Jahi McMath case in California

[feministing]

I posted the same information right before your "drunk as fuck a-hole doctor deserves what's coming" post.

I didn't read the entire thread before replying, just an article in the Miami Herald over the break that said it was a regular tonsillectomy.

[adidas]

Bleeding is typically controlled during the surgery, but bleeding may occur after. Tonsillectomies are typically an outpatient procedure so I assumed complications, if they happened, were probably very rarely serious.

I'll email my attending for clarification and get back to you.

The allegations from the patient's family do sound suspect.

No need to get back to me. I have the statistics on hand. as i said earlier, complication rate of 2.5%, most likely to happen in the first 3 days after surgery. Severe bleeding is the most common complication.

[feministing]

No need to get back to me. I have the statistics on hand. as i said earlier, complication rate of 2.5%, most likely to happen in the first 3 days after surgery. Severe bleeding is the most common complication.

You're right. I just don't see 2.5% as a very high number.

[mockingbird]

Feministing, if you are studying in Singapore right now(?) and that is where you saw the tonsillectomy, I could see the frequency of certain surgeries differing from country to country. Perhaps tonsillectomies are one of the more common surgeries that ENTs do, but I don't believe they are common in general in the US anymore, especially compared to 50 years ago or so. (The only younger person I know who had one had to wait years to get it. I think her doctor hoped she would "grow out of" having repeated throat infections vs. needing the surgery.)

That being said... as a fellow med student, I just hope you have more confidence in your future colleagues. I would gently advise you not to berate other doctors especially when there is so little information about the situation. And as a patient, overconfidence in one of my healthcare professionals is a thousand times worse than not knowing the answer - both for my relationship with them and in terms of preventing medical errors.

I haven't read all the links yet but I hope the family is able to come to terms with what happened. What happened is very sad, but nothing is going to bring their daughter back at this point.

[bionicmlle]

I have been told that tonsillectomies are quite routine, but opinion might differ from doctor to doctor.

Moore (clinically oriented anatomy, p. 1047) says that bleeding is common due to the rich vasculature to and around the palatine tonsil, but it is usually controlled and rarely results in long-term complications or death.

You know, if a medical student told me they were a doctor, I would tell their attending to give them a non-cog write up (if u r a med student then you know exactly what I mean) and reprimand the student myself. If you see "hubris" from senior faculty' you are in NO position to judge that.

This surgery was obviously not "routine" and was on an area likely with scar tissue. There is a reason we have no medical facts and I think previous posters have identified the scam-iness of this case correctly.

[adidas]

What I would be interested in knowing is the chance of serious complication after the third surgery in this area. Do the risks increase as more surgery is done? Also, what is the rate of complications in an obese patient who has has documented severe OSA (and the impact this has on the heart) and major reconstruction of the entire upper airway? Surely those comorbidities have an impact on the risks?

This was a very high risk procedure IMO.

[adidas]

You're right. I just don't see 2.5% as a very high number.

Then you have a LOT to learn. That is a comparitively high complication rate.

[Coconut Flan]

Was the 2.5% for initial tonsil removal? I think it is. This was, it seems, her third procedure and much more involved and would seem to have a higher rate of complications.

To the person who asked if it gets riskier each time. I was told it does. That's why elected to not have a second throat surgery. With the condition I had I was told the complication rate would rise at least ten fold. We found an alternate solution and I've never regretted the decision.

[France Nolan]

I know they are few and far in between. I never once implied that screwed up tonsillectomies occur often.

I'm just in clerkship. I've seen one tonsillectomy. The attending told me it is a simple procedure. Yes, there are individual variations in vasculature but the attending emphasized a attempting to locating the important vessels before proceeding. He was the one who brought up the old-timer hubris bit. I figured you would be discerning enough to realize that it is the exception, not the norm. My attending claims to have never botched a tonsillectomy in a way that resulted in severe complications or death, and he has only heard of one case of post-tonsillectomy death; the surgeon met the hubris description.

I know n=1 is not enough to come to conclusions, but the attending has his hunches.

So basically you're not remotely qualified to give a professional, medical opinion.

[mockingbird]

What I would be interested in knowing is the chance of serious complication after the third surgery in this area. Do the risks increase as more surgery is done? Also, what is the rate of complications in an obese patient who has has documented severe OSA (and the impact this has on the heart) and major reconstruction of the entire upper airway? Surely those comorbidities have an impact on the risks?

