Wednesday, June 30, 2010

Doctor (allegedly) Rapes Sedated Patients

Oh my this just can't be true! "Our patients are always treated with respect and dignity." "There are too many people involved in the care of our patients for anything like this to happen." "Patients would never do anything under sedation that they wouldn't ordinarily do!" "You people are crazy to think that any sexual misconduct could happen to sedated or unconscious patients!" These and other similar statements are on this blog and can be found all over the web. And then I found this little jewel of a web-site. Unethical Doctors « Vitals Spotlight – We Give the Doctor an Exam My my. I want you to check out Dr. Kevin Lang.... GASTROENTEROLOGIST. Isn't this the exact profession where bare bottoms and Versed are routine???? Here's the excerpt, but the rest of the site is good reading as well.

Dr. Kevin Lang: Sexual Misconduct Involving Sedated Patients


Dr. Kevin Lang, a gastroenterologist at Marshfield Clinic and Saint Josepth’s Hospital, resigned after admitting to allegations of sexual advances that were brought forward by at least two female patients.

Wisconsin Department of Regulation and Licensing are pursuing legal action against Dr. Lang based on receiving reports from former patients being touched inappropriately. One patient said she felt his sexual advances while she was recovering from sedation, after her medical procedure was completed.

The clinic is waiting to see if any other patients will come forward, as Lang’s attorney is not denying these allegations, instead communication how ashamed his client feels about his conduct.

The state Medical Examining Board is pursuing claims of about a dozen incidents following endoscopic examinations.”

According to Vitals (bad link removed) Dr. Kevin Lang completed his medical degree at University of Wisconsin, Madison School of Medicine which is one of the top ranking medical schools nationwide.

Please call Marshfield Clinic to report any incidents involving Dr. Kevin Lang: 715-221-6606


Monday, June 28, 2010

And the Beat Goes On

I found this entertaining and frightening article today. For all you medical types that are in denial about the poor quality of our health care and YOUR OWN sub standard care of your patients, this should be a reality check. We are paying through the nose for you people to take enormous risks with our bodies. Check out the stats... Jon Rappoport -- Medically Caused Death in America

Excerpts so that I can italicize and make bold faced!

12,000 deaths from unnecessary surgeries; (per year)

7,000 deaths from medication errors in hospitals; (per year)

20,000 deaths from other errors in hospitals; (per year)

80,000 deaths from infections acquired in hospitals (per year)

As I said in another post, I got off easy! I had an UNNECESSARY surgery, conned into it by an unscrupulous doctor. Then we add in MEDICATION error. I should never have had Versed OR general anesthetic and ESPECIALLY in the huge doses that were given to me. I got one of those HOSPITAL ACQUIRED INFECTIONS that could EASILY have killed me! My medical records are in the 2009 posts if you want to read the lies, omissions and the overuse of drugs. Take a look at my x rays while you are there. You can see just how poorly my surgery was performed. I TOLD THEM that I was to have a nerve block, pain medication of the opioid family and anti nausea meds ONLY!!! Look what they did to me.

As for the other 119,000 people killed every year as a result of hospital treatment, this horror has to be laid at the doors of those institutions. Further, to the degree that hospitals are regulated and financed by state and federal governments, the relevant health agencies assume culpability.

To my knowledge, not one person in America has been fired from a job or even censured as result of these medically caused deaths.

Yes, many persons and organizations within the medical system contribute to the annual death totals of patients, and media silence and public ignorance are certainly major factors, but the FDA is the assigned gatekeeper, when it comes to the safety of medical drugs. The buck stops there. If those drugs the FDA is certifying as safe are killing, like clockwork, 106,000 people a year, the Agency must be held accountable. The American people must understand that.

The entire article has even more alarming things to say about the medical field. Please read the whole thing.

Saturday, June 26, 2010

Empirical Evidence

For those of you who claim that Versed abhorers are "tin foil hat" people, who claim that Versed doesn't paralyse people, read this article;Manipulation under Anesthesia: Neurological Effects of Different Modes of Anesthesia (Added July 5th 2010; For those health care "professionals" who claim that patients do NOT talk and answer questions without censoring their thoughts while under the influence of Versed, please note the drug that Versed is compared to, Sodium Pentathol. Recognise that drug? IT'S THE TRUTH SERUM DRUG! This piece draws parallels between modes of action between the drugs... The difference being increased AMNESIA with Versed. Says so right here.

I have reproduced it in its entirety here so that I could add emphasis... Sooo italics and boldface are mine except as noted.

Manipulation under Anesthesia: Neurological Effects of Different Modes of Anesthesia

By Brad McKechnie, DC, DACAN

The purpose of this article is to lend some insight into the neurological effects of general anesthetic regimens and sedative/hypnotic regimens employed during manipulation under anesthesia.

Thus, two key areas for paraspinal muscle spasm production and pain transmission within the spinal cord are affected: internuncial neuronal reactions; and myoneural junction. By depressing internuncial neuronal transmission within the spinal cord, the pathology producing the abnormal muscle spasm is taken out of contact with the alpha motoneurons located in the anterior horn of the spinal cord's gray matter. The alpha motoneurons are responsible for producing activity in skeletal muscle.

Figure 1

In the intact pain-spasm-pain cycle, the site of the spinal or paraspinal pathology is reflexively linked to the alpha motoneurons in the cord's anterior horn, leading to a reflexive muscle spasm in response to pain (Figure 1). By temporarily depressing this activity within the spinal cord via administration of sedative/hypnotic medications, one key pathway for the facilitation of paraspinal muscle spasm is removed. As these substances also affect the myoneural junction by depressing skeletal muscle transmission, the flaccid paralysis of the paraspinal muscles necessary for the MUA procedure is enhanced (Figure 2). (Please note that the desired reaction (flaccid paralysis) is merely ENHANCED by Versed. This can be done without the permanent mental disruption of Versed...)

