# "Anesthesiologist trashes sedated patient" **URL:** \ **Category:** In My Humble Opinion\ **Created:** [June 24, 2015, 10:19pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403 "2015-06-24T22:19:35Z")\ **Posts on this page:** 17\ **Page:** 5
**Author:** ![joyfool](https://avatars.discourse-cdn.com/v4/letter/j/df788c/32.png) [@joyfool](https://boards.straightdope.com/u/joyfool)\ **Post date:** [June 27, 2015, 2:50am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/81 "2015-06-27T02:50:56Z")
> [@Joey\_P](#): > > No, I don’t think that was the case at all. I think that was the anesthetist’s way of punishing the patient for being annoying or a baby during pre-op. Nothing more, nothing less. Make a joke, whatever, but I think the doctor should have his license revoked (either for a set length of time or permanent) as punishment for signing off on the report. I don’t think I worded that well. I meant it was their way of doing that to him, as a “hahaha, joke’s on you” sort of thing, for the very reasons you mentioned. He was a pain in the ass (or so they thought), and they labeled him as such. ---
**Author:** ![Acsenray](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/acsenray/32/4519_2.png) [@Acsenray](https://boards.straightdope.com/u/Acsenray)\ **Post date:** [June 27, 2015, 3:24am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/82 "2015-06-27T03:24:06Z")
> [@Joey\_P](#): > > But I think the doctor should have his license revoked Both the anaesthesiologist and the gastroenterologist are doctors. > [@](#): > > I’m not 100% sure about that. Would it have been victimless if the patient wasn’t even in the room while they made those comments? If they made them after hours when they were just talking (hey, did you see that rash, probably syphilis haha). If you change all the facts, then everything is different. The defamation claim stood because the two doctors and the nurse were not the only people in the room. > [@](#): > > but if I go to up to a coworker in the backroom and say ‘the customer was a jerk’ and he says ‘yeah, he was kind of an ass to me too’ and that’s as far as it goes, who’s the victim? The customer doesn’t know it was said, the other employees don’t find out, it’s not nice, but I’m not sure that anyone was victimized. Retail clerks are completely different here. We are talking about people with positions of trust and authority viciously mocking someone who is unconscious and helpless and at their mercy trusting them to do their best to diagnose his health problems. They have his life in their hands at that moment. > [@](#): > > Also, just to be clear, because I don’t think everyone is catching it, the syphilis and TB comments were made TO the patient, (post op, so it’s possible he didn’t remember), but it’s hard to tell if he’s joking with them too. Did you actually read the reports? He was under sedation and unconscious during the procedure. It was the two doctors and the nurse talking to each other. They weren’t talking to him, because he was completely out and getting his ass probed. They wouldn’t have dared speak like that if they were talking TO him. > [@](#): > > I’m also curious if they’ll be allowed to stay on at the hospital/group while this is sorted out or get fired (in which case their unions will probably fight for them) or if they’ll resign right away. You haven’t read the reports, have you? The gastroenterologist was dropped from the case—he probably settled. The anaesthesiologist was long fired from her practice and she moved to Florida. She worked with a practice there for a while but her current status is unclear. The medical board has not commented on any disciplinary action against either. > [@](#): > > and get help from their respective unions. You realize these guys are physicians, right? Doctors. M.D.s. It’s highly unlikely they are members of any labor union. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [June 27, 2015, 4:48am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/83 "2015-06-27T04:48:48Z")
I don’t think the victim should have been awarded huge monetary damages, but such medical professionals, IMHO, really ought to have lost their jobs for such unprofessional behavior. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [June 27, 2015, 4:52am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/84 "2015-06-27T04:52:37Z")
> [@Acsenray](#): > > Did you actually read the reports? He was under sedation and unconscious during the procedure. It was the two doctors and the nurse talking to each other. They weren’t talking to him, because he was completely out and getting his ass probed. > > They wouldn’t have dared speak like that if they were talking TO him. You’re right, he was out for the STD jokes, but the ‘punch you in the face’ part was made to him during post-op. > [@](#): > > You realize these guys are physicians, right? Doctors. M.D.s. It’s highly unlikely they are members of any labor union. I didn’t know they didn’t have unions. What if they’re hospital employees? Would they have unions then? I know of a lot of independent doctors that decided to become members of a large group in Milwaukee to get rid of all the headaches of running a business. All these doctors became employees of the larger group. Couldn’t they get Union Representation? In fact, here’s a union specifically for representing physicians. > **[Homepage 2024](https://www.uapd.com/)** > > The Union of American Physicians and Dentists is the largest union for licensed doctors and advanced practice clinicians in the nation. We give more than 7,000 providers a voice in the workplace to advocate for themselves and their patients. [Here’s](http://blog.medicaljustice.com/can-doctors-form-a-union/) an article that says employee physicians can unionize. A few other articles I’m reading say basically the same thing, if the doctor is a hospital employee, they can be part of a union. But even if they’re not part of a union, they’ll surely have a malpractice insurance (probably by law). I don’t know how malpractice insurance works, but it’s possible those guys would go to bat for them. But I’m claiming ignorance on that. It might depend on the level of coverage they have. ---
