“No good deed goes unpunished” is an aphorism attributed to more than one origin -Oscar Wilde and Clare Booth Luce. The origin may be a mystery. Its meaning to an Iowa anesthesiologist is not.
An obstetrician performed a C-section on a patient who was 35 weeks pregnant. The patient had persistent vaginal bleeding, so the following day the obstetrician performed a complete hysterectomy. During that case, the anesthesiologist placed an IV which infiltrated. Later that day, the patient underwent a third surgery to “relieve pressure in her arm and hand” – presumably a fasciotomy. Six days later, a fourth surgery was performed – to close the wound.
The patient sued both the obstetrician and anesthesiologist. Each doctor was represented by separate counsel. They were sued based on different claims. There was no corporate relationship between the two. You get the picture. It was like two separate malpractice cases being tried by a single jury.
During the obstetrician’s testimony, a juror fainted in the jury box. The anesthesiologist leaped up from the galley and rendered aid. The juror recovered and was dismissed. The judge interviewed each remaining juror to make sure they could remain fair, neutral, and impartial. Each replied they could. Plaintiff’s motion for a mistrial was denied.
The jury later delivered its verdict. No liability for either the obstetrician or the anesthesiologist.
The patient appealed this verdict arguing that warm feelings generated toward the anesthesiologist by helping the fainting juror prejudiced both physicians’ collective case. The Iowa Court of Appeals remanded the case for a new trial for both the obstetrician and anesthesiologist. Ouch.
But wait, it gets worse. If you’re the anesthesiologist.
This case was appealed yet again to the Iowa Supreme Court. It held that while the anesthesiologist helped the stricken juror, the obstetrician did not. So, it was OK to deny the motion for mistrial against the obstetrician. Why? The obstetrician had done nothing to generate “warm feelings” from the jury. He sat on the sidelines. And the claims against the obstetrician were entirely separate from the claims against the anesthesiologist. The obstetrician’s case was over. He won.
The anesthesiologist was not so lucky.
When he helped the juror, this potentially prejudiced the case against the patient (plaintiff). Mistrial was declared. He now gets a chance to defend his case one more time. Double ouch.
If another juror faints in the jury box, what will the anesthesiologist do next time? Any guesses?
Jack v. Booth, 2015 WL 292051 (Iowa, January 23, 2015)
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This is interesting to me on several levels. I have very, very small lumen veins. It’s an inherited characteristic. Along with that goes great difficulty in setting IVs.
I developed a significant phlebitis on one occasion after a major surgery. It did not get infected but was very painful and swollen for several weeks.
Some people are more “prone” to phlebitis than others. The cause is not completely understood. Almost any time I get an infiltrated IV, I will develop at least a mild case. Sometimes it happens even without an infiltration. For me, all IV’s get “sore.”
I never did and would never sue the surgeon or RN. It’s just the way I am. It’s not their fault. Obviously I would rather not be that way. But I am lucky in other ways. I don’t have diabetes. i can eat cookies.
We all have physical “weaknesses” of various sorts. It’s the human condition. My advice to the lady who got the phlebitis:”Get on with your life. You have other things to do that are more useful and meaningful than suing doctors and nurses.”
Michael M. Rosenblatt, DPM
I wonder why the counsel to the anesthesiologist did not invoke the “Good Samaritan” statue. Being so lawsuit thirsty the plaintiff’s counsel might have argued “gross negligence” on part of the obstetrician since he deliberately did not act as a “Good Samaritan” to the juror in need. It is absurd how lawyers can twist non-malicious events into a dreadful series of trials – all for a fistful of dollars. Pathetic. I hope the anesthesiologist does not ever have such an event – but should bad luck strike again – I would, on my way to help the juror, stop and state for the record that I am on my way to help the sick juror as a good samaritan
Depends on the ologist’s IQ–whether it ‘s north or south of 100.
You write “The obstetrician’s case was over. He won.” It escapes me how having your name forever stained with a sensational malpractice suit, going to trial, repeating the process in appellate court, and then again in the state supreme court, over a period of years, can in any way be called “winning.” From the day you are served with a lawsuit, there is no winning. There is only losing. The only question is what and how much you lose–time, money, sleep, trust in humanity, reputation.
As for the anesthesiologist, I hope he learned from his multi-year ordeal. Perhaps Dr. Medical Justice’s readers will learn too. Minimize your exposure to our insane legal machinery. Stay in your seat.
After giving this thought, the anesthesiologist should have kept his seat unless if he was asked to provide medical attention. He wasn’t at dinner or a movie being a Good Samaritan. He was at the trial of his life, and if it looked and smelled vasovagal, he should have sat – unless the defibrillator came off the wall. I’ll have to blame his attorney for not restraining his client. Wishing all a healthy happy 2017!
