there may have been adequate reasons for it in order to allow the procedure to take place properly and/or control her pain/discomfort afterward.

3) So, if that happens, it will take longer for her to get back to her baseline. And on a Friday, late afternoon evening, that can turn into an issue. They may not have had a nurse to bring her back to you because she was having to stay there longer than anticipated and they need to remain with her and attend to her.

4) Nursing was pushing her to leave likely because they don't have staffing there after hours. That is an issue and I would think there's a contingency plan in place for if that happens. I'm glad you advocated for her to stay if she wasn't awake enough to go home.

5) Not every hospital has capabilities to admit pediatric patients. There are different age cutoffs and it depends on the hospital and the staffing. Plus, depending on staffing, it might be available one day and not another if you don't have any/enough pediatric trained nurses at a certain time. There's nothing that can be done about that. Not much different than having a procedure done at any outpatient center. If something goes awry, they can't just admit. It's simply not possible.

6) The only option in that scenario is to transfer her to another hospital if they don't have a place to safely monitor her with appropriate staffing. And since it's unplanned, yes, there's never going to be a guarantee of another room without going to the emergency department.

I get this is incredibly frustrating. In the end, keeping her safe is the priority and it sounds like that's what they did, keeping her there until 11pm until it was ok for her to go home. Not planned, but in this scenario, seems like the best option and other than the delays and frustration, it worked out. I understand the desire to place blame somewhere and I'm not saying it was ideal, but assuming the sedation she received was appropriate for what was going on and knowing that some kids just take a lot longer to recover than others, then this may have just been a cascade of unfortunate events that you can't really prevent.

Just my $.02.
Not to hijack, but you should offer your services to husbands to walk their wives off the ledge.............to late for me, I'm already divorced. Buy your write up is spot on and well thought out.
 
Thanks for the response.

Answering a few of the items above:
1. Surgeon did say she 'cleaned the area up' and then stitched her back up, wound vac just wasn't needed.
2. She did get an airway put in. Seeing as she just had surgery a month ago and there were no issues, I'd think they would look at the meds given then and follow a similar plan. She did get a nerve block for the original and not this one so I get it's not a 1 for 1, but neither were the procedures.
3-6. I get it. You can't plan for everything, but post op with delays and related protocols seemed a bit off here. I'm less frustrated with this one as sometimes you have to roll with the punches. Wife not so much.
 
Oh, and one last thing I should have specifically pointed out:

No anesthesiologist is trying to give more medicine than necessary. The goal is to get by with as little as possible to do what needs to be done.

Otherwise, everyone takes too long to wake up/recover and that causes problems. And, more importantly, it only serves to increase risk.

Yes, that combination of medicine is potentially lethal. ALL sedation/anesthesia is. That's why you have someone there dedicated to just that person, why they are on monitors, and why the risk of serious injury/death with any anesthesia is explained. Which again, that's why the person dedicated to doing this is ALWAYS trying to give as little as possible and keep it as safe as possible. That's the #1 goal.
 
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Thanks for the response.

Answering a few of the items above:
1. Surgeon did say she 'cleaned the area up' and then stitched her back up, wound vac just wasn't needed.
2. She did get an airway put in. Seeing as she just had surgery a month ago and there were no issues, I'd think they would look at the meds given then and follow a similar plan. She did get a nerve block for the original and not this one so I get it's not a 1 for 1, but neither were the procedures.
3-6. I get it. You can't plan for everything, but post op with delays and related protocols seemed a bit off here. I'm less frustrated with this one as sometimes you have to roll with the punches. Wife not so much.
Again, without knowing specifics, I can't answer too much.

But as to why they didn't "follow a similar plan", what they were doing, the nerve block, the expected time, all of those things influence what kind of medicine/agents are used for anesthesia. There isn't a one size fits all plan. These are 2 completely different situations (Ortho surgery vs possible wound vac/closure). Not surprising at all that she received different medicines.

I'm glad she ended up not needing the wound vac and hope she recovers quickly.
 
Waiting in hospitals can be extremely frustrating, I get that. But let me play devil's advocate. The only reason they released her from post-op recovery is because you were demanding it. It sounds like she should have been kept in there until she was able to move around on her own better.
 
End of the day, you'll have a hard time proving "damages"

But I get how it's frustrating and I'd consider filing a complaint with the appropriate medical board.
Also, reading this, I thought I would point something out:

Having a complaint filed against a doctor to the medical board is not inconsequential. EVERY complaint, no matter how trivial or unfounded, will get investigated and, even if fully dismissed, then has to be reported for every license application, renewal, and hospital credentialing and can have a potential impact.

This is not saying never to file a complaint, but there are typically other avenues to approach before going that route. Reach out to the doctor directly. Talk to patient relations at the hospital or care center where the issue took place.

Medical board complaints are taken very seriously (as they should be) and should be reserved for things like professional misconduct, negligence, discrimination, or outright incompetence/substandard care. And while that may have happened in this situation (again, it's hard to say without the actual details), I don't think it's the best first (or even second or third step).
 
Waiting in hospitals can be extremely frustrating, I get that. But let me play devil's advocate. The only reason they released her from post-op recovery is because you were demanding it. It sounds like she should have been kept in there until she was able to move around on her own better.
It really doesn't sound as if they explained that.
 
Agree 💯 with @gianmarco.

Prolonged, yet inadvertent sedation is pretty common, and not always easy to predict. Doesn’t seem like they strayed from standard of care in their management thereof.

I’d focus your energy on facilitating your daughter’s recovery.

As an aside, why do they think the surgical site didn’t heal on its own? I’d watch very carefully for signs/symptoms of infection, as this would be a common explanation.
 

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