Dr. Boachie Named in Lawsuit

[leahdragonfly]

I was quoted my risk of blindness as 1 in 600,000 or something like that. You just have to hope the guy before you wasn't number 599,999.

[Back-out]

Confused on several counts

1) I've had numerous operations in my lifetime, only one intrinsically more serious than any general anesthesia is (minimally invasive neurosurgery on my cervical spine). ALL of them required me to sign lengthy consent forms essentially stating I would not hold the surgeon responsible even if my head falls off (and a similar slew of outcomes as long as the one Linda posted).

What I as a patient want to know are the PROBABILITIES.

2) Secondly, how come this lawsuit is mentioned but not the one I'll link below? It DID hit the New York Times and so far as I know, all "reputable" news media. (Still not clear just what happened PPW

I have a strong prejudice in favor of transparency about medical outcomes even though as with all news, most readers don't understand enough statistics to digest the actual meaning of big splashes presented - least of all in "medical breakthroughs." It's hard enough to find studies to give patients a notion of the risks they run - read "impossible" - based on physicians' track records, one's personal cohort (age and difficulty of surgery) and relative quality of facilities.

With that bias built-in to our ability to get information (why? Mostly because of the protective cabal against disclosing negative megative information to the public), I can't understand why any patient would want to cast a further pall on disclosing malpractice suits - including, of course, especially if negligence was proven.

Just consider the detailed listings of possible side-effects for any and all medications! No one would take any med without knowing what the frequency of occurrence of any of them were. Some of them are listed even if the negative event is not known for sure to be related to the medicine itself, their inclusion being for the sake of liability protection. There is such a thing as lying by excess of information! Consider the online consents we all sign without even scrolling, for countless contracts accepted by a mere "click". The government has also mastered this art, of concealing important facts by burying them in haystacks of unimportant ones.

Without odds, no one can make a cost:benefit analysis about anything, and "informed consent" is impossible.

http://www.nytimes.com/2015/05/30/ny...gery.html?_r=0

http://www.nydailynews.com/new-york/...icle-1.2240814

[Jamie1955]

A surgeon who is doing his job by dotting his "i's and crossing his "t's has a surgeon coordinator who meets with you once surgery is scheduled. The doctor himself may not go over even single possible complication, Paperwork is hardly their job.however you do have the right to that list well in advance of your surgery. My surgeon provided the list with a request for signature that I was aware of them. The list also has a disclaimer that there may be unknown risks included as well. I was aware of all the risks and proceeded with surgery. The reason this girl is able to file suit is that she was not informed of one particular risk. This is all so unfortunate. Very sad story for all.

[green m&m]

Someone that appears to be this woman's mother posted here prior to the surgery and the posts indicated her case was very complex, so much that some surgeons had rejected to take her on as a surgical patient.

The media always spins the story one way or other.

I couldn't find anything anything related to this specific case on NYS e-file search so maybe it never made it to court, but I don't know if I was searching correctly.

[Pooka1]

Perfect choice of photos, Ed! Spot on.

[titaniumed]

The worst thing about something like this hitting the papers or tabloids is that the truth gets skewed. The story gets sensationalized, and a judgment passed by readers based on inaccurate and unfair data. What they should do, is drop the case, and sue the newspapers and give her the money.....Lawyers sue people. Sue the right people. Thanks to the papers now, every single person that needs surgery on the planet is afraid of going blind......

I had a guarantee. I was guaranteed 100% that something would go wrong. And it did, I was lucky that my issues were minor compared to some of the devastating things that can happen with deformity surgery. I waited long enough. You can only handle so many “alarming” pain events. This 100% guarantee was a brilliant shock method used by my surgeon to get the message across. It worked well, but in the end he mentioned “It will help” That’s what I needed to hear. I then told him “I can hang” no matter what happens. Ok for me as an adult, how do you tell a parent or young child that the chances are not good, only to have them leave the office in tears? This is hard.

50 years ago, extreme surgery was this thing that you only heard about from someone else......Major surgery, scoliosis surgery, brain surgery, etc was something that everyone shook their heads at. I heard from many people “Are you nuts?” That was the attitude. “No, I’m not nuts, I need to have scoliosis surgery done some day”. Damn it.

Today, we have come a long way, but the attitude is different. Surgeries are accepted more, which can be a good or bad thing......

