Dallas Anesthesiologist Being Sued Over Deadly Surgery Admits to Texting, Reading iPad During Procedures

ChristopherSpillersChristmas.JPG
Note: The original headline incorrectly stated Dr. Spillers had admitted to using Facebook and texting during Milne's surgery. It has been changed to more accurately reflect his testimony.

.Mary Roseann Milne, 61, checked into Medical City Dallas on April 13, 2011 for an operation to correct an irregular heartbeat. The procedure, an AV node ablation, is routine, at least as far as heart surgeries go, but something went wrong. Ten hours after her surgery began, Milne was pronounced dead.

The family has filed a medical malpractice suit against Medical City and two individual doctors involved in the procedure: surgeon Dr. Robert Rinkenberger and anesthesiologist Dr. Christopher Spillers. It's set to go before a Dallas County jury in September.

One of the claims the jury will decide is whether Milne was a victim of "distracted doctoring" on the part of Spillers, a point that was pushed hard by the family's attorney, Maria Wormington, during depositions in the case. The depositions provide a clear window into the roles personal technology and social media can play in the operating room.

See also: Medical City is Dallas' Most Expensive Hospital

In her interrogation of surgeon Rinkenberger, he said that Spillers, the anesthesiologist, failed to notice Milne's dangerously low blood-oxygen levels until "15 or 20 minutes" after she turned blue. Until then, Rinkenberger said, Spillers had provided numbers showing that the patient's blood-oxygen levels were normal.

From the deposition:

Rinkenberger: I think the saturations as written are incorrect.

Wormnington: Do you think Dr. Spillers made them up?

R: Most likely.

W: Why would he do that?

R: Don't know.

W: Was he reading a book or talking on the phone or surfing the internet when he was managing Mrs. Milne's anesthesia?

R: Yes.

W: Tell me all of the things he was doing.

R: I don't know. I was busy working.

W: How do you know that he was engaged in other activity?

R: Well, he's working in front of me and I can see what he's doing, and he was.

W: All three of those things?

R: I can't answer that. That was -- he was -- he was doing something.

W: On a piece of equipment?

R: On -- on a piece -- either his phone or cell phone or pad or something.

W. All right. So the anesthesiologist was on his cell phone or on his iPad --

R: I believe so, yes.

W: -- playing games or surfing the internet?

R: I can't answer that.

W: But he wasn't watching Mrs. Milne?

R: No.

W: How many times did you look up and see him doing that?

R: You know, I was -- I was trying to finish up the case. I don't -- I can't tell you that.

W: Well, you remember at least one time? How many other --

R: Absolutely.

Rinkenberger goes on to testify that it's fairly routine for anesthesiologists to check their phones during procedures, though he would prefer that they didn't.

R: You know, we see this sort of thing with these procedures. I mean, they're long procedures. We see this kind of thing, and usually I -- it's not -- doesn't seem to be a problem especially with relatively short procedures. What can I say? I mean, it happens.

Wormington took Rinkenberger's deposition last April. When she interviewed Spillers on February 28 of this year, he confirmed much of the surgeon's testimony about his device usage, but he forcefully denied that it's common or poses a danger to patients.

Wormington: Do you routinely play games on your phone while managing anesthetic care?

Spillers: No.

W: Do you surf the Internet?

S: No.

W: Ever?

S: Well, depending on your definition of surf. I do not spend an extended period of time accessing the Internet. I have logged on to the Internet before especially if -- specifically if I have a question about the patient's medications, about the procedure, yes, we'll often, you know, do a search and find out information pertaining to the case. I will occasionally check e-mail. I will occasionally check scheduling for the office. But in general, no, I -- the time spent on the Internet during a case is, you know, very brief, a couple, three minutes.

W: Do you post on Facebook while you're managing anesthetic?

S: No.

W: Do you think that would be an unsafe thing to do?

S: To post on Facebook, would it be unsafe? It wouldn't be recommended.

W: Why not?

S: Well, because you're supposed to be monitoring the patient. You wouldn't want to be spending time in extraneous activities that were not related to patient care. Is it possible to do so safely? Yes, because we have ways of monitoring the patient. But I don't do that.

W: You never do that?

S: Post on Facebook during a case?

W: (Nods head up and down.)

S: No.

W: Because you feel it would be unsafe?

S: Yes, it -- well, it's -- I don't do it. I'm -- it's -- I'm doing my job. I'm not there to post on Facebook. I could do it safely, but I don't.

W: Do you read the paper or read books or do anything else other than monitor the patient?