**Author:** ![Acsenray](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/acsenray/32/4519_2.png) [@Acsenray](https://boards.straightdope.com/u/Acsenray)\ **Post date:** [June 27, 2015, 1:04pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/85 "2015-06-27T13:04:41Z")
> [@Joey\_P](#): > > You’re right, he was out for the STD jokes, but the ‘punch you in the face’ part was made to him during post-op. No, it was all said during the procedure, and he was unconscious for it all. > **[Patient records audio of his operation and hears doctors laughing at his penis](https://metro.co.uk/2015/06/25/patient-secretly-records-audio-of-his-operation-and-hears-doctors-laughing-at-his-penis-5265472/)** > > They also said he could have Ebola. > [@](#): > > ‘After five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit,’ Ms Ingham was heard saying during the colonoscopy procedure. > [@](#): > > I didn’t know they didn’t have unions. There are doctors unions, but they are very small and the vast majority of their members are government employees. It is highly unlikely for an American physician in private practice to be a member of a labor union. > [@](#): > > But even if they’re not part of a union, they’ll surely have a malpractice insurance (probably by law). I don’t know how malpractice insurance works, but it’s possible those guys would go to bat for them. But I’m claiming ignorance on that. It might depend on the level of coverage they have. Malpractice insurance kicks into gear _when you’re sued for malpractice_. Ingham and Shah were sued for malpractice. The claims against Shah were dismissed, perhaps as the result of a settlement—meaning cash payment by his insurance company. The judgment against Ingham will be paid by her insurance company. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [June 27, 2015, 2:27pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/86 "2015-06-27T14:27:52Z")
> [@Joey\_P](#): > > I didn’t know they didn’t have unions. What if they’re hospital employees? Would they have unions then? I know of a lot of independent doctors that decided to become members of a large group in Milwaukee to get rid of all the headaches of running a business. All these doctors became employees of the larger group. Couldn’t they get Union Representation? That sounds like a large group practice. Sometimes those group practices are run as partnerships, much as many law firms are. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [June 27, 2015, 3:01pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/87 "2015-06-27T15:01:09Z")
> [@Dewey\_Finn](#): > > That sounds like a large group practice. Sometimes those group practices are run as partnerships, much as many law firms are. No, I’m talking way, waaaay bigger than that. I was referring to something like Aurora Health Care or Wheaton Franciscan. These are both large groups in my area. Checking online, Aurora (the bigger of the two) has 1500 doctors (as employees), over 6000 nurses, 15 hospitals, 185 clinics, 80 pharmacies, over 25,000 employees and that doesn’t count the doctors that just have clinics in their professional towers that are affiliated with them but aren’t employed by them. While the CEO is a doctor, it’s a 4 billion dollar a year enterprise. It’s not like when 4 or 5 doctors get together and open a clinic together. I know quite a few doctors that were in private practice (either alone or as the type of group you were talking about) that decided to move their practice into Aurora. They became Aurora employees in order to get rid of some of the headaches of running a business. No more payroll, no more HR, no more trying to find new patients. Two nurses having a spat with each other, send them to Aurora’s HR department and let them figure it out. Someone wants a raise, have them call the payroll department. The fridge in the break room isn’t working, call maintenance. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [June 28, 2015, 4:05am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/88 "2015-06-28T04:05:52Z")
From the AMA ethics code: “The patient has the right to courtesy, respect, dignity, responsiveness, and timely attention to his or her needs.” ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [June 28, 2015, 4:08am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/89 "2015-06-28T04:08:35Z")
Sure, but keep in mind that not all doctors are members of the AMA. ---
