Doctor makes controversial and life saving choice ... thoughts

[166035]

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[45408]

He wouldn't have lost his license. Even a malpractice suit would have been a long shot. Malpractice requires negligence + harm. Everett was already a quadriplegic immediately after the hit. You can't get much worse than that.


EDIT - I had only heard about the immediate chilled IV, not the later one during the OR. I guess that was more risky. Even still, he had good reason to believe it would work.

 

[decafplease]

I worked for a MD who did something that no one expected and few would have had the courage to do, based on a hunch. She saved a woman's life. I would want a physician who was willing to do whatever it takes to save my child/spouse/own life without worrying about a lawsuit.

Good for him, he saved a young man's functional ability. He's a hero.

And I agree with Prowler. I doubt anything worse could have come from it. Considering there is nothing else to be down besides stabilizing the patient, I don't believe he would have been hit with malpractice because he wouldn't have caused any additional harm to the patient by icing him.

 

[VoiceofReason]

I feel strongly that people should think for themselves. It's the most important thing you can learn to do, in my opinion.

So, not being a trained M.D., and not knowing this doctor's reasoning behind thinking the treatment might work, I can't really comment. But it looks at first glance like he was thinking for himself, and may have done something amazing for someone.

If the doctor here had sound reasoning, grounded in science and EBM, for thinking that this treatment might work, then I support what he did.

 

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[darkelven29]

Really? I thought the doctor would have to obtain consent from Kevin or his guardians explaining that the technique was experimental and dangerous. And then if he follows the procedure after consent, he can't even be sued from malpractice. The link doesn't work on my cpu.

 

[45408]

I'm human," says Cappuccino. "Things passed through my mind. If I do this and it blows up in my face, I'm exposing myself to a lot of scrutiny. We could lose the house, lose the cars, the kids don't go to college. But I had to be able to put my head on the pillow that night and believe that I did the best job I could do."


He seems to believe his career and life would have been greatly altered from its current state if it did not work. Also, the effect of hypothermia can cause other medical problems such as heart arrhythmia which, if they happened, would have been in addition to Everett's condition and thus causing harm. Negligence could come in in the case of using experimental procedures not proven to work. Also, people have gained the ability to walk after injuries such as this ... therefore it would not have been hard for Everett's family to argue this procedure had caused harm had it not been so successful.

It made it a more dramatic news story. I don't think his family would have had much to go on in a lawsuit if he had not regained ability to walk.

 

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[Maxprime]

"There was contentious debate at the hospital. At least two doctors, including Gibbons, did not want to induce hypothermia, which can have dangerous side effects such as heart arrhythmia, blood clotting problems, pneumonia and organ failure."

What if one of these conditions set in and ended up killing him?

From what I've read, he was conscious but paralyzed. He could have consented to treatment himself.

Given a 10% (made it up) risk of death compared to being paralyzed from the neck down for life, I'm willing to bet that most professional athletes would risk the dice.

 

[neuroprotector]

At the same time, hypothermic therapy for many kinds of neuro injuries has a lot of literature support, and is coming back. It's an extremely effective therapy for reducing infarct damage, and is one of the few consistently effective means of neuroprotection we have. It was risky, of course, but it's not like he was stabbing in the dark. I bet a potential suit against him would be harder than a lot of people think.

 

[Thewrongstuff]

Doesn't hypothermia also sloooow down apoptosis, so it is very useful for people who have had a heart attack/stroke?

 

[Depakote]

This is more appropriate for Topics in Healthcare.

moving

 

[bebos21]

Everett suffered a fracture dislocation between the third and fourth cervical vertebra. So there was an injury to the cervical spine and cervical spinal cord. But the spinal cord was intact. There was disc material pushing on the cord and bone was applying pressure as well.

"The vertebrae were out of alignment," said team orthopedist Dr. Andrew Cappuccino, who specializes in injuries of the spine. "The vertebrae of the spine line up like box cars of a train. The third cervical vertebra had translocated completely over the front of the fourth cervical vertebra causing a scissoring effect on the spinal cord."

"Emergency decompressive surgery was performed Sunday night to prevent pinching of the spinal cord," said team medical director Dr. John Marzo as part of a Monday afternoon press conference at One Bills Drive.

The surgery was performed by Cappuccino and Dr. Kevin Gibbons at Millard Fillmore Gates Hospital in downtown Buffalo after consent was granted by Everett who was awake and alert along with his mother who was reached by phone. The surgery lasted about four hours as Everett had his third and fourth vertebrae fused together.