Figure 2

Sodium Pentothal produces induction of anesthesia within 60 seconds of administration, reflecting its rapidity of central nervous system penetration. The patient's blood pressure will decrease during the procedure and the heart rate will increase. Awakening from sodium Pentothal reflects the redistribution of the drug from the central nervous system to inactive tissue sites in fat and skeletal muscle. Sodium Pentothal's liver clearance rate is from 15-20 percent per hour. Should this procedure of sedation be utilized for a patient treated on an outpatient basis, it is necessary for someone to accompany the patient to the outpatient facility that will be able to drive the patient home after the procedure.

Patients sedated with sodium Pentothal may report amnesia for events occurring during the procedure. Versed has effects similar to those of sodium Pentothal with the exception that the memory loss for events occurring during the procedure is greater than with sodium Pentothal. In contrast, general anesthetics produce graded depression of all levels of central nervous system function by increasing the threshold at which firing occurs, thereby decreasing transmission. General anesthetics create a blockade of neuronal activity within the substantia gelatino'sa of the spinal cord's dorsal horn. The substantia gelatino'sa is the site which receives incoming nociceptive impulses entering the spinal cord. From this location, the noxious pain impulses are sent to the cortex via the lateral spinothalmic tact and to the anterior horn at the corresponding segmental level to create muscle spasm to the muscle or muscles acting over the joint or area serving as the origin of the pain impulse (Figure 3).

Figure 3

The alteration of central nervous system function by general anesthesia follows a pattern characterized as a combination of ascending and descending depression of the central nervous system that spares the medullary centers unless large doses of anesthetics are used (Figure 4).

Figure 4

The first areas of the central nervous system affected by general anesthetics are the lower segments of the spinal cord and the cerebral cortex. With more intense levels of the anesthetics, the central nervous system depressive effects spread upward through the spinal cord and downward through the subcortical and mid-brain levels to converge on the medullary centers which house the autonomic centers necessary for vegetative function, and on the cervical spinal cord region supplying motor function to the diaphragm via the phrenic nerve.

Due to the more complex technical nature and risk factors of general anesthesia, it does not share the popularity of the sedative/hypnotic method of anesthesia for the MUA procedure.


  1. Myers FH, Jawtez E, and Goldfein A: Review of Medical Pharmacology, ed 7. Lange Medical Publishers, Los Altos, California, 1980.

  2. Katsung BG: Basic and Clinical Pharmacology. Lange Medical Publishers, Los Altos, California, 1982.

  3. Stoelting RK, Miller RD: Basics of Anesthesia. Churchill-Livingstone, New York, 1984.

Brad McKechnie, D.C., D.A.C.A.N.
Pasadena, Texas


Thursday, June 24, 2010


Here is an ALERT from the NHS! Notice how "safe" this drug is. Risk of midazolam overdose: NHS alert CME at Pharmacology Corner Excerpts following. Italics and boldface type are mine.


Some adult patients are being overdosed with midazolam injection when used for conscious sedation. The presentation of high strength midazolam as 5mg/ml (2ml and 10ml ampoules) or 2mg/ml (5ml ampoule) exceeds the dose required for most patients. There is a risk that the entire contents of high strength ampoules are administered to the patient when only a fraction of this dose is required. Doses often exceed that required, are not titrated to the patient’s individual needs, do not take into account concurrent medication (e.g. opioids) and may involve high risk groups for example, the frail or the elderly. There is frequent reliance on injectable flumazenil (antagonist/reversing agent) for reversal of sedation in patients that have been over sedated.

Patient Safety Incidents

The NPSA has received 498 midazolam patient safety incidents between November 2004 and November 2008 where the dose prescribed or administered to the patient was inappropriate. Three midazolam related incidents have resulted in death." That's right people, THREE REPORTED DEATHS due to Midazolam! Want to bet how many there REALLY were? The ones that the medical people SWORE couldn't have been caused by their precious drug?

It is my belief that since the NHS is a cumbersome and non responsive entity like our own FDA, that this is under reported. Just as our own reports to the FDA are met with resistance so must the NHS reports be minimized. However late, the NHS has some mandates concerning the use of Midazolam for "conscious sedation." You have to read the article. Finally SOMEBODY is listening. It only took from the mid 80's til 2009 to get this, but however glacial the progress, it IS progress.

Monday, June 21, 2010

Here's how I feel about health care in pictoral form.

Hieronymous Bosch

Hell (circa 1490) by Hieronymous Bosch 1450-1516


Hieronymous Bosch "The Cure of Folly"

White House Phone Answerer Says FINE!

I called the White House a few months ago to complain about the lawbreakers and criminal drug pusher types in the medical field. After all I had heard Obama declaiming how we have to "bend the curve of health care costs downward." Sounds wonderful doesn't it? If they quit using the dangerous drug Versed on everybody and FORCED medical people to comply with the regulatory dictate of "informed consent" they could save MILLIONS of dollars every year in unnecessary health care costs couldn't they? NOT SO FAST!

The man who answered the White House phone gleefully informed me that he felt that Versed was used to prevent lawsuits, like this was a justifiable excuse to melt people's minds! I generally don't tend to lump people into categories, but this gentleman had a heavy ghetto accent. What would he care about some stupid white lady complaining about illegal drug use by health care "professionals?" I was totally shocked by this statement. Versed as a lawsuit deterrent! Oh yeah that makes it OK. (NOT) So Obama isn't the slightest bit interested in "bending the curve of health care costs downward" at all. It seems to me, after my conversation with his minion, that Obama is only interested in having the government take over health care so that any "profit" that health care insurers get will be transformed into government money. Yippee for the so-called "Health Care Reform." It isn't reform at all.

With the attitude of his ghetto boy phone answerer it means even more unnecessary mind control injections for the benefit of health care providers and the coffers of the government! Not forcing health care people to follow the law, and then giving them immunity from lawsuits (they already have this in the main part, but they want MORE immunity) will only result in INCREASED costs and a wholesale assault on patients. Are you starting to feel as I do that we are all slaves on the plantation and it doesn't matter what medical people do? Must keep those slaves in line... Who would listen to their slave anyway?

This is not an isolated incident with Obama. His take on securing our border is this "If we do anything to secure the borders then Republicans (like they are evil people and like ALL Democrats are in favor of having open borders for drug smugglers and human traffickers) won't vote for "Immigration Reform." Reform only means "amnesty for lawbreakers" and "anything goes," whether we are talking about health care or illegal immigration. Question anything coming from the government that has the word "Reform" in it. Reform only means bad things for us citizens...

