List Archives

Fri May 29 12:07:23 BST 2009

I don't think Pret was saying that the PROCEDURE was illegal.

Physicians' licenses to practice medicine, in the US, says "Medicine and
Surgery", even if Internist.

Moreover, even credentialing issues would not apply (at least in most)
hospitals - which wouldn't be a legal, could be licensing, issue - because
privileges (every I have ever been) specifically say:

(Note that is from a document for a PA)

"Any restriction on the specified services granted me is waived in an
emergency, and in such situation, my actions are governed by the applicable
section of the policies governing Limited Health Practitioners."

I assume that MD credentials carry the same waiver.

I think he was talking only about the disclosure, which WOULD be a Federal
offense under HIPPA.

Lorick

Lorick Fox, MPAS, PA-C

Gianaclis Support Complex

+20-3-448-2335 or +20-45-240-9450

Fax +20-45-243-1191

Mobile +20-18-230-4448

> -----Original Message-----

> From: trauma-list-bounces at trauma.org [mailto:trauma-list-

> bounces at trauma.org] On Behalf Of Pret Bjorn

> Sent: Friday, May 29, 2009 3:43 AM

> To: 'Trauma-List [TRAUMA.ORG]'

> Subject: RE: Blind burr holes - word from the source

> 

> This isn't a transaction.  That he should be grateful is as true as it is

> irrelevant.  This patient doesn't owe anyone his privacy.  As a community

> of

> professionals we should take pains to respect that.

> 

> The details in this case are unsurprising and probably harmless; but

> they're

> still the kid's details to discuss or publish; not his doctor's.

> 

> Pret

> 

> 

> -----Original Message-----

> From: trauma-list-bounces at trauma.org [mailto:trauma-list-

> bounces at trauma.org]

> On Behalf Of LNMolino at aol.com

> Sent: Thursday, May 28, 2009 3:54 PM

> To: trauma-list at trauma.org

> Subject: Re: Blind burr holes - word from the source

> 

> Pret I agree on point one but I think you're reaching on point 2.

> 

> 1) Kid is not in the US so a semi moot point

> 

> 2) I think based on the media the family was told point blank he's dead or

> we do this and here is what this is.

> 

> 3) The vast majority of folks even in the US would be grateful given

> outcome.

> 

> 4) had he still had a negative outcome I am glad for the Dr he was NOT in

> the US as I am sure he'd be eaten alive even in a courtroom with a level

> balance  sadly but that's another thread.

> 

> Louis N.  Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance  Consultant/Trainer/Author/Journalist/Fire Protection

> Consultant

> 

> LNMolino at aol.com

> 

> 979-412-0890 (Cell  Phone)

> 979-690-7559 (IFW/FSS Office)

> 979-690-7562 (IFWF/SS Fax)

> 

> "A  Texan with a Jersey Attitude"

> 

> "Great minds discuss ideas; Average minds  discuss events; Small minds

> discuss people" Eleanor Roosevelt - US diplomat  & reformer (1884 - 1962)

> 

> The comments contained in this E-mail are  the opinions of the author and

> the author alone. I in no way ever intend to  speak for any person or

> organization that I am in any way whatsoever involved or  associated with

> unless I

> specifically state that I am doing so. Further this  E-mail is intended

> only

> 

> for its stated recipient and may contain private and or  confidential

> materials retransmission is strictly prohibited unless placed in  the

> public

> 

> domain by the original author.

> 

> 

> 

> In a message dated 5/28/2009 11:04:59 A.M. Central Daylight Time,

> p.bjorn at netzero.net writes:

> 

> And with  respect, it doesn't matter.  If anything, the boy's notoriety

> makes

> his protected health information more difficult to  sterilize.

> 

> In the US, Julie's email would likely be evidence of a  federal crime

> committed by Dr. Wallace -- unless the patient's family had  consented to

> this detail of description.

> 

> Pret

> 

> -----Original  Message-----

> From: trauma-list-bounces at trauma.org

> [mailto:trauma-list-bounces at trauma.org]

> On Behalf Of  LNMolino at aol.com

> Sent: Thursday, May 28, 2009 10:49 AM

> To:  trauma-list at trauma.org

> Subject: Re: Blind burr holes - word from the  source

> 

> Pret with respect the kid was on the International news.

> 

> Louis N.  Molino, Sr.,  CET

> FF/NREMT-B/FSI/EMSI

> Freelance   Consultant/Trainer/Author/Journalist/Fire Protection

> Consultant

> 

> LNMolino at aol.com

> 

> 979-412-0890 (Cell   Phone)

> 979-690-7559 (IFW/FSS Office)

> 979-690-7562 (IFWF/SS  Fax)

> 

> "A  Texan with a Jersey Attitude"

> 

> "Great minds discuss  ideas; Average minds  discuss events; Small minds

> discuss people"  Eleanor Roosevelt - US diplomat  & reformer (1884 - 1962)

> 

> The  comments contained in this E-mail are  the opinions of the author and

> the author alone. I in no way ever intend to  speak for any person or

> organization that I am in any way whatsoever involved or  associated  with

> unless I

> specifically state that I am doing so. Further this   E-mail is intended

> only

> 

> for its stated recipient and may contain  private and or  confidential

> materials retransmission is strictly  prohibited unless placed in  the

> public

> 

> domain by the original  author.