"Dr. Gibbons and myself worked first on the front side of the cervical spine to remove the disc, realign the spine and to fixate the spine between the third and fourth vertebrae with a bone graft, with a small cage, and with a plate and four screws," said Cappuccino. "We had the spine in good alignment and it was confirmed on all x-ray studies."

The second half of the surgery involved placing Everett face down.

"A second incision was made on the back of his neck," said Cappuccino. "The spine was decompressed or the pressure was relieved. The spinal cord was completely decompressed and the spine was fixated from the back with four screws and two small rods. At that point in time an intra-operative ultrasound was performed to evaluate the cord, the covering of the cord and the cord itself were completely intact and looked good."

Everett, who spoke to his mother personally before the surgery, said he did not want her to worry and that he loved her and his sisters and that he would get better according to Cappuccino. His mother has since arrived in Buffalo from Texas and saw her son in his sedated state.

Following surgery he was placed in the intensive care unit and was put on a respirator by choice as high cervical spine injuries carry a greater risk of respiratory failure if respiratory support is not provided. Everett was also placed in a deeply sedated drug-induced state to protect the integrity of the surgical procedure.

Prior to putting him in that state, Everett had decreased sensation, but the ability to feel all of his limbs. This test also showed voluntary movement in his legs, though it was being stated by the doctors that it is only a preliminary result and should be construed as neither a positive nor negative result. It's too early for a prognosis which is why Everett's case is being labeled an incomplete spinal cord injury.

The doctors at this time do not know whether the injury will contract or expand from this point forward. An accurate prognosis will likely not be determined for another 72 hours at the earliest.

Dr. Cappuccino cautioned that Everett is still considered to be in a life-threatening situation, though his chances are improved following surgery.

"I want to caution everyone to understand that this was early in the healing phase and this is not a prognostic indicator and this young man suffered a potentially lethal and grave injury," said Cappuccino. "So we are still gravely concerned."

On the positive side Everett's high fitness level as an NFL player is deemed an asset in his battle to recover from this severe injury according to the physicians.

As far as assessing Everett's chances of walking again Cappuccino said the tight end's chances are not good.

"By life I'm an optimist, but as a scientist and a clinician I have to tell you statistically the chances of that occurring are very small," Cappuccino said.

According to Cappuccino, Everett remembered the entire play that led to this severe injury. Prior to surgery the team's spinal specialist informed Everett that his chances for a full neurologic recovery were less than five to 10 percent and that surgery was his best alternative but still an option. Everett chose surgery.

"Kevin said, 'Do everything that you can to help me with this,'" said Cappuccino.

 

[45408]

"There was contentious debate at the hospital. At least two doctors, including Gibbons, did not want to induce hypothermia, which can have dangerous side effects such as heart arrhythmia, blood clotting problems, pneumonia and organ failure."

What if one of these conditions set in and ended up killing him?

Then that would be a harmful result, obviously, but you can get lots of those side effects from many procedures or treatments. If the physician was acting on good information to perform that treatment, I think malpractice would be a long shot, and losing his license would be completely out of the picture. Doctors lose their licenses for prescribing themselves narcotics or molesting patients.

 

[McDoctor]

It's very possible, maybe even likely, that the outcome would have been the same without inducing hypothermia. Therefore, the patient may have been exposed to unnecessary risk without any additional benefit.

That's the whole point of doing randomized controlled trials. In this case, there's no way to know if the experimental procedure had any impact, or if the patient would have recovered just as well with usual therapy.

 

[Llenroc]

With compression spinal cord injuries, the possibility of recovery is there. With severed spinal cord injury, there's virtually no chance of recovery. That's the important distinction here. I'm not sure if the hypothermia played much of a role at all.

 

[Bungalow Boy]

It's very possible, maybe even likely, that the outcome would have been the same without inducing hypothermia. Therefore, the patient may have been exposed to unnecessary risk without any additional benefit.

That's the whole point of doing randomized controlled trials. In this case, there's no way to know if the experimental procedure had any impact, or if the patient would have recovered just as well with usual therapy.

That's the most correct interpretation of the whole story. We don't know what saved the patient. We need RCTs. There are many interventions that look logical but unless we have evidence that they do not do any harm, we should refrain from doing them.

If media starts praising such adventures then we might be living in a world with many more misadventures soon.

Unless doctors start following what has evidence and participate in researches to find newer and better things, we cannot guarantee a quality health care. It will just be adventures that doctors will be looking for in every patient.

 

[tibor75]

. There are many interventions that look logical but unless we have evidence that they do not do any harm, we should refrain from doing them.

Ridiculous.

If you follow that logic, you can't practice medicine. In the grand scheme of things, there are very few RCTs...and even less in the field of critical care and surgery.

 

[leopanther]

What a doctor should be