Friday, June 18, 2010

Originally this blog was mainly about Midazolam

Weirdly enough, although this blog originally started as a NO MIDAZOLAM/VERSED blog, it is evolving as I root around in the medical field. Versed is only the tip of the iceberg. My ill fated encounter with medicine as practiced today was the TOTAL disregard of my wishes about anesthesia, IE, no sedation type drugs and no general anesthetic. This started my saga. Next on the agenda was the total and complete lack of communication from my surgeon as well. He concealed pertinent information including such items as where the incision was going to be, side effects, risks, and alternative procedures. He also concealed his lack of skill, letting me believe that he was an EXPERT at this surgery. ZERO communication regarding the anesthesia and the surgery is NOT an auspicious start.

Which leads me to this next revelation! Read Adventures in Cardiology also listed in another post and then read THIS! BlogCatalog This is must read material if you ARE a woman, have a mother that you like, a girlfriend or wife. This is how we are viewed by the medical community. The complete disregard for us or our bodies is shocking. It's a short article and I draw your attention to the comments section.... in particular the comment from June 16, 2010. It wasn't me making any of these comments by the way. Do you see a pattern of abuse by medical practitioners and a singular lack of restraint on their part? Do see any reason why the medical folks are screaming about "tort reform?" As egregious as their behavior is, it is still impossible to hold these people to any kind of standard OR hold them accountable for violations of the law and/or their ineptitude.
Here is the excerpt; as usual the italics and bold face are mine.
At June 16, 2010 10:50 PM , Anonymous ViolenceAgainstWomen said... I was hysterectomized and castrated without my consent, and even at my refusal to consent. If you say "no" to sex with a man and he rapes you, he will be arrested. If you say "no" to a hysterectomy, and the doctor hysterectomizes you anyway, the doctor is rewarded. What kind of sick country is this? I've learned the hard lesson that doctors have immunity when it comes to hacking up and mutilating women and they know it. I also filed a fraud complaint with my insurance company and they said they don't investigate that type of fraud, but they are sure there waiting for their money if you recover in a lawsuit. My attorney told me the same thing you were told, that the police wouldn't help me. I surpassed the police and contacted the county prosecutor, who also blew me off. Why are doctors criminally immune to medical abuse? I read your blog post about your's sickening that they will investigate if the doctor fondles your breasts, but if he does bodily harm against your will then that's okay. These cases are criminal not civil. I don't know what country I live in anymore either. I'm ashamed to be an American.

As I glean this kind of thing, I become more and more alarmed. It isn't just women either. There was a story not too long ago about a man who had his penis cut off by the surgeon, also without "informed" consent. Just because he may have signed a generic style "consent to treat" masquerading as "informed" consent doesn't give these medical people carte blanche, although they all seem to view it that way. If the patient verbally says NO even after they sign the hold harmless agreement, oh, sorry, the ahem "informed consent" that means that their consent has been withdrawn. That's the LAW! Here is that link;Man Sues, Says Doctors Amputated Penis Without His Consent - Health News Current Health News Medical News -

And here is what the Dr. says;Man's Penis Removal Was 'Medically Necessary' to Treat Cancer, Doctor's Lawyer Says - Health News Current Health News Med... NO DOCTOR IT WASN'T "MEDICALLY NECESSARY" TO FORCE TREATMENT ON THIS MAN!!!!! Do you get that? The scope of medical intervention is up to the PATIENT! The patient did NOT want his penis excised for any reason. It isn't YOUR decision to do something this drastic without the permission of the person who owns the body. It is up to the person whose body is to be mutilated to make that decision as to whether or not the benefits out weigh the risk. I point out that most men have a relationship with their penis that most women don't understand. It's a guy thing. This man may have been suicidal after this nasty business. How is it helpful to cut off the prized penis, if the (previous) owner of said then kills himself?! Some people prefer not to have radical intervention, so that we have DNR orders, or do you disregard those as well?

I echo the sentiments of the poster above who states; " I'm ashamed to be an American." So you have my experiences chronicled here, plus many, many people who are complaining about the high handed treatment with Versed they receive at medical centers, and these others with physical problems CAUSED by medical people... I know that the heart lady Pam received Midazolam, and I also believe that the hysterectomy lady and the penis man most likely received the little miracle drug Versed to quell any insurrection by these patients. Nice going medical people. TONE DOWN YOUR ARROGANCE! We are in charge of our own bodies and we are getting sick and tired of being forced into more treatment than we want. That goes for Versed and the wholesale assault on our bodies by people who shouldn't even be butchers. Thanks Tim from for bringing the hysterectomy blog to my attention!

Thursday, June 17, 2010


I don't know what the heck is going on in our health care world, especially CRNA's, but I would like to know WHY? Why are you people so insufferably arrogant? You are an over paid human body technician, that's all! Those in anesthesia "know what I'm talkin' 'bout!" (quote from comments section) Even doctors are weighing in on this issue. Why are you acting like this?

Why are you guys giving us a drug, Versed/Midazolam that you KNOW we won't like? Then when we complain you guys pompously proclaim that "everybody" loves this drug. No, they DON'T! It is absolutely unfathomable why you would make a claim like this! It's preposterous on its face! There are zero drugs that everybody likes! Sooo why do you do it? Does reality enter your world or is it left at the hospital door? There are many of us who absolutely HATE this drug, something like half of us... Yet you knock all of us in the head with it on any pretext whatsoever. Why?

Why are you people attacking us verbally when we express our dislike of Versed? Does it make you feel better? Does attacking us and besmirching our character, mental health and abilities make you feel like we don't count and so our opinions are more easily dismissed? Statements like "tin foil hat" people are spoken to make us feel better about Versed? Or do these nasty statements make you feel important and omnipotent? Do you ever even have one single moment of doubt about this drug and/or your own abilities? Why ARE you doing this? Do you have even one single smidgen of compassion?