It mentioned that this girl was in a wheelchair before her surgeries. This is an indicator that she wasn’t doing well for some reason, and that being a candidate for surgery or at least successful surgery means being in good general health...... When the odds are grim, and life expectancy is shortened, do you try to make a difference? Or do you simply back off and say, we cant help you? Dr Boachie tries because he cares, and he is no hack. The guy is the best of the best in the world at what he does. This reminds me of Walid’s case, so sad, but it HAD to be done.

All surgical candidates and parents need to be informed about their procedures. If you decide to continue, try to learn as much as you can......(Linda did a great post).

Sharon, I also agree that timing is everything....

I have attached a photo below. which kind of explains what we are up against sometimes. Most of the time, there is no problem, but every once in a while, there is a problem. If you stand up against a bear, know what can or cannot happen.

Ed

[Pooka1]

I think surgeons are put in an impossible position. Surgery is held as the last option when everything else has failed but then the surgeon is potentially faced with much more complex surgery.

I understand why there are surgical thresholds but I think someone needs to study the trade-off of waiting until the last possible minute versus doing it earlier and having less morbidity/mortality.

I have always felt that one pediatric surgeon who fused a TL that was under the threshold in order to save lumbar levels must be incredibly brave. Had something gone wrong, he would have been crucified for operating under the threshold yet he was just trying to save the kid's lumbar. These surgeons are in an incredibly dicey position either way.

If these lawsuits succeed, I predict Lenke and others will stop taking the worst of the worst cases and these people will simply have no hope whatsoever. There needs to be some formal mechanism for people who will exhaust all conservative treatments and thereby voluntarily leave the "safer" surgery zone to let the surgeon legally off the hook except for negligence. I just think many if not most of these law suits are caused by the patients themselves understandably trying to avoid surgery and waiting too long. It puts the surgeons in an impossible situation.

Ed mentioned he wished he had his fusion sooner. I wonder if there are others who feel that way. If there are many people who feel that way then I think surgeons have to be much more candid about the ramifications of taking the time to exhaust all conservative methods. It doesn't seem clear to people that there are time windows on some of these cases.

[mariaf]

Agreed, Melissa. Had the story run strictly in the NY Post, I would be a little skeptical as well. The link I posted is from the NY Daily News (the story also ran in a couple of other publications, besides the Post, but I don't have the names in front of me).

As for other well-known doctors in the field (whether it's Betz, Samdani, Newton, Vitale, etc., etc.), I'm afraid that in this day and age there is all sorts of information - good and bad, proven and unfounded - out there on the internet. Everyone is dealing with the same issues. I have absolutely nothing against Dr. Boachie - I simply had lunch with someone the other day who brought this case up and sent me the story. (She's the parent of a child who had fusion surgery a few years ago and since the story seemed of interest to her, I figured it could have been of interest to someone here and/or relevant to discuss since this is a scoliosis forum). My intent certainly was not to offend or upset anyone.

[mabeckoff]

As a New Yorker, I do want to state that the newspaper that ran this story, The New York Post, is a trashy paper. It is a tabloid. Has this story run in either The New York Daily News or The New York Times? When I lived in NY/NJ, one never trusted any story that only ran in The New York Post.

[LindaRacine]

Again, I respect all opinions and ask for the same. That said, if I make a mistake at work, I just go back and fix it, which might involve something as simple as sending an email - so there is quite a difference. And sometimes mistakes made in any workplace ARE brought to light - intentionally or unintentionally - by others. It happens - it's part of life. We all deal with it even though we may not like it. If I did nothing wrong and the mistake was not my fault, then that will usually come to light in the end as well.

I guess my view (and again, I respect other views and ask for same) comes down to this. If, for example, a surgeon had these allegations levied against him (true or not in the end, that's why I say "allegations") and I was considering having him perform surgery on me or my child, I would want to know about it so that I could look into the facts and make my own informed decision. If the allegations turn out to be unfounded, great. While I do understand that IF an allegation is proven to be false, it's not completely fair to the surgeon that the allegations were public, I get that.

However, on the other hand, IF the allegations in any case turn out to be true (i.e., "even if an error was made"), it's not fair to prospective patients NOT to know about them.

And for me, if I am going to err on one side or the other, I would err on the side of protecting the patient. Again, just my personal opinion.