S: I'm always monitoring the patient. There have been times when I have read materials in the OR. Occasionally I've read a book during a long case but not very often. But even when I'm doing so, I'm always listening to the pulse ox, always checking the blood pressure, always -- you know, at least every five minutes. I'm looking at the monitor at least every 30 seconds, looking at the patient at least every 15 minutes. But, no, it's not a common occurrence.

He reads the books -- some fiction, some nonfiction -- on his iPad. Occasionally, Spillers says, he'll fire off a quick text. During the Milne case, he might have exchanged a few texts and possibly checked his email, but there was no Internet surfing, no literature, and definitely no Facebook posts, which would be inappropriate.

None of this proves that Spillers was negligent, either in Milne's case or in other procedures. Anesthesiologists have a ton of down time. It does, however, set up an incredible gotcha moment toward the end of his testimony, when Wormington introduces posts from Spillers' personal Facebook page:

Wormington: Can you read the highlighted portion?

Spillers: Oh, wow. Yes. Okay.

W: Can you read it?

S: "After enduring the shittiest Friday I've had in a while, I just found out my next patient has lice. Freakin lice. I didn't even know they still made those. Help."

W: So I think you told me earlier it would be inappropriate to post something on Facebook about your patients.

S: Yes, I did. I was -- the point of it was the lice, but yes.

W: As at the corporate representative for Tx-An (the company Spillers works for), do you approve or disapprove of your decision to make that posting?

S: I disapprove. I would discourage it.

W: Are you going to implement some policies to help yourself not make these postings in the future?

S: Yes. I will never do it again.

The next exhibit is another Facebook post:

W: Can you read the highlighted portion?

S: Okay. "Just sitting here -- sitting here watching the tube on Christmas morning. Ho, ho, ho."

W: And what is the photograph of?

S: An anesthesia monitor.

W: Is that anesthesia monitor hooked up to a patient?

S: Yes.

W: Are -- is the data on the anesthesia monitor that of a patient?

S: Is the data -- like the vital signs? The vital signs are, but there's no identification of the patient.

W: And I think you told me earlier in your deposition that it would be inappropriate to post
anything about a patient on your Facebook.

S: Well, specifically, but these are just numbers and there's no way to really identify it with a particular patient.

W: So do you think it is appropriate to post the anesthesia monitor with patient data on it on your Facebook?

S: Well, there's no specific patient data. It's
just numbers.

W: So I'm -- so you don't have a problem with it; you think it's okay?

S: No. It's okay.

W: Now, I think you told me earlier that you never post on Facebook while you're doing anesthesia -- while you're managing anesthesia.

S: Not to my recollection.

W: Well, clearly you do post on Facebook sometimes when you're managing anesthesia because you were managing anesthesia at that moment.

S: Well, not necessarily because I took the picture but that doesn't mean I posted it at that time, because you can take a picture and then go to your pictures and then upload it onto Facebook after --

W: Okay. So --

S: -- wards.

W: -- where it says "just sitting here watching the tube on Christmas morning," you are clearly referring to the fact that you have to be doing an anes -- managing an anesthetic procedure on Christmas morning and you're watching the anesthetic monitor, fair?

S: Uh-huh.

W: So obviously --

S: Yes.

We contacted Spillers' attorney on Monday for a response but haven't heard back.

Send your story tips to the author, Eric Nicholson.


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28 comments
VigilantDoc
VigilantDoc

@Eric Nelson: 

"Anesthesiologists have a ton of down time."


No, that is patently false.  Intra-operative time is NEVER, EVER "down time" for an anesthesiologist.

There are periods of low stimulus and low danger. There is a lot of time spent with a patient with stable vital signs.  But this is not "down time".  VIGILANCE is the motto of the American Society of Anesthesiologists.  An anesthesiologist should be constantly vigilant - to blood pressure, heart rate and rhythm, respiratory pattern, temperature, fluid balance, blood loss, etc - no matter whether the case is complex or straightforward, or whether the patient is healthy or not.  If Dr. Spillers is proven in court to have not been vigilant, then he should face the consequences.  

But Mr. Nichols needs to educate himself about the differences between tabloid journalism and the expectations of medical professionals.  As a proud practicing anesthesiologist, suggesting that the majority of my working day (the quiet, stable intra-operative period) is DOWN TIME is completely inaccurate and terribly offensive.

Ragnar
Ragnar

I realize that the Observer is nothing close to a medical journal but if you are going to post an article related to medicine or healthcare, it might help to do some research or gather factual information about the specific case. Obviously none of this happened before this article was 'written' which explains the tabloid-style headline. This article offers nothing except an open door to uninformed reader speculation. 