Why do you guys demean us when we point to long term anxiety, memory and other emotional problems after you slid this one drug into our veins? Does it occur to you that WE ARE NOT LYING AND WE ARE NOT INSANE! Why don't these long term side effects matter to you? Are you all so filled with self importance that you don't give a damn what happens to us in the long run as long as this Versed makes your life easier short term? Why are you acting like this? Don't you make enough money doing next to nothing? Versed makes your job easier still, so you slam us with it, without giving a damn about that Versed creates these issues in us and makes our lives harder? Why is that?

Whether you like it or not there ARE laws about what you are doing. Do you think that these laws don't pertain to you and if so, why? There are informed consent laws that you are not following. There are laws about CRNA's being supervised. Why do you deny facts? A fact is a fact, but while you guys are claiming falsehoods as facts, IE that we all love Versed, that it "relaxes" us, that it kills pain etc. at the same time you are claiming that real provable facts like THE LAW are false, why? Why do you feel so sanguine about breaking the law? This is very disturbing to us patients.

Why do you deny that Versed is dangerous? Versed has killed any number of patients. It has caused respiratory arrest in many many patients even when they were able to be resuscitated, yet you deny it's dangerous! Why? You have to inject the the tiniest amounts ever so slowly so that you don't KILL US! Still you continue to claim it is safe. This attitude is INSANE! But you accuse those of us who don't want anything to do with Versed of being insane. This attitude doesn't make any sense to me, so why do you have it? You are supposed to have a superior education, but from your own examples, I have doubts... Why do you guys do and say things that make me think that you are deranged? How are we patients supposed to TRUST you with our lives when we have serious reservations about your mental health, simply because of this whole Versed thing?

Why would you medical people think that we would want a drug that basically dehumanizes us? Why would normal people want a drug which is so degrading? Why would we need a drug to "help us relax" when we are already relaxed enough? Why would patients want a drug which causes us to behave in an undignified manner? Why would we want a drug that allows you to use LESS PAINKILLER, and let's you laugh at our agony? What makes you think that we all want amnesia? Why would we want a drug which forces us to be obedient, even when we are unhappy about what you are doing? Why would we want to risk the long term PTSD like symptoms? Why would you imagine that we would want these things? Can you tell the difference between your own imagination and reality?

Ever since I was poisoned with Versed by a nasty little CRNA, I've been trying to get answers to these and other questions I have pertaining to the love affair medical people have with Versed and all I get is ATTITUDE! Why is that?

Tuesday, June 15, 2010

Turf Wars In Alphabet Soup Land; AA vs. CRNA vs. MDA

While my encounter with a crna was NOT amusing in the slightest bit, I find it hysterical that crna's are getting their comeuppance! I have dealt with their insufferable arrogance and mistreatment at their hands. They are not doctors and have limited capabilities. Paindoc from has some choice statements to make about them! Although Paindoc can be a pain himself, he is correct on many issues even though his irascible temperment can turn people off. Can't argue with the truth. I have some excerpts here in a compilation. (big surprise right?) These are from this discussion; CRNA Vs. MD - Page 2- Nursing for Nurses (Italics and bod face are mine)

Originally Posted by paindoc

"It is so presumptious of superiority when one makes ridiculous statements about holding ones life in their hands.... Airline pilots make less than CRNAs and hold the lives of hundreds to over a thousand in their hands every day. Workers in nuclear power plants make only a small fraction of CRNA salaries but hold the lives of millions in their hands everyday. I think CRNAs (and doctors) need to get real about their presumed self importance and need to recognize: 1. a person off the street can be trained to give anesthesia in a couple of months and do it well 2. other countries doctors and nurses make less than factory workers (eg. Germany) 3. both doctors and nurses in this country are way way overpaid."

"Well, don't be mislead by those saying it is not about is ALL about money. CRNAs make far more than any other group in nursing and more than many physicians. Their educational requirements are minimal....currently 6-6.5 years of training, and with an average salary of $185,000 per year, that comes out to around 30,000K per year of training. Anesthesiologists train for 12 years and have virtually the same income per year of training.
CRNAs have a very cushy lifestyle working an average of a little less than 40 hours a week (since most are employees, employers frequently don't enjoy paying an extremely high paid nurse time and a half for overtime). Therefore, the average CRNA makes around $92 an hour in salary alone, and then add on the benefits, and it puts them way over this amount. There are many times between cases when there are long turnover times, holes in the operating schedule due to improper scheduling or inefficiencies or cancellation of cases, etc, when CRNAs will frequently go out for smoking breaks or sit in the physician's lounge reading newspapers or hobnobbing in the cafeteria with the medical staff. Many hospitals have significant down time in the OR which frequently translates into free time (= not working time) for CRNAs. It is a life of luxury and bliss compared with most nurses who are slogging it out on the wards or having to listen to patients complain endlessly. CRNAs simply knock their lights out and voila! No more complaints! To quote a CRNA from another forum:" "...knock their lights out and voila! No more complaints!" This pretty much sums up my experience with Aaron my CRNA.
04-13-2008, 06:09 AM
"Do not get so worked up guys, we all know the salary is one thing that drew us. It is not what keeps year after year. It is no different in any profession, medicine sports business. Do not get upset, the lure of good pay way will interest the most motivated and education will winnow out those cannot do it."
CRNAs should be proud to make more than 97% of the American population working only 40 hours a week! It is a dream job everyone would aspire to. As much as CRNAs complain about their jobs sometimes, it ain't flippin' burgers, and they live in the privilege of wealth and power that few in our society achieve."

"It is useful to engage in self examination in order to produce cogent thought about one's life profession especially when there are those that have become so insouciant that they have developed their own self consistent set of ideas that are quite divergent from other professionals. Since most CRNAs are mere employees of others, the benefits they receive include salary and time off, which are hours that have to be worked in your stead while you bask on the beaches of your Florida second house or are on one of your IPG cruises. So with the whole package of salary and benefits, you are still in the 97th percentile of the population. Isn't that great! Isn't that something patients should understand about CRNAs, that a nurse would come with a pricetag each year that dwarfs what the patient's will earn over 5-10 years? Yes, CRNAs are overpaid. No, I have not been crying about the sky falling for a long period of time- fact is CRNAs make more than ALL other nurses, most lawyers, most primary care physicians, most PhDs who may work 60 hours a week to your 40, and have just as much responsibility. The sad fact is anesthetiizing and awakening a patient with no significant deviations in homeostasis could be done 99% of the time by a person with 6 months training out of high school. We need a less expensive alternative than CRNAs (and MDAs) considering the built in safety factors that come with modern monitoring and the relative paucity of significant homeostasis imbalance induced by modern medications.
The "experience" one needs for CRNA school is not educational training: it is a job requirement just as those going into medical school have some experience in the medical field on their resume before applying. Just as many lawyers have done some work in the legal or paralegal field before being accepted to law school. To count a job requirement as educational training is a farce and is disingenuous."