Would you want everyone who reads the NY Times to know about any of Dr. Betz' lawsuits, even the ones in which he didn't prevail? It's one thing for a surgeon's co-workers to know about the problem (and believe me, they do, at least in the case of most hospitals). It's quite another thing to have everyone in the world know about it, especially when the surgeon hasn't been found liable.

The problem with the whole scenario is that surgeons will eventually be unwilling to take on difficult cases, because they risk this type of exposure.

[mariaf]

Agreed that we have no idea if any error was made.

Even if an error was made, I have a problem with people going public with this sort of thing. Can you imagine if something similar happened to you every time you made a mistake? It's devastating enough for something to go wrong, but when someone goes public with it, I can't even imagine how that would feel. Again, I think it might be entirely different if the surgeon or anesthesiologist were intentionally negligent.

Again, I respect all opinions and ask for the same. That said, if I make a mistake at work, I just go back and fix it, which might involve something as simple as sending an email - so there is quite a difference. And sometimes mistakes made in any workplace ARE brought to light - intentionally or unintentionally - by others. It happens - it's part of life. We all deal with it even though we may not like it. If I did nothing wrong and the mistake was not my fault, then that will usually come to light in the end as well.

I guess my view (and again, I respect other views and ask for same) comes down to this. If, for example, a surgeon had these allegations levied against him (true or not in the end, that's why I say "allegations") and I was considering having him perform surgery on me or my child, I would want to know about it so that I could look into the facts and make my own informed decision. If the allegations turn out to be unfounded, great. While I do understand that IF an allegation is proven to be false, it's not completely fair to the surgeon that the allegations were public, I get that.

However, on the other hand, IF the allegations in any case turn out to be true (i.e., "even if an error was made"), it's not fair to prospective patients NOT to know about them.

And for me, if I am going to err on one side or the other, I would err on the side of protecting the patient. Again, just my personal opinion.

[mabeckoff]

Agreed that we have no idea if any error was made.

Even if an error was made, I have a problem with people going public with this sort of thing. Can you imagine if something similar happened to you every time you made a mistake? It's devastating enough for something to go wrong, but when someone goes public with it, I can't even imagine how that would feel. Again, I think it might be entirely different if the surgeon or anesthesiologist were intentionally negligent.

People are only human and they make mistakes. With my first surgeon in NC, I had several friends and family members wanting me to sue him. I just did not want to drag the whole thing through court. Dr Bederman fixed me up the very best that he could and I will spend the rest of my life like that.

[LindaRacine]

Agreed that we have no idea if any error was made.

Even if an error was made, I have a problem with people going public with this sort of thing. Can you imagine if something similar happened to you every time you made a mistake? It's devastating enough for something to go wrong, but when someone goes public with it, I can't even imagine how that would feel. Again, I think it might be entirely different if the surgeon or anesthesiologist were intentionally negligent.

[mariaf]

I agree there are risks to any surgery. I had to sign a consent form for my son's surgery - and even though it was several years ago, that's not something you forget. And yes, surgeons are sued all the time, but in this case someone was left wheelchair bound and blind, so that's not the same thing as simply being sued. I'm NOT saying for sure Boachie was at fault - that's for a court and/or a jury to decide. Maybe the damage to this girl could have been prevented - maybe not. I'm sure there are many times when things go wrong in the OR that nobody could have prevented. There are also surely some instances where a surgeon (or someone else in the OR) IS at fault. They do sometimes make mistakes. As a mother, and one with a daughter close to this girl's age, my heart simply goes out to her, that's all. If we would give the surgeon the benefit of the doubt, why not the patient? Now, that may not be everyone's view and that's fine - it's just my personal feeling and I respect the rights of others to feel differently.

[LindaRacine]

I had known that Dr. Boachie was going to retire for at least a year before it actually got announced.

I'm fairly certain that every one of your surgeons has been sued, probably multiple times. The vast majority of suits have no basis. When something goes wrong and a patient has a complication or a bad outcome, everyone suffers, including the surgeons and the anesthesiologists. Most of these problems are not caused by neglect. These medical professionals can do everything in their power to protect their patients from experiencing complications, but stuff still happens. When a professional is negligent, they're at fault. If they don't take the appropriate steps to minimize the possibility of something going wrong, that's negligent. If they operate while under the influence, that's definitely negligent. Otherwise, I think we need to understand that we're just one of the unlucky ones.

