It’s not uncommon to have medical malpractice clients express a desire to see physicians face criminal charges or lose their medical licenses over negligent health care. In my experience, though, this is exceptionally rare.
In fact, after handling hundreds of medical negligence cases over my legal career, I’ve only seen one physician face criminal prosecution and a prison sentence. You may have heard of that surgeon being called Dr. Death in podcasts and on a TV show. We represented Jerry Summers, who was rendered quadriplegic from operating room and post-operative care of Christopher Duntsch, MD, a/k/a Dr. Death.
Now, another surgeon is in the news facing felony charges of first-degree aggravated assault and criminally negligent homicide. This time, it’s plastic surgeon Geoffrey Kim, MD, who was scheduled to perform an elective breast augmentation procedure.
There are a lot of things that caught my attention about this tragic case.
First, the anesthesia and procedure were being done at an outpatient surgery center, rather than a hospital. Based on my experience, outpatient surgery centers are generally not as prepared to handle emergencies, such as respiratory or cardiac arrest, then the hospital. That’s why they call 911 when something happens, to take patients to a hospital that’s equipped and staffed to handle the emergency.
Second, the anesthesia provider is also being charged and being prosecuted. The anesthesia care wasn’t provided by a physician. Instead, a certified registered nurse anesthetist (CRNA) was the sole anesthesia provider. Rex Meeker, CRNA, is being charged with criminally negligent homicide.
Third, it’s alleged that the surgeon and CRNA took over five hours to call 911.
Medical Board action against the surgeon
On January 9, 2020, the Colorado Medical Board suspended Dr. Kim’s medical license in an order that found objective and reasonable grounds to believe that he deliberately and willfully violated the Medical Practice Act and/or that the public health, safety, or welfare imperatively required emergency action.
On February 27, 2020, the Board entered a stipulation and final agency order that placed Dr. Kim on probation. According to the order, after the CRNA administered anesthesia, the patient went into cardiac arrest and began turning blue. The plastic surgeon, Dr. Kim, entered the operating room and immediately began cardiopulmonary resuscitation (CPR). The patient never regained consciousness.
Incredibly, according to the Board order, the surgeon didn’t call 911 for emergency personnel to transport the patient to the hospital following her systolic arrest for approximately five hours. According to the civil lawsuit, the patient was eventually transported to hospital and later died.
Interestingly, the Board order has a section with the heading “ONSITE ANESTHESIOLOGIST.” It requires that during the duration of Dr. Kim’s probation, he’s only allowed to perform surgical procedures that require general anesthesia and conscious sedation with an anesthesiologist present in on site.
The Board requires the anesthesiologist to be a board-certified physician licensed by the Board with no prior disciplinary history and no financial interest in Dr. Kim’s practice. The Board stated its preference that Dr. Kim perform surgeries in a hospital, rather than officer-based setting, during probation period.
Colorado Board of Nursing action against the CRNA
The anesthesia provider involved, Rex Meeker, became a registered nurse in 1984 and certified registered nurse anesthetist (CRNA) in 1995.
In December 9, 2021 order, the Board alleged that the CRNA injected a combination of local anesthetics, both near the maximum of the recommended guidelines, and the patient had an adverse reaction. In a prior order from January 2, 2020, the Board noted that the CRNA administered 250 mg of lidocaine with epinephrine and 62.5 mg of bupivacaine.
According to the Board, with 15 minutes of the injection, the CRNA noticed cyanosis (blue color) on the patient that quickly spread to her arms, hands, and torso. Although the CRNA reported a normal sinus heart rhythm and oxygen saturation levels in the mid-90s, this year they decided to manually ventilate the patient and stop the infusion of sedatives.
Within five to ten additional minutes, the patient went into cardiac arrest, and the CRNA and surgeon continued resuscitation efforts. The CRNA then administered medications to reverse the sedation. According to media reports and the lawsuit, the CRNA administered nine doses of Narcan. Narcan is a medication that is typically used to reverse drug overdoses.
According to the Board, the CRNA recommended to the surgeon that they transfer the patient to the hospital but did not attempt to call 911 for over five hours after the patient experience cardiac arrest. The Board noted that as an advanced practice nurse, the CRNA had the responsibility to timely contact emergency services and refer the patient to a hospital.
Although this year he disagreed with the Board findings, he permanently relinquished his license and the right to practice as a professional nurse and CRNA in the State of Colorado, in lieu of a formal disciplinary hearing.
Points to ponder
This tragic case illustrates some common themes that I’ve written about over the years, based on my experience in handling medical negligence and wrongful death cases.
• Location of surgery. Insurance companies love surgery centers over hospitals and so do surgeons who own them. Both of them love surgery centers because of money. Insurance companies pay surgery centers less than hospitals for operating room services. Surgeons who own surgery centers get to keep the lucrative facility fees.
When selecting a surgeon, it’s not only important to be comfortable with the surgeon’s technical competence, but also to understand the location where the surgery will occur—and the emergency capabilities. During discovery in many cases, we’ve obtained emergency transfer agreements between outpatient surgery centers and hospitals. For my family, it would be my choice to have any surgery in a hospital, where the highest level of care can be provided in the event of an emergency.
• The anesthesia provider. This is a charged and controversial topic in healthcare these days. Anesthesiologists are physicians. Certified registered nurse anesthetists (CRNAs) are not physicians, but their lobbyists and professional associations are advocating for CRNAs to have the right to have independent practices unsupervised by an anesthesiologist.
Ultimately, it’s up to the patient to consent to the anesthesia provider. In many cases we have handled, patients and family members have told us that they were unaware of who would be handling anesthesia care in the operating room. They explained that in anesthesiologist physician met with them before the procedure and there was no mention of the fact that the CRNA would be part of the team or, in fact, that the CRNA would be running the show anesthesia-wise in the operating room.
I firmly believe that anesthesia staffing should be part of the informed consent conversation and pre-anesthesia evaluation that’s required by the standard of care. As a patient, you may be comfortable with the training and competence of a CRNA. But you may not have the right to request a physician anesthesiologist’s care.
At a minimum, I recommend that patients and families asked pointed questions about anesthesia staffing before procedure.
If you’ve been seriously injured because of poor anesthesia or surgical care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.