"It is futile to argue with facts. CRNA salaries have bloated to the point they should indeed become the focus of not only hospital administrators and anesthesiologists, but also the MDs that work twice as many hours per week as CRNAs, have substantially more education, and assume far more liability risk all for the same salary as a CRNA.Another little nasty fact is that there are many CRNAs practicing that have less than a BS RN, in fact have no 4 year college degree at all. They come from the 2 year or 3 year RN programs, some of which were hospital schools rather than colleges. In 1992 the predominate degree achieved by nurses matriculating into the CRNA programs was a 2 year RN, period. Many of these CRNAs continue to practice today and are paid the same as a MS + BSRN. Furthermore they are paid the same as a MD primary care physician that had requirements of 4 years college, 4 years medical school, and 3 years residency in 1992.
You are correct in assuming this message needs to be disseminated to other bulletin boards and I plan on doing exactly that, beginning with the primary care bbs and working my way up through hospital administrator bbs. Just the facts...just the facts...."
It is my sincerest hope that this Dr. does just what he threatens.

Crna's point to alleged studies which state that their skill is no less than an anesthesiologist's skill. No difference in statistical outcome between the two they claim. They both cost the same... (AA people claim that they make the same money as well, so this is not a cost savings at all.) But now, enter Anesthesia Assistants, the AA designation. THEY claim that THEIR skill set is on par with the crna's skill. Here's a link; The Ultimate site for the Anesthesiologist, Anesthesiologist Assistant, Anesthesia Assistant!

Here's an excerpt; How safe are Anesthesiologist Assistants compared to CRNA's? A four year study in Cleveland, Ohio's University Hospitals comparing Anesthesiologist Assistants and CRNA's
safety records showed that the two professions were virtually identical. The Medical Center conducted the
research study over four years (1999-2003) and studied more than 46,000 cases involving Anesthesiologist
Assistants and CRNA's (23,0000 cases each). They concluded by stating, "Complication rates were no higher
for Anesthesiologist Assistants than CRNAs." more information can be found at

So, while the crna's are strutting around claiming to be just as good as doctors and demanding that they be treated with deference by MDA's (and patients) they are also screaming bloody murder about the AA people. Well, now imagine that! Now these haughty crna's are getting a taste of their own medicine! (pun intended)

Here's what one AA applicant says. " Before any CRNAs decide to leave derogatory AA comments about this post be forewarned I am familiar with your biases and political indoctrination in school. My former girlfriend is a CRNA and we used to have many discussions regarding this specific topic. Also, her private opinion was that being an RN was also useless in preparation for being a CRNA, though I doubt you would get her to say that in public. As such, I believe that these CRNAs are basically scared and are extremely arrogant and misguided in their attempt to control the entire field of anesthesia."
This site has some very amusing squealing from crna's about the AA people. Anes. Assistants vs CRNA Facebook Of course you want some excerpts before you waste your time looking at what a bunch of nurses are upset over don't you? Here you go. CRNA Shop Started in response to the wall post regarding increased AA usage in the US. If anyone can enlighten: do they have different restrictions, why are they comparing themselves to CRNA's, and what's the AANA doing with AA? Boo hoo, these cretins are comparing themselves to us, and our exalted position! What is the AANA going to do about these people???!!!
You need to read this entire post by Gregory which follows. Can you believe the HUBRIS of these people?
Anne Response by Maryland Asso. of Nurse Anesthetists President:

President's Address

Gregory G. Taylor CRNA, MS

"To the newly elected MANA Board of 2009-2010, to past board members, to the past presidents of MANA, for whom I hope to continue your remarkable legacy, AND especially, to all the CRNA's in the state of Maryland, I humbly accept the position of President."

"We as a group, have faced many issues over the years: scope of practice issues; regulatory issues; the right to bill independently and practice independently. Last year we faced another challenge to our ability to practice in Maryland with the introduction of legislation to Open/Start a program at Johns Hopkins University for the training and ultimately the licensing of Anesthesia Assistants." I hope they do this. At the very least it would slap some of the arrogance out of CRNA's.

"As you are all aware, we defeated this first attempt with a coordinated attack lead by past president, Michelle Duell, our lobbyist, Bill Kress, past presidents Kathy Nugent and John Bing, your MANA Board and a host of dedicated CRNA's, who all stepped IN and UP at differing times to write, call and visit legislators, and to testify in Annapolis on behalf of MANA."
Yes, CRNA's dedicated to that easy money and dedicated to self aggrandizement.

"I wish I could tell you that was the end of it, but you all are astute and educated on this issue, and you know this will not die easily or quietly.
At present, MANA is actively continuing a dialogue with Maryland House and Senate members, both sympathetic to MANA and those supporting Johns Hopkins and the AA program. This is where our PAC money becomes so important. We need the money to support our efforts through donations to political fundraiser's etc. AND we need YOU, the CRNA's of MD, to speak to legislators in your respective districts and make your voice heard."
I also urge everybody in MD to contact your state legislators and demand that we break the strangle hold that crna's have on anesthesia so that we can get some price relief on health care. The AA's claim to be as good as the crna's who claim to be as good as the MDA's. So AA = Dr. Who is cheaper?

"Letters and emails are effective and noted, but nothing beats a face-to-face moment to introduce yourself, educate them about why an AA program is unnecessary and then ask for their support to defeat this onerous legislative initiative." Why is the AA program unnecessary? Don't you believe in a free market? The only reason you guys got where you are is because 1) Former President Clinton's mother was a crna and 2) there was a shortage of anesthesiologists (allegedly) and 3) crna's were supposed to save health care dollars. We want health care costs to go down. They are unsustainable... This means that we need to replace crna's with others who hopefully won't be so full of themselves and so demanding and so expensive. Are crna's starting to feel what MDA's have felt watching crna's try to take over anesthesia?