How many times have you heard of surgeons telling patients that there are no guarantees? In case someone forgot, THERE ARE NO GUARANTEES. And, yes, I believe that when this patient was consented, she was probably not told that she might lose some of her sight or that she might end up in a wheelchair. It would literally take hours for our surgeons to tell us absolutely everything that might happen to us during and after surgery. And, even then, we might have a complication no one else has ever experienced. I'm not sure of this, but I believe that the risk of death is actually higher than the risk of blindness (though both are rare). The patient was almost certainly told that there was a risk of death, and yet she decided to proceed with surgery. If she had been told that there was a risk of blindness, would she have changed her mind? We are all told that these are very serious surgeries with very serious complications. Have any of you ever changed your mind about surgery because of what you were told in the consent process? Look at the list of complications at the end of this post. I'd be interested to hear from people who would specifically not have surgery because of something on the list.

A few studies of interest:
http://www.ncbi.nlm.nih.gov/pubmed/25946720

Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.

http://www.ncbi.nlm.nih.gov/pubmed/22504517

A total of 306 patients aged 63 years (range, 50-83), with 83% women. Mean follow-up was 54 months. Mean Cumulative Illness Rating Scale score was 5 (range, 0-26). Main curve was 50° (range, 4-96) with apex between T12 and L2. Ten percent of patients had anterior surgery only, 18% had double anteroposterior approach, and 72% had posterior surgery only. Seventy-four percent (226 patients) had long fusions of 3 or more levels and 44% (134 patients) were fused to the sacrum. Forty percent (122 patients) had a decompression performed and 18% had an osteotomy. There were 175 complications for 119 patients (39%). No cases of death or blindness were reported.

Here's a list of complications put together by the International Spine Study Group:
Infection
• Major
o Deep
o Pneumonia
o Sepsis
• Minor
o Superficial
o UTI
o C Diff infection

Implant
• Major
o Hook dislodgement
o Interbody fracture
o Interbody migration
o Rod fracture
o Rod dislodgement
o Screw fracture
• Minor
o Painful implants
o Prominence
o Screw malposition
o Interbody subsidence
o Crosslink dislodgement
o Set screw dislodgement
o Screw bone interface loosening

Radiographic
• Major
o DJK
 Not requiring surgery
 Requiring surgery
o PJK
 Not requiring surgery
 Requiring surgery
o Pseudoarthrosis
• Minor
o Coronal imbalance
o Curve decompensation
o Heterotopic ossification
o Sagittal imbalance
o Adjacent segment degeneration

Neurologic
• Major
o Visual deficit/blindness
o Brachial plexus injury
o CVA/Stroke
o Spinal cord injury with incomplete deficit
o Spinal cord injury with complete deficit
o Nerve root injury with weakness
o Retrograde ejaculation
o Bowel/Bladder deficit
• Minor
o Neuropathy or sensory deficit
o Pain (radiculopathy)
o Peripheral nerve palsy
o Delirium

Mortality
• All major

Cardiopulmonary
• Major
o Cardiac arrest
o Pulmonary embolism
o Respiratory arrest
o DVT
o Congestive heart failure
o Myocardial infarction
o Reintubation
o Acute Respiratory Distress Syndrome
• Minor
o Coagulopathy
o Arrhythmia
o Pleural effusion
o Hypotension
o Congestive heart failure

Vascular
• Major
o Vascular injury
• Minor
o coagulopathy
o Thrombophlebitis

Gastrointestinal
• Major
o Obstruction
o Perforation
o Bleed requiring surgery
o Pancreatitis requiring surgery
o Cholecystitis requiring surgery
o Liver Failure
o SMA Syndrome
• Minor
o Ileus
o Bleed not requiring surgical intervention
o Pancreatitis not requiring surgery
o Cholecystitis requiring surgery

Renal
• Major
o Acute Renal failure requiring dialysis
• Minor
o Acute Renal failure requiring medical intervention

Operative
• Major
o Retained sponge/instrument
o Wrong surgical level
o Unintended extension of fusion
o Vascular injury
o Visceral injury
o EBL >4L
• Minor
o Dural tear
o Fixation failure (hook/screw)
o Implant failure
o Pedicle fracture
o Posterior element fracture
o Vertebral body fracture

Wound Problems
• Major
o Dehiscence requiring surgery
o Hematoma/seroma with neurological deficit
o Hematoma/seroma, no neurological deficit requiring surgery
o Incisional hernia
• Minor
o Hematoma/seroma not requiring surgery
o Hernia