In the words of Michelle Obama, “I am sometimes embarassed to be an American” The fact that this act of goodwill and perhaps life-saving effort can engender this reaction and negative downstream effect to a fellow doctor is personally hurtful to me. I don’t understand why there is not more outrage and perhaps THAT is the problem. We are like rats in a skinner box, no longer jumping when we are shocked. I for one will be retiring early (in US system only) due to the insurance debacle and the public attitude perhaps represented by our friendly plaintiff “professionals”.
Forgive me but IVs do infiltrate all the time. In our society patients gain more weight than they should during pregnancy, weigh more than they should before pregnancy, or just weigh more period, and also do less physical labor with their arms (men and women). This leads to significant smaller veins than in the past, leading to more difficult sticks and more veins that don’t tolerate threading an IV. My spouse had veins scarred from IV Dilantin post neurosurgery in the 1980’s. Her veins remain terrible. This is not her fault.
So, if IVs infiltrate as a known course of events, where is the malpractice. There is no intent. The harm was transient and relieved.
The four pillars of causation for malpractice:
duty, breach, causation, and damages don’t appear to be present here. The anesthesiologist’s duty is to establish an IV, he did and infiltration is a known complication. There was no breach of care. The patient was not ignored, but was sent for the surgery to fix the infiltration problem.
While the IV start was present the infiltration was not the anesthesiologists fault as this could have occurred at any time after the start. I am sure he verified that the IV worked well at the time. The vein could also have leaked from a prior puncture. So, there is no causation. While the patient suffered damages, they were presumably short lived.
This case in certain states that require physician panel review and approval before a malpractice case proceeds, (ex. Indiana) would likely never have let this case go forward a first time let alone a second.
Finally given the current environment any physician who jumps in as a Good Samaritan is not necessarily protected under those laws because they are deemed to have superior knowledge and therefore have a duty to perform at a higher standard of care. So, if things go wrong as they often due in such emergency circumstances, the physician rendering aid can wind up being sued for malpractice, and the Good Samaritan law will not be a shield.
Therefore one must wrestle with one’s conscience and decide whether to render aid in such situations and risk being sued or render aid knowing that one did what one was trained to do. Given the multiple years of a malpractice case, in such circumstances it is difficult in today’s legal climate to just jump in and render aid.
This is the legal system’s fault. It is far too easy to sue a physician. The legal barriers to such suits are much too low. Ditto for breaching Good Samaritan laws to sue a physician rendering aid.
We all pass motor vehicle accidents and such on a daily basis. Most of us want to help, that is what we do! Case in point, yesterday on I -95. My heart and sole said, stop and help, my brain said, keep driving. What a sad state of affairs. What has become of our wonderful profession? I bet, impulsively, most of us would have jumped up to help that juror. With so many of us retiring early who is going to take care of us as we get older?
Thank you for the thoughtful and valuable coments. It is indeed critical to look at least 10 steps ahead before responding to what appears to be routine assessment and rendering initial care to a person in acute need. Unfortunately, “Only in America” can you, quite reliably, get severely punished for doing so
After reading all of the above comments, I am glad that 8 years ago I had the opportunity to move back to Canada following 14 years in practice as a neurosurgeon in the USA. We have lawsuits in Canada and unfortunately there is a tendency to follow US social patterns over time. As such, they are becoming more common, but the threshold for filing remains higher.
I have always assumed, that because of our profession and superior knowledge and skills compared to a lay ‘Good Samaritan’ we have a moral and ethical duty to help the juror who fainted, or the motor vehicle collision victim. Are we not potentially doing harm by not attending to them, and therefore not keeping our Hippocratic oath?
On Dec 30th, while travelling on HWY 401 through Toronto, I witnessed an SUV cut off by another car in the left passing lane at about 70 mph. The SUV hit the cement median blocks, careened off and hit a trailer truck and then spun all the way over to the right lane, narrowly missing me. I immediately pulled over and with all traffic now being stopped (and miraculously without a pileup) I could safely attended to the injured passenger until EMS, police etc arrived. Fortunately there were no serious injuries. Of those that stopped and exited their vehicles to help, I was the best trained to help until the other medical professionals arrived.
I stopped for several reasons – first I am a physician and it is my duty to help (I believe the only exceptions are that I am incapacitated by the MVC or that I have a very high likely hood of injury or death in my attempts to render help). Secondly, I was an immediate witness to the collision and the police should be aware of what I saw.
I believe that acting in this way is an obligation of our citizenship in any community in which we live, whether or not we are medical professionals.