> 

> 

> 

> In a message dated 5/28/2009 8:41:58 A.M. Central  Daylight Time,

> pbjorn at emh.org writes:

> 

> I assume  there  are no patient privacy regulations in effect?

> 

> Else, we   should be careful how (or even IF) we discuss these details in

> an

> open  global  forum.

> 

> Pret

> 

> -----Original  Message-----

> From:  trauma-list-bounces at trauma.org

> [mailto:trauma-list-bounces at trauma.org] On  Behalf Of julie  miller

> Sent: Wednesday, May 27, 2009 7:11 PM

> To:  Trauma-List  [TRAUMA.ORG]

> Subject: Re: Blind burr holes - word from the   source

> 

> 

> OK, have just got off the phone with neurosurgeon involved  -  David

> Wallace. Here is his account:

> 

> - there was NO CT scan  done

> -  the child had a bruise just superior and anterior to the right  ear

> - the  child had a fixed, dilated right pupil and was coning (I  think he

> said  something like 'opposite clonic attack')

> - the  neurosurgeon  took the  call at 10am from a general practitioner

> (not

> a surgeon)

> - they found a  household drill in the hospital  kitchen and dipped the

> tip

> in alcohol-iodine  solution

> - the GP  didn't know how to put the drill together - someone had  to do

> it

> for  him

> - he drilled through both tables of skull and enlarged the  hole  with

> bone

> forceps with the neurosurgeon talking him through it on   speakerphone

> - he was able to suction out 20 mls of blood.

> - the   pressure head was relieved and the pupil came right down

> - a drain tube  was  placed and he was airlifted to the Royal Children's

> Hospital  where he had a  "big craniotomy" within a few hours

> - there was still  considerable clot and  the artery was still bleeding

> - the child was  extubated that evening and  was fine

> - he was discharged home post-op  day 3

> 

> Furthermore, this  neurosurgeon (with 35 years experience)  told me of two

> other cases in his  professional memory where country  general surgeons

> performed burr holes and  then let the patients wake  up intact and go

> home

> without

> referral to a  neurosurgeon for  formal craniotomy. One patient (a 16 year

> old girl) died at  home  later that night and the other is still in a

> persistent vegetative   state now 20 years later.

> 

> So I suppose the lesson is that burr  holes  are a good temporizing

> measure

> for someone in extremis to take  the pressure  off until they reach

> definitive care, but on their own  won't solve the   problem.

> 

> Regards,

> Julie

> 

> 

> 

> 

> ________________________________

> From:   "mvossak at yahoo.co.uk" <mvossak at yahoo.co.uk>

> To:   trauma-list at trauma.org

> Sent: Thursday, May 28, 2009 12:26:46  AM

> Subject:  re: Blind burr holes

> 

> 

> Thanks for the reference,  Matt. Maurice King  also covers the subject

> thoroughly in his  "Primary Surgery". Julie, I would  love to know whether

> this

> patient had a scan. Perhaps the life saving blind  burr hole is the  stuff

> of

> 

> surgical legend, not surgical myth as I have  recently  been suspecting!

> 

> A neurosurgeon friend of mind drilled six  when  their scanner was broken.

> The clot was eventually found at autopsy in  the  posterior fossa.

> 

> Maybe instant gratification will come with  the next  one...

> 

> Miranda

> Worcester South  Africa.

> 

> Miranda

> 

> I  think most people who work in developed  countries don't get it. One

> has

> 

> to

> do what one can do with the  facilities you have. In Rwanda and  similar

> places a dropping  conscious level with localising  signs/fracture/blown

> pupil

> mandate exploratory burr holes: 3 on each side.  There will  be a lot of

> negative burr holes, but there is no way you can  avoid  that. A fracture

> in

> the temporal fossa with a lucid interval will   have a high yield of

> extradurals.

> 

> If you have an X-ray machine  you  can see where a fracture is and that

> then

> becomes the most likely  site of  mischief. You could also do a direct

> puncture carotid  angiogram and take a  couple of films which could show

> you

> a

> midline shift or  haematoma.

> 

> If you have a CT scanner  then you get the most accurate info  and do not

> do

> negative burr  holes.

> 

> Check out   http://openlibrary.org/b/OL10554765M/Neurosurgery-in-the-

> Tropics

> 

> Matt   Oliver

> Bendigo

> Australia

> 

> -----Original  Message-----

> From:  trauma-list-bounces at trauma.org

> [mailto:trauma-list-bounces at trauma.org]

> On  Behalf Of Miranda  Voss

> Sent: Tuesday, 26 May 2009 11:27 PM

> To:   trauma-list at trauma.org

> Subject: Re: Blind burr holes

> 

> 

> No,  truly  blind, most recently in Burundi just after the war when  we

> couldn't even  get a plain x ray.

