Editor’s Note: While this case did not have an anesthesiologist, the hired expert was an anesthesiologist. it is also a procedure we give anesthesia for routinely, so I have included it.

A 51 year old woman presented to a physician’s office for liposuction.

Her medical history was significant for an orthotopic heart transplant that she had received 8 years prior due to a dilated cardiomyopathy. In an interesting twist, Dr. Mehmet Oz (of television and now government fame) had performed her heart transplant.

The liposuction procedure was performed in the office without any anesthesia provider.

The procedure was completed at 11:00am, and the patient did not have any complaints.

At 1:45pm while drinking a glass of water and waiting for her ride, she collapsed.

CPR was administered and the patient brought to the hospital where she arrived at 2:26pm.

She could not be resuscitated and was pronounced dead at 3:10pm.

The patient’s sister representing her estate sued the plastic surgeon:

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Upon further investigation, numerous red flags were discovered about the physician.

While many people assumed that he was a plastic surgeon, he had actually completed an internal medicine residency without formal surgical training.

Only 1 year prior, his license was placed on probation for 3 years and he was heavily fined by the state medical board for unspecified reasons.

As part of his probation period he was only allowed to perform specific procedures, which did not include liposuction.

Here is the original autopsy from this liposuction case, with an “undetermined” manner of death.

The state prosecutor learned of the case, and filed criminal charges against the doctor.

After the autopsy was released, the district attorney’s office visited the medical examiner.

After a conversation, the autopsy was re-released, amended.

The plaintiffs attorney filed a motion for summary judgment, in which he argued that because the doctor was being charged criminally, the judge should declare that he was negligent and the malpractice lawsuit could skip to determining damages.

The physician’s defense hired an anesthesiologist expert to claim that he wasn’t negligent.

To complicate the matters for the physician, he was accused of altering the patient’s records.

The original consult form found in her purse mentioned her heart transplant, but the copies that the physician turned over during the investigation had this entry removed.

The documents he turned over included a question about prior hospitalization, which was marked “no”.

He also documented that her midline sternotomy scar was “mid-chest, old, well healed” and was from a “skin surgery” to remove a “cyst”.

The doctor’s defense attorney would later comment to the press that “mistakes may have been made, and panic may have set in”, in regards to the falsified records.

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Outcome

The plastic surgeon voluntarily surrendered his medical license.

He was indicted on the following criminal charges.

He took a plea deal, in which the manslaughter charge was reduced to “criminally negligent homicide” and falsifying records.

He was sentenced to 60 days in jail after pleading guilty.

This civil case against him brought forth by the patient’s sister was settled for $500,000.

MedMalReviewer/Anesthesiologist Analysis

1. This was always going to be a tough case to defend. I think the defense expert did as great of a job as was possible. The judge was impressed by much of what he wrote in his thorough opinion. In commenting on the autopsy-

   “It is difficult for me to give credence to a supposedly scientific report prepared by a neutral city medical examiner that relies in part on non scientific hearsay information provided by a non-neutral party in a related homicide prosecution.”

   Should the DA be allowed to knock on the medical examiners door and influence a change of documentation to further their own criminal case?

2. I attempted a literature search of heart transplant patients and increased sensitivity to local anesthetic cardiac toxicity, but came up with nothing. That said I don’t need a study to tell me this is a bad idea. The mega doses of local anesthetics in liposuction (up to 55mg/kg) have in general never sat well with me. These doses go far beyond the standard recommendation to limit lidocaine to 7mg/kg to avoid LAST. An anesthesiologist would have canceled this case. Sometimes we exist to save surgeons from themselves. If you want to read a really heart-breaking case about an anesthesiologist accidentally killing a patient with lidocaine, this MedMalReviewer.com case about a cervical fusion is worth your time.

3. Altering a medical record after the discovery of a bad outcome is almost always a bad idea, but especially so in this case in which the physician even faced criminal charges for doing so. It’s easy to let panic set in once a bad outcome happens (as stated by the physician’s defense attorney) and make a bad decision. If you feel panic starting to set in and are tempted to alter the record, please talk to your malpractice insurance company or hospital risk management before proceeding. This is a constant theme across every specialty including EM in this stroke case, radiology on this PET scan, and the recent case about an anesthesiologist changing the FiO2 after an OR fire burned a young girl’s face. I have additional upcoming cases with false documentation including one that the plaintiff’s lawyer is pushing for a live audit of a falsified EMR

4. The settlement value may seem low here compared with other cases of wrongful death. It is easy to quantify lost wages and compensation, and put a price tag on long term care costs. However, it is much harder to quantify the value on human life. This patient had no husband and no children, there is no one depending on her to work, there is no one who misses out on the wages she will never earn.

5. This is one of the few cases I’ve ever seen in which a physician faces criminal charges for his actions. The line between negligence (a civil matter with financial consequences), and the criminal issues of negligent homicide and manslaughter. On one hand it makes me fairly uncomfortable to know that a malpractice error could result in jail time, but on the other hand his conduct in continuing to perform procedures he had been explicitly told to stop by the state medical board makes it so egregious that it feels warranted.