"This battle cannot be fought by just the MANA board and/or the University of Maryland School of Nurse Anesthesia, but must be fought by All practicing CRNA's in MD."

"A second issue facing CRNA's and our physician colleagues is the fast moving trend to take away "fee-for-service rights" in outpatient ASC's, GI centers, and even some plastic surgery centers by NON-anesthesia physician by creating a "legal" LLC Anesthesia Corp. pay the CRNA a flat daily rate, or hourly rate. Under their plan, the CRNA signs over billing rights to this "anesthesia corp.", which is then able to pocket the left over anesthesia gross." Well, yes, this would be a trend toward cost cutting. You guys are, after all, NURSES!!! What the hell? Pocket the left over anesthesia gross. Are you insane? What do you think my boss does? He pockets the left over gross from my work! I am paid an hourly wage which doesn't even begin to come close to what you get, and MY boss flies all over in his own jet, paid for with the sweat of my brow. Sigh. You guys should be paid around $30 an hour. Come back down to Earth...

"This model has been long established in hospitals, with a number of Nationwide and some local companies negotiating a fee for the company and then paying the CRNA a daily/hourly rate. What is troubling is that the CRNA's are not able to negotiate the " fair market rate " for their services. They must accept the "going rate" or their services are terminated. These non-physicians are making as much as a 50% profit from our anesthesia services. CRNAs take all the risk, and yet they get the profits. Is this "Smart Business or illegal Business"; at best, we know it is unethical." This is rich... You are talking about "unethical" behavior? YOU are talking about "illegality?" After what you arrogant wannabe doctors put your patients through in regards to informed consent, (lack of) not revealing that you are a mere nurse not a Dr., and assaulting patients with your control drugs in violation of the law? Fair market price for a crna should be about 30 dollars an hour. You are NOT taking "all the risk" your PATIENTS are taking all the risk. How often do you get sued for harming you patients? Plus, they are NOT taking the profits, YOU ARE! A six figure salary in the 97th percentile as Paindoc notes isn't enough for you people? Where do you get that they take 50% PROFIT! Jeez I wish I could make a 50% PROFIT and still over pay my employees like that. I don't hear any complaining about the profit the hospital makes on its other nurses. And I don't hear these other nurses getting militant and demanding that the hospital pay them ALL the profit for their work! HUBRIS!

"The Board of Nursing AND the Board of Physicians have jointly agreed to hear this issue. Stay Tuned!" Patients should call the Board of Nursing AND the Board of Physicians and tell them that crna's are not Dr.s, yet are making obscene salaries. Demand that a cheaper substitute be found for them, (AA's) just the way that the crna's in their turn were supposed to be cheaper substitutes for REAL doctors.

"The third and final point I'd like to highlight is dealing with the economics of a changing healthcare system. The landscape of the healthcare debate raging in our country presents many land mine's. We all have personal views as well as professional ones about the best outcome. However, it doesn't matter whether we are democrat or republican, supportive of this administration or not, the best approach is to have "a seat at the table". This is the approach the AANA has taken. It is better to be a "Player" in the healthcare debate than just cry "foul" from the sidelines. To that extent, we need to support our national organization with the same vigor and enthusiasm we give to our state. This means continuing to pay our dues, support our national PAC and give physical presence, letters, and emails when called upon." Typical union crap. As I've said before, health care MUST be the next bubble to burst. It simply cannot remain such a high cost and yet have less and less skilled people, such as yourselves, and now apparently AA's caring for us. Honestly an AA couldn't have been any worse than the creep crna who did my "anesthesia." Again I urge every patient to call, e-mail and make an appearance at the local office of your legislators, both state AND federal. Put a stop to these rich crna's controlling our health care AND OUR POLITICIANS and make them accountable to US!
I urge all of you who agree with me that these people need some kind of controls put on them to MAKE A DIFFERENCE! Call your state legislators, your Board of Health and Welfare, your Doctors Board, your Nursing Board. Say that we want cost savings and crna's aren't it. Ask them why we have to pay a little nurse the same salary as a doctor or MORE! If we are going to be treated by other than doctors shouldn't there be a savings?


Here is the law that I *thought* pertained to the supervision of CRNA's.

42CFR485.639 (2) In those cases in which a CRNA administers the anesthesia, the anesthetist must be under the supervision of the operating practitioner except as provided in paragraph (e) of this section. An anesthesiologist's assistant who administers anesthesia must be under the supervision of an anesthesiologist.
(2)(e)Standard: State exemption. (1) A CAH may be exempted from the requirement for physician supervision of CRNAs as described in paragraph (c)(2) of this section, if the State in which the CAH is located submits a letter to CMS signed by the Governor, following consultation with the State's Boards of Medicine and Nursing, requesting exemption from physician supervision for CRNAs. The letter from the Governor must attest that he or she has consulted with the State Boards of Medicine and Nursing about issues related to access to and the quality of anesthesia services in the State and has concluded that it is in the best interests of the State's citizens to opt-out of the current physician supervision requirement, and that the opt-out is consistent with State law.

Seems pretty straight forward doesn't it? Guess again... Here is a reply I got from Anesthesia Provider Pay to Drop 60% - Page 6- Nursing for Nurses#post4360046 "This (law) deals with billing for CMS services. There is not a federal law that deals with supervision of CRNAs. Scope of practice issues are dealt with on the state level.

You can call it whatever you want, but the practical aspect is that CRNAs in every state suffer no more supervision than the operating practitioner requesting anesthesia. There is a big difference between meeting a legal/billing definition for "supervision" and actual supervision

According to this poster the law as quoted is only giving permission for billing practices that in my non lawyerly thinking constitute FRAUD! "There is a big difference between the legal/billing definition for "supervision" and "ACTUAL supervision.'" So, to you and me this law clearly states that CRNA's are required by law to be supervised, but it actually means that they can BILL for supervision without actually PROVIDING supervision. Health care has gone mad. No wonder health care costs are through the roof. Not only are they injecting us with a patient control and amnesia drug for their own gratification which adds thousands of dollars to any medical procedure, they are also BILLING for other services which are not being provided. I wish they would dispense with the Versed and quit billing for a supervisor when none is provided. Just cost cutting...