**Author:** ![2gigch1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/2gigch1/32/3313_2.png) [@2gigch1](https://boards.straightdope.com/u/2gigch1)\ **Post date:** [June 28, 2015, 5:12am UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/90 "2015-06-28T05:12:38Z")
What strikes me is this event will help shape future interactions between patients and doctors, especially when the patient is about to be rendered unconscious. Whereas once we assumed the blanket of professionalism by staff would protect the patient, now that is thrown entirely into question. A few years ago I had to get an endoscopy. Just prior to being knocked out I was being interviewed by the anesthesiologist and I become uncomfortable with her attitude, to the point that I considered stopping the procedure and leaving. And indeed today I am sure I would not have gone through with the procedure (I now regret I didn’t then). ---
**Author:** ![Tibby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tibby/32/17030_2.png) [@Tibby](https://boards.straightdope.com/u/Tibby)\ **Post date:** [June 28, 2015, 3:56pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/91 "2015-06-28T15:56:09Z")
> [@Melbourne](#): > > … > (2) harmlessly upsizing a medical result to get more money _or to please the patient_ is also not unknown, and in a regulated environment like AUS or the UK, the authorities fall on you like a ton of bricks when they catch you. In the USA, that’s the function of the courts and damages. _But it’s the institutions not the patients who are the primary victoms_… > [@Dewey\_Finn](#): > > Just because we don’t have universal health coverage in the US doesn’t mean that healthcare is an unregulated environment. Quite the opposite, actually. And if a clinician falsified a diagnosis, even at the behest of the patient, he or she would be subject to discipline, up to and including prosecution. I’m almost positive that a much larger quantity of bricks fall on US physicians who are convicted (or even just investigated) of healthcare fraud and abuse than those in AUS or the UK. For physicians, facing medical malpractice is a cakewalk compared to insurance fraud. Healthcare F&A is a serious federal crime (can also be a state crime) in the US and includes both civil and criminal components. And the False Claims Act reaches much further than just Medicare and Medicaid. US Attorneys can and do throw the [RICO Act](http://www.nolo.com/legal-encyclopedia/content/rico-act.html) into the mix of medical F&A and that’s when things really get hairy for hapless doctors. I’d rather be convicted of first degree murder than healthcare fraud and abuse. It’s good to get truly fraudulent docs out of practice, but the net the Department of Justice uses to catch the crooks has too fine a mesh and innocent docs get sent to prison and many more get bullied into accepting outrageous plea bargains, that typically include high dollar penalties and restitution, house arrest and revocation of medical license (making paying penalties and restitution quite difficult). But, considering the charges and sentences US prosecutors typically seek in healthcare fraud (often tens of millions of dollars, 5, 10, 20 or more years in prison, forfeiture of all assets and loss of medical license) coupled with the high cost of white collar crime defense (almost certainly costing over a million dollars…you can’t use someone like _Slippin Jimmy_ to successfully defend healthcare fraud), then you begin to understand why many doctors (innocent or guilty) cop a plea rather than go to trial. Trial is too costly and too risky. Innocent billing errors can easily trigger an audit. Audits can trigger an investigation by the FBI. Insurance companies actively encourage patients to blow the whistle on doctors (better not piss your patients off). If the investigation goes full bore, the doctor’s life will never be the same…even if he’s never formally charged with a crime. I’ve known three physicians who faced federal healthcare fraud charges. One was almost certainly guilty and got what he deserved (years in prison, $millions restitution), another was almost certainly not guilty and did not deserve what he got (his head blown off: he committed suicide by shotgun weeks before his trial was to begin) and the third was definitely innocent and just investigated (not charged), but still lost everything (practice, life savings and marriage). These [two](http://www.haciendapub.com/medicalsentinel/police-state-medicine-nature-beast) [articles](http://www.haciendapublishing.com/medicalsentinel/can-health-care-fraud-be-ended) are old, the problem persists. In fact, I believe the civil penalty has been upped since those articles from $10,000 to $250,000 per offence. _“Doc, we found a dozen instances where we think you miss-coded a procedure. We’re going to extrapolate for the last 10 years and figure you miss-coded all 10000 times you did that $50 procedure. Either take our plea bargain, or we’re going to seek $2.5-billion at trial.”_ I don’t think that’s too much of a stretch. ---
**Author:** ![Acsenray](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/acsenray/32/4519_2.png) [@Acsenray](https://boards.straightdope.com/u/Acsenray)\ **Post date:** [June 28, 2015, 8:18pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/92 "2015-06-28T20:18:35Z")
I know very well a fed who prosecutes docs for Medicare fraud. He told me they don’t do any bullshit guesstimating. They have all the diagnosis data from the doctor’s entire career and then start pulling samples from various stages to find a pattern. And then they send in undercover investigators and informants with wires to catch them in the act of intentional fraud, not just inadvertent miscoding. ---