This was a very high risk procedure IMO.

I have little experience with surgery beyond ones I have had done to me, but I do know one reason risk increases after having a previous surgery in the same area is increased scar tissue. I believe this is both because it's weaker than normal tissue and can build up and get in the way. That is one reason why women are advised not to have a lot of C-sections, both because of increased risk for uterine rupture (weakness) and placenta accreta (placenta is attached too deeply to the uterine wall so doesn't detach normally after birth, and then can cause excess bleeding when it does detach, or the woman might require surgery to remove it).

[Arete]

You can tell me that the surgeon fucked this to hell and back (which I seriously doubt) and it still does not change

-the fact this child is dead and not coming back

-the fact there is a charlatan lawyer on the West Coast trying to make a name on this tragedy

-the fact there is a charlatan "institute" on the East Coast willling to get some free publicity and money from this tragedy

-the fact that Jahi's mother, in her extreme grief, has lost touch with reality and is allowing charlatans to carry out their own agendas and is not allowing her child to be laid to rest with the dignity she is due.

Lord, have mercy on all of us, we have Screwed Up here.

[bionicmlle]

Actually, I now realize there are at least two Sprocket-Trials posts:

http://sprocket-trials.blogspot.com/201 ... egacy.html

http://sprocket-trials.blogspot.com/201 ... cmath.html

Again, someone please let me know if you think I should break the links.

GT - thanks so much for posting those! Awesome summaries.

[mags]

I know they are few and far in between. I never once implied that screwed up tonsillectomies occur often.

I'm just in clerkship. I've seen one tonsillectomy. The attending told me it is a simple procedure. Yes, there are individual variations in vasculature but the attending emphasized a attempting to locating the important vessels before proceeding. He was the one who brought up the old-timer hubris bit. I figured you would be discerning enough to realize that it is the exception, not the norm. My attending claims to have never botched a tonsillectomy in a way that resulted in severe complications or death, and he has only heard of one case of post-tonsillectomy death; the surgeon met the hubris description.

I know n=1 is not enough to come to conclusions, but the attending has his hunches.

So, you're not a real doctor. Got it. Clearly your plan to pretend to be a doctor didn't work. You should know that making blanket simplistic statements about complex subjects you have no real experience with is not the way to prove yourself or gain the respect of others. Tell me, did you evaluate your attending for the "hubris description." Maybe you should because attendings should be teaching actual statistics and clinical care and sharing helpful advice from their many years of experience and study instead of (apparently) teaching students to take anecdotes and broadly applying it to practice. I would encourage you to look up the rate of bleeding for post-op tonsillectomies for yourself instead of emailing your attending. Also, unless your attending has had a look at Jahi's medical records then he should also be reserving judgement.

I am an actual doctor. I have graduated medical school, finished residency, and worked in both private practice and as an attending in an academic setting. I am fully licensed and board certified. I have seen several "simple quick procedures" go bad through no fault of the patient or negligence on the doctor's part. Complications of "simple procedures" are rare but can happen with even the best technique. Colons get perforated during a normal colonoscopy. Arteries get lacerated or dissected during an otherwise routine heart cath. Arteries are hit during an ultrasound-guided paracentesis to drain abdominal fluid. All are simple outpatient procedures that went bad and the patient didn't have symptoms until he/she showed up in the ER a few hours after same-day discharge.

I suspect that in a few years after you've accumulated some actual experience, you will look back on this post and be really embarrassed.

[adidas]

Thank you Abigail and Mockingbird for the posts about scar tissue. That makes a lot of sense.

If we look at the 2.5% complication rate for the first simple tonsillectomy then consider that this was the third surgery, then look at the fact that it was a complex surgery involving reconstruction of the entire upper airway including removal of the tonsils and adenoids, plus removal or reshaping of the uvula as well as sinus and soft palate tissue removal, THEN factor in the other comorbidities, this was an extremely risky procedure.

I'm not saying that her family should have expected this tragic outcome, just that their statement that she went in for a simple tonsillectomy and had no health problems beforehand is not true.

Edited for typo

[anniebgood]

Feministing, if you are studying in Singapore right now(?) and that is where you saw the tonsillectomy, I could see the frequency of certain surgeries differing from country to country. Perhaps tonsillectomies are one of the more common surgeries that ENTs do, but I don't believe they are common in general in the US anymore, especially compared to 50 years ago or so. (The only younger person I know who had one had to wait years to get it. I think her doctor hoped she would "grow out of" having repeated throat infections vs. needing the surgery.)

