Dr Shafer
Walgren
lack of continuous monitoring : egregious violation. It directly caused Mjs death
lack of continuous documentions : egregius and unconscionable violation : documenting is part of giving care; if he had done this, he would have seen that the oxygen saturation lowered, the different heart rythm. Violated the right of MJ and his family, because they do not know what happened.
failure to timely call 911 : egregious violation . In that setting, MJ could not have been revived without assistance. It was the highest priority , given the lack of help and equipment. If there had been impediments to call 911 , propofol should not have been given.
Assuming CM realised there was a problem at 12, doesn't understand that CM left a voice message to MAW and how it took 20 mn to call 911. Unconceivable, completely and utterly inexcusable. Doesn't know what to say.
If Cm left only for 2mn, believes MJ would be alive, with a bad brain damage, because the necessary equipment was not there. After 2mn, with the possibility to ventilate, MJ would be alive and uninjured.
How effective is a one hended CPR on a bed : when you push on the chest , the patient sinks into the bed, it's ineffective. You need 2 hands, one hand is not enough. Even if cm had his hand behind Mjs back, it's ineffective, you need your body weight.
Cm should have called 911, moved Mj to the floor. Based on Cms interview, the issue here was not that the heart stopped, he stopped breathing. If there was a pulse, he needed to have oxygen into his lungs. There was no need for CPR if there was a pulse.
Mouth to mouth is for a lay person, when there is no other means. For a docor it's the demonstration you dont have the equipment you need to ressucitate. Mouth to mouth air has only 18% oxygen. The patient needs oxygen.
Cm described raising MJ's legs : minor violation : it's a waste of time. You would do this if you think there is not enough blood in the heart. Suggests that CM was clueless about what to do.
What is flumazenil : it's a drug that can reverse or antagonize valium type of drugs. Works with lorazepam and midazolam.
Was it appropriate to give flumazenil : there was nothing wrong with giving it, but Dr Shafer thought it was curious , because it doesn't fit with 2 X 2 mg given hours before. Dr Shafer thinks that CM knew that there was a lot more lorazepam.
Deception of paramedics an UCLA doctors, not mentionning propofol : egregious and unconscionable violation. A person's life was in the balance, it's inexcusable. He also lied about the witnessed arrest. A witnessed arrest is usually something like a heart attack. A respiratory arrest is assumed to not have occured in the presence of a physician, it would not have led to a cardiac arrest. So the therapy of the paramedics and ER doctorq was not appropriate. In an arrest you have only seconds to choose a treatment, peramedics and Er doctors were not given the corect information. Witholding information is a violation of patient's trust.
Polypharmacy : it's administering many drugs at once; it was the case. Serious violation; Doesn't make any sense. Midazolam and lorazepam are very similar drugs. They do the same thing to the brain. The only difference is how long they stay in the system. Doesn't understand why CM switched from midazolam to lorazepam and back. Suggests that CM did not understand the drugs he was giving.
Was 25mg a safe dose ? In this setting, there was no safe dose. Midazolam an lorazepam were given. MJ had received benzos for 80 nights, he could have been dependant, or in withdrawal from the benzos. MJ could have been dependant or in withdrawal from propofol (Dr Shafer has never heard of propofol given for 80 nights, doesn't know what it would do). There is no safe dose in these cicumstances.
Taiwan study : dr shafer has evaluated this study, as a result of his work in this case. There are over 13 000 papers about propofol, 2500 about propofol and sedation. Propofol and insomnia : 1 article, its the Taiwan study, published in 2010.
Treating insomnia with propofol was an egregious violation.
Would not have published the Taiwan study : the dose of propofol that was given is not mentionned i the study. Inadequate evidence : 64 people is not enough, the editors were not familiar with propofol or with insomnia. The study was done in a hospital, by anesthesiolgists, patients fasted, were monitored, an infusion pump was used, propofol was used for 2 hours , for 5 days, during two weeks. No other medication was given. The patients were treated within the standard of care. The article highlights CMs deviations from standard of care.
Described 17 egregious deviations , among those 17, 4 are both egregious and unconscionable. Each one individualy were likely to result in Mjs death. They were foreseeable.
Walgren lists the 17 deviations, to fast for me.
Even if MJ had taken lorazeapm and self adminsiterd propofol, would these 17 deviations still stand, would you consider CM responsible for Mjs death ? yes.
Doctor patient relationship : dates back centuries ago. Doctors are permitted to know the most private and personal details. Doctors are entitled to give powerful drugs thant can kill and do harm, cut open a patient's body, you are entrusted to do that because you put the
patient first. When Cm agreed to give propofol to MJ, he put CM first. When CM was showing up every night with propofol and saline bags, he was putting CM first. When Cm withheld info from paramedics and ER doctors, he put CM first.
Recess, until tomorrow 8 45