Firstly, there is no such thing as 'routine surgery', every patient and every case is different and comes with a different set of challenges and surprises. The idea that an AV Node ablation is 'routine' and therefore free from problems is even more ludicrous. An AV Node ablation, in layman's terms means running a catheter into a leg or groin blood vessel, up into your HEART and then BURNING or FREEZING the catheter so it will form SCAR TISSUE at precise points INSIDE YOUR HEART and stop the erratic electrical impulses that cause cardiac arrhythmia (irregular heartbeats). 


Regardless, I understand the article is focusing on the social media aspect and not the medical aspect but there's no evidence that Spillers used social media during MIlne's case. The picture posted is from another case entirely, so it has no meaning here. Trying to pass the picture off as relevant, plus the tabloid headline is a sad example of 'Gotcha' journalism. It is articles like this and TV shows like Grey's Anatomy, etc. that the general public is ignorant and fearful of healthcare.


(And for what it's worth, the patient's vitals on the monitor picture are perfect.)

ptx444
ptx444

   I am an anesthesiologist let me inform some of the general public about some facts.  We are now REQUIRED to keep electronic records in the OR therefore by definition 100% of anesthesiologists are on the computer while surgery is underway. Which means we are watching a computer screen not the patient.   Also we constantly receive texts and phone calls from nurses or surgeons or fellow staff members regarding patient care that we have to respond to.

  100% of anesthesiologists america are guilty of texting or using the computer during cases therefore 100% of anesthesiologists are "distracted doctors" at some point during surgery. 

     This needs to and should be included in this article for fairness.  

dingo
dingo

The AMA requires 13+ years of post-secondary education for anesthesiologists but they don't require them to lock down their gadgets before entering surgery. 



animas
animas

It may be a futuristic scenario which may never materialize-- but under the current iteration of PPACA you may not be able to chose your physician and I can guarantee that hospital ACO employers and lower cost health insurance"limited networks" may not employ the best physician laborers.  As the recent Baylor Neurosurgeon debacle indicates-even a guy with a good resume may be a problem. ... Just something else to worry about, i guess. (I have never seen a health insurer or hospital which was not interested in profit and lower cost).  As Ezekiel Emmanuel MD has stated "choice is overrated"  (maybe NOT).

dfwenigma
dfwenigma

My general experience as an individual, having worked with physicians directly in the past, is that many, not all have a "God complex". They say and do things that are completely inappropriate. Sharing with a colleague in a closed environment without others present is one thing - but posting on the Internet, communicating information about patients even if its not personally identifiable is actually against the law. Tying the information to the patient would be a criminal offense, but just sharing a picture of a patient's data that might somehow be tied back to them by someone else would be enough to compromise patient privacy. This doctor violated his professional standard of ethics. He should be sanctioned, fined and should lose his privileges for a distinct period of time. It's unfortunate - good anesthesiologists are tough to find - but no one should be sharing patient information.

hayleegill
hayleegill

He might've taken a picture beforehand but why would he take a picture unless he premeditated posting it online? And how would he be thinking about posting it online if he's focused on work? He would've had to be pretty excited about an O2 reading to take a picture of it on his personal cell phone-and still remember what he was wanting to say after the surgery when he could finally post it. Those surgeries can last 12 hours. He was distracted any way you look at it. 


Rusticle
Rusticle

The doctor didn't admit to using Facebook during a surgery, and the post in question happened 8 months after the patient died. But yeah, it's more important to have attention grabbing headlines than accurate ones.

TheRuddSki
TheRuddSki topcommenter

Gee, if only there were time stamps on FB posts and texts.

J_A_
J_A_

You'd think a dr would be smart enough to realize FB posts are public info. Does he post selfies with patients under anesthesia too?

theninjaunicorn
theninjaunicorn

@Ragnar you couldn't be more wrong.  I am very close friends with the daughter of the women mentioned in this article.  Everything in here is factual and the family recently did an interview with a journalist for their story to be aired on TV.  A life was lost... a mother/wife/daughter.  For you to say "none of this happened before the article was written... tabloid-style headline" is insenstive and shows YOU are the uninformed reader.  And change your name... it doesnt suit you.