Do you want an ANESTHESIA ASSISTANT doing your anesthesia alone? That's even worse than the nurse doing it. According to this poster from your anesthesia assistant is on his or her own as well. (It would follow the line of reasoning that this person sets forth. If the law about supervision doesn't pertain to CRNA's then neither does the law of supervision for the anesthesia assistant pertain to themselves.) Have you seen anything in your "informed consent" about this? Is there a place on the "informed consent" where you give permission for a sketchily trained CRNA (in my opinion based on my personal experience)or a practically untrained anesthesia assistant (also IN MY OPINION), these people are NOT doctors and aren't in the same league.) to perform your anesthesia, ALONE? Not on your life. That informed consent probably vaguely mentions that you will allow anybody your physician chooses to do whatever they choose to you. Obviously this is all just more double speak from our "professional" health care people. It's unbelievable that these people can't read plain English and go on to interpret the law to mean something entirely different than the law as it is written.

Here's a recent lawsuit about this very subject;Doctors Sue To Stop Unsupervised Nurse Anesthetists from Administering Anesthesia Apparently California legislators don't understand the LAW as it pertains to this either.

EVEN IF federal regulations state that in order to get FEDERAL funds you must comply with the above law, most hospitals accept medi-care. If these entities violate the law as written and deviously choose to interpret the law as the poster from does, doesn't that mean that they risk losing reimbursement for these patients? Can they no longer accept patients unless they are privately insured so that they can continue this apparent fraud? Are these hospitals et al even allowed to deny care to medi-care patients? If not, then they must follow the law as it is written, right? Hence the odd interpretation...

The more I delve into this, the worse it becomes.

Monday, June 14, 2010

Midazolam and Malpractice

Versed and Midazolam Hydrochloride - Attorney, Lawsuit, Law Suit, Case, Claim, Settlement, Lawyer, Litigation This is a good site if you are researching Midazolam/Versed claims in malpractice. This is just one outfit... I have excerpted (as usual) the pertinent information.

Versed - Jury Verdicts

______ RECOVERY Infant plaintiff given excessive amounts of general anesthesia during surgery causing cardiac arrest - Polonged period of inadequate resuscitation - Permanent hypoxic brain injury - Spastic quadriplegia.
This malpractice action arose out of events which occurred during the 21-month-old infant plaintiff's third surgery to repair a congenital heart defect. The plaintiff alleged that the defendant anesthesiologist in charge of the anesthesiology aspect of the infant's care negligently administered excessive amounts of Versed, an anesthetic agent. The plaintiff contended that despi...
- from The National Jury Verdict Review and Analysis


Versed - Jury Verdicts
The family of the plaintiff, a male landscaper in his mid-40's, filed this medical malpractice action against the defendant emergency room physician, anesthesiologist and the hospital where the plaintiff was treated following a one car collision. The plaintiff alleged that he was given an overdose of the drug, Versed, by the defendant emergency room physician, went into respira...
- from The Pennsylvania Jury Verdict Review and Analysis


Versed - Jury Verdicts

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The plaintiff, a 59-year-old female, contended that she was admitted as an out-patient at the defendant hospital for purposes of a colonoscopy. The plaintiff asserted that prior to the procedure, she was administered Versed and Demerol intravenously.

The plaintiff contended that following the procedure, she contacted her son to come to pick her up as was previously planned...
- from The Pennsylvania Jury Verdict Review and Analysis


Here's an extra lawsuit from the KC Daily News;

KC woman's lawsuit alleges her father's death due to doctor's Daily Record and the Kansas City Daily News-Press Find Arti.

KC woman's lawsuit alleges her father's death due to doctor's

Daily Record and the Kansas City Daily News-Press, Oct 12, 2006 by Charles Emerick

A Kansas City woman claims an untreated pressure sore caused her father's death five years ago.

Though Herman G. Bell died when he was given too much Versed before a treatment, Sheila Battles alleged her father would not have been in that situation if he had received appropriate care by Dr. Thomas W. Frederickson at St. Joseph Medical Center.

During opening arguments at the trial Wednesday in Jackson County, Brad Honnold, lawyer for the plaintiffs, told the jury that Frederickson should not have discharged Bell on April 4, 2001.

"If a physician does not meet the standard of care, then he is negligent," Honnold said.

Bell spent much of January, February and March 2001 at St. Joseph, according to Honnold. When he was first released in late March, hospital staff ordered that home health nurses care for him.

Two days later, a nurse noticed a 1-centimeter-by-1-centimeter pressure sore on Bell's tailbone. He also experienced other complications and returned to St. Joseph.

On April 1, four days after he returned to St. Joseph, Dr. Sandra Coufal made the first note regarding Bell's sore, Honnold said. Coufal asked for the assistance of the hospital's wound care team.

The wound care team followed up April 3, when a nurse noted that Bell had "numerous skin tears."

Lab tests taken that day also revealed a high white blood cell count, which should have sounded an alarm, Honnold told the jury.

Bell was released from St. Joseph the following day. His wound was not measured again, but a doctor's note described it as a "large, open sore."

The day after his release a home health nurse described the sore as a stage three wound that measured 9.2 centimeters by 11.3 centimeters and was foul-smelling.

"That is consistent with a wound that has become infected," Honnold said.

Bell returned to St. Joseph Health Center on April 9. He stayed there until June 30 and then was moved to Kindred Hospital the next day.

On July 30, 2001, Bell was prepped for treatment. He received 3 milligrams of Versed all at once, according to Honnold. The medication, which should be given in smaller doses, caused respiratory arrest and led to Bell's death.

Honnold said the sore grew to be as large as 15 centimeters by 14 centimeters.

The plaintiffs will present two expert witnesses during the trial to testify that Frederickson failed to treat the sore, meaning he did not meet the standard of care.

