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Hospital cost saving efforts can lead to early extubation, medical malpractice

Removing a breathing tube too quickly can lead to brain injury or death

There is a trend in healthcare to push toward reduced services in order to save costs. This has manifested itself in several ways.

Currently, in Texas and other states, mid-level practitioners, such as physician assistants (PA), nurse practitioners (NP), and certified registered nurse anesthetists (CRNA), are pushing for new laws to allow them to practice independently. Many PA, NP, and CRNA industry and lobbying groups contend that mid-level providers who are not physicians provide the same quality of care that physicians do, but with the substantial cost savings.

As a former hospital administrator, I am in no way against the important role that PAs, NPs, and CRNAs play in providing meaningful access to quality healthcare to patients. Based on my significant experience as a Texas medical malpractice attorney, though, there’s a big caveat. When something unexpected happens during the provision of care, complex patients are generally better off with a physician in the room. It’s when there’s a complication that the difference in training and experience between mid-level providers and physicians is critical to patient safety.

While during this legislative season, this debate has been at the forefront of my mind, another cost-saving measure came up during a recent deposition. I was deposing a pediatric critical care physician who was an attending physician in a major Houston area hospital and a medical school professor. In this medical malpractice case, the central issue is the timing for extubation of a complex infant patient.

Before discussing this doctor’s deposition revelation, though, I should back up a minute.

This patient was born with a congenital heart problem. He went back to the operating room a number of times during his first year of life for dilatations cardiac catheterization procedures to improve his cardiopulmonary status. For these operations, he was intubated and placed under general anesthesia and sedation.

Intubation involves placing an endotracheal (breathing) tube through the patient’s mouth and into the airway. The tube is connected to an anesthesia machine that secures and controls oxygenation and ventilation.

Extubation refers to the removal of the tracheal tube. Under the standard of care, the timing of extubation is of critical importance. I’ve handled both pediatric and adult cases where premature extubation lead to death or severe brain injury. This happens because of a variety of reasons, including the effect of anesthetic medications on the body’s physiology. When a patient already has an impaired cardiovascular status, the risk of returning a patient from ventilator-supported breathing with intubation to normal, unassisted breathing on room air is dramatically increased.

In this infant’s case, he went into the cardiac catheterization lab for a procedure to improve his heart and breathing functions. In other words, all his treaters at the hospital knew that he did have normal physiology. Yet, the critical care attending physician whom I deposed was quick to offer that he was the lead author on a study telling the benefits of early extubation of pediatric heart patients.

A quick dive into the medical literature of a number of well-known hospitals in Texas and elsewhere have adopted programs to push for early extubation, even for complex pediatric cardiac patients. These articles don’t hide that the motivation of these studies is cost savings, rather than patient safety. Interestingly, though, despite the push for early extubation, there’s been no demonstration of reduction in overall per patient expense.

It’s sad to see the field of medicine healthcare migrate to an insurance and accounting oriented focus, rather than patient safety. If you or someone you care for has been injured because of hospital physician, nursing, or administrator pushes efforts to reduce or care in Texas, then contact a top-rated and experienced Houston, Texas medical malpractice lawyer to discuss your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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