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On 06/08/2005, a 32-year-old woman presented to a plastic surgeon for pre-operative consultation to schedule elective liposuction to the abdomen, thighs, and buttocks.
On 06/13/2005, the plastic surgeon ordered pre-operative laboratory results and an EKG.
On 06/14/2005, the pre-operative laboratory results revealed a urine positive for glucose and ketones. Random blood glucose level was 352 mg/dl.
Between 06/08/2005 and 06/21/2005, the plastic surgeon was the sole treating physician for the patient.
On 06/21/2005, the plastic surgeon performed liposuction. Following surgery, the patient developed tachycardia and was admitted to the hospital. She developed diabetic ketoacidosis.
On 06/23/2005, she was transferred to a different hospital for septic shock, respiratory failure, and renal failure.
On 08/05/2005, the patient was discharged from the hospital.
The Board judged the plastic surgeon’s conduct below the minimum standard of competence for failing to review urine, blood, and EKG studies prior to surgery, clearing the patient despite hyperglycemia, failing to order additional lab results given initial abnormal lab values, failing to obtain consultation regarding the hyperglycemia, and failing to maintain adequate medical records.
The Board ordered 50 hours of community service, six hours of continuing medical education in diabetic surgical patients, and five hours of continuing medical education in risk management. His license was suspended for a period of one year with 9 months stayed. After suspension, his license was to be placed on probation. During probation, a boarded physician was to indirectly supervise the plastic surgeon and review at least 25% of the plastic surgeon’s patient records. Surgical restrictions were ordered including only performing minor liposuction surgery, performing at an accredited outpatient facility or at a hospital, and using an anesthesiologist for all procedures. The plastic surgeon was also ordered to submit quarterly reports including the following:
1) A brief statement of why he is on probation.
2) A description of the practice location.
3) A description of current practice.
4) A brief statement of compliance with probationary terms.
5) A description of the relationship with monitoring physician.
6) A statement advising the Board of any problems which have arisen.
7) A statement addressing compliance with any restrictions or requirements imposed.
Date: January 2009
Significant Outcome: N/A
Case Rating: 3
Link to Original Case File: Download PDF
A patient was first seen by an obstetrician when her gestation period reached 24 weeks. The prenatal records do not show a CBC. The estimated date of confinement is noted as 7/8/2000, but the date of the ultrasound test and its specific findings are not documented.
On 4/28/2000, the obstetrician performed a one-hour glucose test, but no result was noted in the patient’s prenatal record.
On 5/17/2000, the patient was admitted to a hospital for education regarding diabetic diet and insulin administration. The obstetrician started the patient on an insulin regimen of 10 units NPH in the morning and 5 units NPH in the evening. The patient was taught how to inject the insulin and monitor her blood sugar levels with an Accu-Chek. An ultrasound performed at the hospital showed an amniotic fluid index (AFI) of 12 cm and an estimated fetal weight of 2265 grams. The patient was discharged on 5/19/2000 and instructed to return in one week, which she did not do.
On 6/23/2000, the patient returned to the obstetrician for prenatal care. A gestation period of 38 weeks was recorded. However, the obstetrician’s prenatal records did not note the patient’s hospitalization for diabetic instruction or that the patient had gestational diabetes requiring insulin.
On 6/27/2000, the patient was hospitalized after being injured in a fall. An Accu-Chek of the patient showed a glucose level of 269. The obstetrician was notified of this result but did not note the patient’s diabetic status or back injury in her prenatal record.
On 6/28/2000, the obstetrician noted that on said date he delivered the patient’s baby but the patient’s baby was not, in fact, delivered on this date. The obstetrician noted the following in the discharge record: “[T]erm pregnancy – vaginal delivery – pitocin augmentation with normal labor and delivery. Normal postpartum – fall no sequelae.”
On 6/28/2000, a fetal weight of 4217 grams was shown by ultrasound. The hospital radiologist noted the possibility of macrosomia.
On 7/5/2000, the patient was seen at the obstetrician’s clinic. A gestation period of 39.3 weeks was recorded.
At 3 p.m. on 7/13/2000, the patient was admitted to the hospital while in active labor. The obstetrician examined the patient at 5:06 p.m. and found her cervix dilated to 5 cm. A fetal scalp electrode was applied at 5:45 p.m. At 6:30 p.m., the obstetrician noted decreased long term and short term variability. Only a rim of cervix was left with the vertex at -1 station. At 8 p.m., the cervix was completely dilated. The patient was put in a lithotomy and encouraged to push. At 8:36 p.m., no further fetal heart rate tracing was undertaken and attempts were made to try other electrodes.
At 8:40 p.m., the vertex was brought to a +2 station. At 8:49 p.m., a vacuum was applied with delivery. A shoulder dystocia occurred and a proctoepisiotomy was cut with delivery of the posterior shoulder first. The infant was deceased at time of delivery.
The Board judged the obstetrician’s conduct to have fallen below the standard of care given failure to note the diagnosis of diabetes and macrosomia, failure to accurately document the clinical course of the patient, failure to appropriately assess the heart rate tracing when the patient was in labor, and failure to consider the performance of an immediate delivery at 6 p.m.
Given his above conduct and multiple other instances of gross negligence, the obstetrician was placed on probation for 5 years with stipulations to complete a clinical training program equivalent to the Physician Assessment and Clinical Education Program offered at the University of California San Diego School of Medicine, complete a medical record keeping course, and undergo clinical monitoring.
Date: April 2004
Significant Outcome: Death
Case Rating: 2
Link to Original Case File: Download PDF