**Author:** ![Acsenray](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/acsenray/32/4519_2.png) [@Acsenray](https://boards.straightdope.com/u/Acsenray)\ **Post date:** [June 28, 2015, 8:20pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/93 "2015-06-28T20:20:57Z")
> [@Dewey\_Finn](#): > > Sure, but keep in mind that not all doctors are members of the AMA. That’s not really an excuse. It’s s very basic, common sense ethical standard that I don’t doubt is within the scope of familiarity of all physicians, even ones that haven’t joined the AMA. ---
**Author:** ![Tibby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tibby/32/17030_2.png) [@Tibby](https://boards.straightdope.com/u/Tibby)\ **Post date:** [June 28, 2015, 9:46pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/94 "2015-06-28T21:46:44Z")
> [@Acsenray](#): > > I know very well a fed who prosecutes docs for Medicare fraud. He told me they don’t do any bullshit guesstimating. They have all the diagnosis data from the doctor’s entire career and then start pulling samples from various stages to find a pattern. And then they send in undercover investigators and informants with wires to catch them in the act of intentional fraud, not just inadvertent miscoding. I know quite well a federal AUSA; I’ve spent many hours speaking with attorneys and top medical consultants from perhaps the most formidable healthcare white collar crime defense law firm in the state, if not the country; and I personally know some affected physicians. Trust me; there are innocent doctors in prison for crimes they did not commit and plenty more innocent ones that have copped pleas. Federal investigations and prosecutions are life altering and sentences are draconian. I’m not saying there are not above board federal prosecutors, or FBI agents. But, there are more than a few overzealous prosecutors and agents who resort to dirty tricks and engage in wrongful prosecution, not necessarily on purpose, but perhaps more often by negligence. And my guess is that wrongful prosecution occurs with healthcare fraud at a much higher rate than with other federal crimes for a couple of reasons. First is that healthcare cost containment is a potential political bonanza. Find a way to reduce healthcare costs? Put those over-billing doctors in the federal pen for a few decades? You’re a hero and you will be voted into office forever. Another reason is that medical coding is complicated and ambiguous (many procedures can be interpreted different ways, depending on who is doing the interpreting). Many debates go on at medical seminars about how to code correctly and compliantly—it’s not black and white, and an audit/investigation can be triggered simply because a doctor’s billing profile is an outlier in his community (not necessarily billing more…just differently, for what could be a very reasonable and innocent reason). So, if doctors themselves have trouble interpreting the “down the rabbit hole” absurdity of ICD-9 (and 10 will most likely be even more bizarre) how do you expect the FBI and federal prosecutors to understand it? They are not doctors. Sure, they have their own medical consultants (very well compensated)…but, chances are, the consultants don’t understand it either, plus they very well could have an agenda…an agenda to keep the prosecuting attorney happy by finding fault. Don’t get me wrong, there are plenty of bad apple doctors out there, and I’m glad those that get caught are hibernating in prison. But, if you do more research you should conclude that many good apples are paying the price of guilt by association. Your federal prosecutor friend may be sincere, but he’s not telling you the whole story. Not by a long shot. ---
**Author:** ![chizzuk](https://avatars.discourse-cdn.com/v4/letter/c/e36b37/32.png) [@chizzuk](https://boards.straightdope.com/u/chizzuk)\ **Post date:** [June 28, 2015, 10:25pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/95 "2015-06-28T22:25:52Z")
Setting aside for a minute the asshole behavior of the doctor, what would have happened if this guy had had his colonoscopy across the river in Montgomery County instead of Fairfax County? Maryland is a two-party consent state and so I’m thinking secretly hiding his phone to record the doctors in the procedure room without their knowledge would not have been legal and the tape could not be used as evidence. But I don’t know. As a Montgomery resident and a frequent Post reader, I was confused about why the Post didn’t mention this since some of their Maryland readership might get it into their heads to try this without realizing it could be a problem. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [June 28, 2015, 11:02pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/96 "2015-06-28T23:02:31Z")
Even in the case of the recording being done in a two-party consent state, could the doctors still be disciplined, especially for the false diagnosis? ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [June 28, 2015, 11:54pm UTC](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403/97 "2015-06-28T23:54:47Z")
> [@Dewey\_Finn](#): > > Sure, but keep in mind that not all doctors are members of the AMA. Nowadays, the AMA is little more than a lobbying organization. [Previous page](https://boards.straightdope.com/t/anesthesiologist-trashes-sedated-patient/723403.md?page=4)