Honnold said expert witness Dr. Margaret-Mary Georgiana Wilson, of St. Louis, would tell the jury that Bell's "health care team let (him) down."

And Dr. Larry Rumans, of Topeka, Honnold added, will show that Bell should not have gone home after April 4. He will also testify that Bell's family should not have had to pay $320,000 in medical bills from April 4 to the time of Bell's death.

"Sending something like this home needs a plan," Honnold told the jury as held a picture of the sore on Bell.

Bruce Keplinger, Frederickson's lawyer, told the jury Bell died from a drug overdose that had nothing to do with the care he received from Frederickson.

"There is no connection, and Dr. Frederickson did meet the standard of care," Keplinger said. "Nothing Dr. Frederickson did affected (Bell's) life expectancy or his chances to live."

St. Joseph Medical Center, which was originally named as a defendant, settled with the plaintiffs in May.

The trial is expected to continue into next week..

Sunday, June 13, 2010

I don't hate all CRNA's

I don't hate them all... Just the ones who can't do their job without Versed. Here is a collection of CRNA's and their posts on Nurse Anesthetist (CRNA) Forums - Powered by vBulletin which I have respect for. This is from an old discussion about their (alarming) Versed use... nearly 60% of these nurses routinely give everybody Versed. Preoperative use of Versed - Nurse Anesthetist (CRNA) Forums As usual the bold face italics are my own.

Re: Preoperative use of Versed

"I was trained to give it to just about everyone...2mg versed. It was almost a habit. However, I have found that it doesnt always work. If the patients drinks at all that 2mg of versed isnt going to work as far as amnesia is concerned.

I only give it if the patient is totally freaking out....and even then, I would probably give them 5cc's of me much more control.

I probably give it once every couple of months....if even."
Thank you! This person gets it and has curtailed their use of Versed in spite of their habit forming training. By the way I don't drink and the Versed amnesia didn't work on me. Thank God. I think it has more to do with high IQ, rather than an alcohol consumption from my limited experience with people who have had a bad reaction. It's alarming how many high functioning engineer and professional people are reacting to the assault on their cognitive function in the same way.

Re: Preoperative use of Versed

I dont 'always' give it.

There are many pts who I feel it might be a risk to give it to. Im thinking specifically about the elderly who have a crap load of pre-morbid conditions and are ASA 3-4s. Some wont get it at all, some ill wait and give it to in the OR, maybe 1 mg or even 0.5.

I go by the mantra "i can always give more" with these pts.

Sometimes, i dont give it b/c the pt dosent appear to 'need' it. Couple recent pts were not at all anxious, easy going and when i asked them if they wanted anything for nerves they said 'no'. To me, they dont need it.

I often wonder if i should be giving versed to everyone at least after induction to avoid any memory (ante-grade amnesia). However, in reading about it, seems only 40-60% of pts who get versed (in any setting) have amnesia at all. So it isnt reliable.

I have seen some pts get 2 mg of versed and 'dump' right there in front of me with severe hypoension. Also seen some become obtunded and obstruct from low doses. I guess im very cautious with what i perceive as a very dangerous drug. "go low give slow" in what ive been taught with versed!

Thanks Mike. I admire your attitude.
Re: Preoperative use of Versed

I'm with you mike. My thoughts exactly so I won't retype everything you just said. I was interested in hearing about people's ideas of using preoperative versed as it relates to anesthesia awareness.

I am a clinical preceptor where I work and I've been encouraging students to use their judgment when it comes to preoperative sedation with versed. Many students are very surprise by this notion
b/c they have been trained that just about everyone gets versed.
Students are surprise that I even ask patients if they want it or not.
I also try to consider the type of case, if the patient will be going home afterwards or staying. I try to avoid versed, if the patient doesn't need it and will be up and about after a simple procedure like
Egg retrieval, D&C, Carpal Tunnel Release, etc.

You are a professional, unlike those which I try to debase on this blog.

Re: Preoperative use of Versed

Originally Posted by infidel
Above .. about the age of 65 I look at the person a bit closer than under that age. I have seen elderly decompensate with Versed and get squirrely on the way back to the OR.
agree, that's why i was asking.
i've met/heard/read that people will give
it to everyone, regardless if they need it
despite their age.
This is absolutely true. Thanks for agreeing that this dangerous, unpredictable drug isn't for "everyone." You have my respect as well.
Re: Preoperative use of Versed

Some get predicated with anxiolytics (typically Versed), some do not. If I perceive that they need it or want it, then I typically get somewhat heavy handed if they are young and healthy (around 5mg of Versed; I have given more) and I will be at their side continuously before we go to the OR. If they are elderly or with significant comorbidities, I simply titrate the Versed to effect. Like Jan, I also rely on Zantac and Reglan.

I do not routinely give anxiolytics preoperatively as I feel I get a lot of mileage out of just talking to the patient and being at his/her side. It is interesting to see the variations in practices.
This is so nice to read. Thank you for thinking that it is better to TALK to us and be with us rather than taking the easy way out and drugging us. You are ABSOLUTELY CORRECT!
Re: Preoperative use of Versed

I rarely use versed unless I feel the patient truely has anxiety. I believe I can give a larger dose of narcotic with less respiratory depression when I do this. Also, althought I know it is not scientific, I have been told by the PACU nurses my patients seem to awake more quickly. A 1.5 - 3.0 hour half life is not long when you are doing a 6 hour case, but if your case is only 1.5 hours and you give 5 mg, it only stands to reason that you patient will be more sedated in the PACU. They still have 2.5 mg of versed on board, right?
This is excellent Jeff! Thank you for voicing what I am saying on my blog. I am correct in thinking that most people would rather have pain relief than some kind of zombie drug, ESPECIALLY if they do not have out of control anxiety. It's my opinion that slight anxiety would be "normal" in a medical situation and doesn't need something as hairy as Versed.
So there you have it. I don't hate all Dr.s, CRNA's, nurses etc. at all. Quite rightly I like and respect those who have a REASONED approach to their job, with the understanding that they are working with real people, not crash car dummies. Also, I have to say that standing up to armygas with his pathology makes me respect your backbone as well. Many thanks people.