AnesthesiaOK
AnesthesiaOK

@Ragnar  As an anesthesiologist, I could care less about the "tabloid" nature of the article, I care only about a patient who appears to have died due to a failure to remain vigilant. I would add that there is also NO ROUTINE anesthetic. Every anesthetic carries risk, sometimes more risk, other times less risk, depending on the patient's general health, the indication for the surgery and the anesthetic technique required. Whatever social media device(s) this doctor used is completely irrelevant. Lawyers may find this interesting and a new angle to indict doctors, but based on the limited facts presented, the doctor failed to apply the pulse oximeter, turned the oximeter alarm off or ignored the monitor for 15 to 20 minutes during which time the patient's oxygen saturation was "dangerously low". If these pass the veracity test, then this means only one thing: that the anesthesiologist failed to remain vigilant. This is inexcusable.  

GatoCat
GatoCat

@Ragnar  You said, "The picture posted is from another case entirely, so it has no meaning here." How do you know that? I thought we couldn't tell anything about the patient's identity from the picture. But even if it is from another case, it demonstrates an attitude and a behavior that is indeed relevant.

grel
grel

@dfwenigma  What a ridiculous statement to make..'many doctors have a god complex and say and do things that are inappropriate'

What do you do for a living?  As a physician, I think I can tell you that you are completely inaccurate and I would never dare make such an ignorant and sweeping generalisation about any profession.  

Ragnar
Ragnar

@hayleegill  "Those surgeries can last 12 hours"-What surgery are you referring to? The picture posted here from his FB page is from a case that was 8 months later than Ms. Milne's case. There's no way to know what type of case was going on from this picture, unless you're Dr. Spillers or perhaps psychic.

TheRuddSki
TheRuddSki topcommenter

@hayleegill

I'd be willing to wager that the guy is divorced, and I'd bet I know why.

Ragnar
Ragnar

@AnesthesiaOK

You are proving my point about this article. There's too much room for speculation and not enough factual information. How do you know that the SpO2 was turned off or ignored? Because the cardiologist said so? How often do the surgeons or other physicians even know what's going on behind the drape? In his statement, the cardiologist said that Spillers "failed to notice her O2 levels until 15-20 minutes after she turned blue." So, if this is true, what was the cardiologist himself doing during this time? He notices that his patient is blue and just waits for anesthesia to notice or respond? It doesn't make sense. He also believes that Spillers falsified the recorded Sp02 readings? Does Medical City use electronic records? I know that most of the major hospitals in DFW use e-records exclusively as of the last 4-5 years. How would he falsify the O2 record that's automatically entered from the anesthesia monitor to the e-record, and why?? Again, this is all speculation which is the whole problem with this lazily written article. 

Ragnar
Ragnar

@GatoCat  Questions left unanswered by this article:


Did Ms. Milne pass away during the procedure?


What was the medical examiners determination for cause of death?

Ragnar
Ragnar

@GatoCat  The date on the picture: 12/25/2012 vs the date listed in the article for Ms. Milne's case: 4/13/2011. 


I'm not condoning the practice of posting to FB during surgery but to try and prosecute and blame someone for a death of their patient due to social media without evidence is illegal.

hayleegill
hayleegill

@Ragnar @hayleegill  I generalized. Some are 1 hour, some 3 hours, but some have the possibility of lasting around 12 hours.

Ragnar
Ragnar

@TheRuddSki  "I'd be willing to wager that the guy is divorced, and I'd bet I know why."- What does this even mean and how is it relevant?

alteredjustice
alteredjustice

@Ragnar @AnesthesiaOK  "He also believes that Spillers falsified the recorded Sp02 readings? Does Medical City use electronic records? I know that most of the major hospitals in DFW use e-records exclusively as of the last 4-5 years. How would he falsify the O2 record that's automatically entered from the anesthesia monitor to the e-record, and why?? Again, this is all speculation which is the whole problem with this lazily written article."


Seems to me that the doctor himself or the lawyer questioning him should have asked these questions.


Really though, you shouldn't come to the DO if you expect award-winning journalism. It's a glorified clickbait blog (albeit a fairly interesting one).

TheCredibleHulk
TheCredibleHulk topcommenter

@Ragnar @GatoCat  

FTFB:  "Ten hours after her surgery began, Milne was pronounced dead."

The blog does not indicate what the cause of death on the death certificate was.

alteredjustice
alteredjustice

@Ragnar  Could be wrong here, but this appears to be a civil case. Meaning that the lawyers aren't necessarily trying to prove beyond a reasonable doubt, and that a lesser form of proof is needed.


Of course showing a facebook post from a different date is not evidence of him posting on the date of the surgery in question, but it doesn't seem to me that the lawyers are concerned with that (nor do I think it's "illegal").

TheRuddSki
TheRuddSki topcommenter

@Ragnar

I'll bet if you think about a fellow FBing and texting during important "procedures", it might come to you.

BTW, it's a joke.

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