Worth a medical board suspension?

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Absalutely not

This surgeon should be complimented for not just accepting the spleen as
the bleeding source. While laparsocopy is not routine, it is by no means
unacceptable - I venture Ken Mattox's words were twisted to get the doctor
sanctioned - something more must be going on here!!!!

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Senior Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban, South Africa

> A surgeon in northern California was suspended by the medical board of
> California for using a laparoscope during an operative trauma
> evaluation. A pre-operative CT scan had shown a small posterior splenic
> laceration as the likely site of bleeding, causing a pre-operative drop
> in hemoglobin from 11.4 to 9.0 over several hours.
>
> A focused laparoscopy showed the splenic injury not to be the source of
> bleeding but another site (previously undescribed by the CT scan as a
> site of bleeding) was identified in the bowel mesentery instead. A
> laparotomy was then performed and two small but persistent mesenteric
> bleeders were ligated, and a short segment of contused, traumatised
> bowel (to which these vessels had flowed) was resected.
>
> The patient recovered from the operation without any complications and
> an ideal outcome.
>
> The accusation was made that laparoscopy is never indicated in trauma,
> and especially if hypotension occurs at any time during the
> pre-operative period. Although one of the indications for operation was
> an episode of hypotension in the ER (following a bolus of narcotics),
> this patient was shown to have systolic BP of 98 and 99 at the start of
> laparoscopy. Nevertheless, a physician briefly walking by the operating
> room "while the OR was being set up" represented that he had witnessed
> the patient "bleeding rapidly" and "bags of blood" being "squeezed" into
> her prior to operation. There are no pre-operative transfusions recorded
> in the chart or elsewhere, however. (This physician had earlier
> represented to a departmental surgery meeting that he had only seen
> fluids being given; he changed his testimony for the medical board
> hearings.)
>
> This "witness" had also written the original hospital accusation. During
> the hospital peer review, a half-page e-mail from Dr. Ken Mattox
> (confirming a brief telephone discussion between him and a physician
> representative for the hospital) was used as the only expert opinion in
> the case (even though Dr. Mattox was never sent the chart or records to
> review).
>
> The accusation was then sent to the medical board, where the only
> material witness was again the same physician who had originally written
> the accusation.
>
> Two university professors gave opinions in this case (one a director of
> trauma for 10 years and the other a renowned professor of laparoscopy)
> supporting the use of focused laparoscopy in trauma and found no
> departure from the standard of care. They noted the ideal outcome in
> this case.
>
> Nevertheless, an administrative law review recommended sanctions against
> the physician for the use of laparoscopy in trauma and the medical board
> accepted the recommendation without comment.
>
> Is this an acceptable way for trauma standards to be set?
> --
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