Sunday, December 16, 2007

Welcome to the party, pal

With this post, I welcome fellow University of Chicago alum Dr. David Kessler, MD JD, to the ongoing University of California scandals. Dr. Kessler was recently fired as Dean of the UCSF school of medicine. According to this story, Dr. Kessler's firing was preceded by his noting, and documenting, allegations of financial improprieties on the part of the University. He also apparently alleged a coverup regarding those financial improprieties.

When he was fired, according to the linked article, "Kessler said he was surprised." Well he might have been. Though I happen to know, through this blog, of many others who've been forced out of the University of California after uncovering various "improprieties," many of those people never go public. Kessler probably didn't know in advance just what kind of organization he was dealing with. He should have read this blog.

To his credit, Kessler has now gone public with his complaints, and he's perhaps saved other naive University of California recruits from surprise similar to the one he had. So, David Kessler, I salute you. Welcome to the party, pal.


Anonymous said...

You seem to be a person concerned with "informed consent" to medical procedures. What do you think of injecting so many patients with the amnesia producing drug Versed without telling the patient about it. A bunch of us have had a severe reaction to this drug, ie some kind of hyper anxiety and PTSD like symptoms for months and YEARS after being given Midazolam. I adamantly refused this kind of debilitating drug along with a GA for my out patient procedure. I got both, the Versed incapacitating me to the point of being unable to defend myself, or prevent them from giving me a GA, even though the expected amnesia did not manifest itself. I never even got to sign an informed consent because they knew I wouldn't. Nobody will listen to me or any other patient who has had this kind of outcome. Is this drug so much fun for the medical people that they can't resist it? Do we say and do such entertaining things that it's too tempting? Or is it simply that the patient is so malleable and obedient after being sedated that is the draw. Is it fear of malpractice, and an amnestic patient is desirable so they can't sue? Is it a time issue, where they want to hurry through the procedure with unnecessary roughness? I really want to know what the point of forcing people to get Versed is? Can you help us out? Also, since so many of us have complained about these unwanted and long term side effects, why isn't the medical community listening to us?

Jubal said...

Lot of issues there. Right off the bat, if you are a competent adult, then inducing general anesthesia on you without any consent is assault, pure and simple. Of course, GA can legally be induced with implied (as opposed to informed) consent. For implied consent, a reasonable person would believe that you would consent to GA if you could. Implied consent generally applies to emergency situations. Of course, if you are not a competent adult, then GA can legally be administered if your guardian consents to GA.

If you consented to regional anesthesia, there might be a clause in the consent form which allowed the use of GA. A "hidden" clause buried in the consent paperwork would be iffy in terms of proving consent. Such a "hidden" clause would probably NOT constitute informed consent, which is a standard used to differentiate medial procedures from assault, but it could complicate any lawsuit you have.

As for why GA and benzodiazepines are ... ummm ... encouraged by anesthesiologists: I think you have a pretty exhaustive list. My educated guess is that the reason for the encouragement of GA is that GA is faster and cheaper than other techniques, and the use of benzodiazepines makes GA easier to perform.

In fact, when I was a resident at UCLA, there was an anesthetic technique described by some of the anesthesia residents as the "Cedars method" (Cedars-Sinai medical center got anesthesia residents from UCLA). The "Cedars method" was oxygen, lots of benzodiazepines, some nitrous oxide, subanalgesic concentrations of fluranes, and paralytics. No intra-op narcotics. The theory was that the tremendous stimulation (i.e. pain) provided by performing surgery with subanalgesic doses of inhaled anesthetics and no narcotics would keep the blood pressure up, and the benzos would prevent the patient from remembering the event. The paralytics would keep the patient from moving. I believe that the reason this was popular was because (1) the low flurane use and absence of narcotics allowed for quick recovery of unassisted respiration (breathing on one's own) after GA, and thus less time in the OR / recovery room after a procedure, and thus lower costs, and (2) it was a lot cheaper than propofol (use of which is another technique that allows rapid recovery from anesthesia). In short, costs were likely a driving factor.

I hope this was informative, but I don't know how it can be helpful to you. You asked if I could help you. I have no idea how I can. All I know I can do is to raise awareness of these issues in hopes that others might be able to avoid them in the future. If they've already happened to you, I don't know what I can do for you now. I am, however, open to suggestions.

PS: where did your surgery happen? I'd really like to know, and I'm sure other readers of this blog would like to know as well.

Anonymous said...

Hi, I got the surgery at a hospital in Northern Idaho. I'm scared to identify it further in this very public forum. I was under the impression that I could deny treatment at any time during the procedure. I didn't have any informed consent, as such but there was an exhaustive check in document, which I signed at the front desk, secure in the knowledge that I could decline any parts of the proposed treatment. At no time did my anesthesiologist or CRNA discuss with me anything about my treatment, conscious sedation, or the fact that as soon as I got to the OR I would be getting that GA which I had refused. What I got was 2 mls of Versed, then, when they had me helpless I got 10 mls more of the Midazolam. Propofol, Fentanyl, Sevoflurane, and Benadryl. They had my permission for Morphine and a block. The CRNA claimed that Once I was sedated that I "didn't object" to the GA any more. 12 mls of Versed didn't give me amnesia, but it sure made my body flaccid, so I can't imagine the Cedar's method! Imagine me being awake inside my unresponsive body while they kept my blood pressure up with pain that *I* would have remembered. Horrors. I will tell you the name of the hospital if you e-mail me at jmurraytruckin at

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