> 

> Didn't realise the  Australian case was post-scan and  thought the general

> flavour of the  posts suggested that all you need in a  remote environment

> is

> a Black  and Decker, a doctor with a bit of backbone  and a non

> litiginous

> environment and all will be well. Clearly not! My   misunderstanding.

> 

> It can be very difficult to find the clot without  a  scan and I hope I

> never

> have to do it again.

> 

> Miranda   Voss

> Worcester, South Africa.

> 

> 

> The Australian story was  post-CT  demonstrating an extra-axial

> collection.....are your cases  truly blind or  post CT? -

> 

> -----Original  Message-----

> From:   trauma-list-bounces at trauma.org

> [mailto:trauma-list-bounces at trauma.org]  On  Behalf Of Miranda Voss

> Sent: Monday, 25 May 2009 9:00  p.m.

> To:  trauma-list at trauma.org

> Subject: Blind burr  holes

> 

> 

> Re:  Congratulations to Australian Doctor

> 

> I also  read this case with great  admiration for the doctor, the system

> and  the outcome. However, I would  like to give another perspective  on

> blind burr holes.

> 

> I have had to  do it a handful of times  when in the bush with no

> possibility of  referral/advice (NOT South  Africa) and I think it is a

> HORRIBLE operation.  I have only done it  with documented decrease in

> consciousness and  localising signs, but I  have never found a nice

> hematoma that could be  evacuated with good  results; either high pressure

> brain has come pouring  out of the burr  hole, or occasionally there has

> been bleeding that I have  not been  able to stop satisfactorily. It has

> always left me feeling far  from  warm and fuzzy and to be honest, I am

> now very reluctant to do   it.

> 

> Am I the only general surgeon/occasional skull trephiner who  has  never

> had a patient waking up on the end of the  drill?

> 

> Miranda  Voss

> Worcester, South Africa

> 

> 

> From:  "ramalinga reddy"  <drarumalla at yahoo.com>

> To:  trauma-list at trauma.org

> Congrats to Rob  Carson for saving the  chaild

> Many times doctors are afraid to do such thing  for fear of  legal

> implications

> It is the medical faculty which should  educate  the general public so

> that

> litigations are minimised and doctors   do such things confidently

> Hats off to Dr   RobCarson

> 

> 

> Dr.A.R.Reddy

> SKS Neuro Hospitals

> Mobile:   9849018017

> 

> --- On Fri, 22/5/09,   trauma-list-request at trauma.org

> <trauma-list-request at trauma.org>   wrote:

> 

> 

> 

> 

> 

> 

> 

> 

> --

> trauma-list : TRAUMA.ORG

> To  change your settings or unsubscribe   visit:

> http://www.trauma.org/index.php?/community/

> --

> trauma-list  :  TRAUMA.ORG

> To change your settings or unsubscribe   visit:

> http://www.trauma.org/index.php?/community/

> 

> 

> --

> trauma-list   : TRAUMA.ORG

> To change your settings or unsubscribe   visit:

> http://www.trauma.org/index.php?/community/

> 

> 

> **************Cooking  Dinner For Two? Sign Up & Get Immediate Member-Only

> Savings.

> (http://pr.atwola.com/promoclk/100126575x1222652750x1201460983/aol?redir=h

> tt

> p:%2F%2Fad.doubleclick.net%2Fclk%3B215225797%3B37274671%3Bq%3Fhttp:%2

> F%2Frecipes.cookingfor2.pillsbury.com%2F%3FESRC%3D934)

> --

> trauma-list  : TRAUMA.ORG

> To change your settings or unsubscribe  visit:

> http://www.trauma.org/index.php?/community/

> 

> 

> 

> ____________________________________________________________

> Get  your dream car or truck. Click  here.

> http://thirdpartyoffers.netzero.net/

> TGL2241/fc/BLSrjpYYjRV1jEbpw3B3toZkpU9fnYm5NGHmClIatfueWQ3mVF3nvdkTRza/

> --

> trauma-list  : TRAUMA.ORG

> To change your settings or unsubscribe  visit:

> http://www.trauma.org/index.php?/community/

> 

> 

> 

> **************Cooking Dinner For Two? Sign Up & Get Immediate Member-Only

> Savings.

> (http://pr.atwola.com/promoclk/100126575x1222652750x1201460983/aol?redir=h

> tt

> p:%2F%2Fad.doubleclick.net%2Fclk%3B215225797%3B37274671%3Bq%3Fhttp:%2

> F%2Frecipes.cookingfor2.pillsbury.com%2F%3FESRC%3D934)

> --

> trauma-list : TRAUMA.ORG

> To change your settings or unsubscribe visit:

> http://www.trauma.org/index.php?/community/

> 

> 

> 

> ____________________________________________________________

> Hit it out of the park with a new bat. Click now!

> http://thirdpartyoffers.netzero.net/TGL2241/fc/BLSrjpYan8sLhBDntSrm79MLOsA

> aTiKLNM8DEaobiGffUSmcwxJMlsSftq4/

> --

> trauma-list : TRAUMA.ORG

> To change your settings or unsubscribe visit:

> http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Blind burr holes - word from the source