That being said... as a fellow med student, I just hope you have more confidence in your future colleagues. I would gently advise you not to berate other doctors especially when there is so little information about the situation. And as a patient, overconfidence in one of my healthcare professionals is a thousand times worse than not knowing the answer - both for my relationship with them and in terms of preventing medical errors.

I haven't read all the links yet but I hope the family is able to come to terms with what happened. What happened is very sad, but nothing is going to bring their daughter back at this point.

I'm 60 and I think nearly every single one of the kids I went to grade school with had their tonsils and adenoids out during those years. My brother and I were in the hospital at the same time, had surgery on the same day and recovered together. It was a standard procedure and did reduce the number of colds and coughs we had. Today they are few and far between. My oldest was a strep magnet and when I asked his pediatrician if he could be considered a candidate she said they only do it for the sickest kids. Things change with time.

[Stephanie66]

I had a simple tonsillectomy in 1997, as an adult. I stayed overnight, not in ICU. My ex had one done in 1990 and they released him after a few hours....THAT was ridiculous. I think that was back when they were trying to do everything outpatient. Yes, he was a baby about it, but still...

It was pretty rough as an adult.

What were Jahis other surgeries? They took out everything in her throat with this one, right?

[lilwriter85]

I had a simple tonsillectomy in 1997, as an adult. I stayed overnight, not in ICU. My ex had one done in 1990 and they released him after a few hours....THAT was ridiculous. I think that was back when they were trying to do everything outpatient. Yes, he was a baby about it, but still...

It was pretty rough as an adult.

What were Jahis other surgeries? They took out everything in her throat with this one, right?

So far I haven't found an article that details what she else had done. There were articles saying that it was more than a tonsillectomy and in a previous post I speculated that it could have been an uppp surgery because she had sleep apnea. Uppp surgeries can vary patient by patient. I will say that if the surgeons committed an error during Jahi's surgery, I hope he or she she is dealt with. I know that doctors aren't perfect, but I think they serious errors are committed, doctors at fault should be dealt with.

[GawkingToo]

So far I haven't found an article that details what she else had done. There were articles saying that it was more than a tonsillectomy and in a previous post I speculated that it could have been an uppp surgery because she had sleep apnea. Uppp surgeries can vary patient by patient. I will say that if the surgeons committed an error during Jahi's surgery, I hope he or she she is dealt with. I know that doctors aren't perfect, but I think they serious errors are committed, doctors at fault should be dealt with.

On page 5, I posted a link to a court filing that details the procedures she had done.

EDIT: Here it is:

Source: http://thaddeuspope.com/images/Winkfiel ... _2013_.pdf, page 4 (labeled page 2)

Is that a UPPP?

[lilwriter85]

On page 5, I posted a link to a court filing that details the procedures she had done.

EDIT: Here it is:

Is that a UPPP?

Yup, it's a uppp.

[gardenvarietycitizen]

But this round of surgeries wasn't her first, was it? She had something else done before?

[Coconut Flan]

According to a few sources, it was supposedly her third.

I also read that it was uncommon to perform a UPPP on a child.

[Terrie]

The sprocket trials blog highlights an important fact that I think too often gets overlooked in these cases. As long as this case drags out, important equipment that the hospital has limited numbers of, such as the ventilator, is not available for actual living people. All so Jahi's mother doesn't have to deal with her grief and lawyer can get on tv.

(Please note, I have sympathy for Jahi's mother, but no one should be indulging her like this).

[notsocommon]

The next manufactured outrage is a brewin!

Huck has weighed in.... mike-huckabee-links-brain-dead-california-girl-to-nazi-death-camps-forced-abortions

Asshole should have stopped at "I am not a medical Dr and have o medical training, but...."

[Coconut Flan]

You aren't jeopardizing anything by removing a dead person from a ventilator. Yet I know people who will listen to him and be all up in arms about the situation.

[salex]

The next manufactured outrage is a brewin!

Huck has weighed in.... mike-huckabee-links-brain-dead-california-girl-to-nazi-death-camps-forced-abortions

Asshole should have stopped at "I am not a medical Dr and have o medical training, but...."

I have developed a repulsion toward him greater than even Limbaugh......