Last week on the UNPA website, someone posted a link to a Prezi entitled “Do I Meet Standard of Care? A Critical Look at a Charles Yingling Presentation.” [NOTE: this Prezi has been removed from the web by its author.]
Basically, the prezi reviews a malpractice lawsuit in which judgement was made for the plaintiff and the defendants were ordered to pay $20 million in damages.
The post first appeared to me on LinkedIn, but it was a little confusing. I reviewed the prezi several times, and I came away with three questions. My first question was, who made the presentation? The title mentions Charles Yingling, but I knew he didn’t actually develop the presentation. My second question was, where is the original Charles Yingling presentation, to which the prezi refers? My third question was, where is the “critical look at [the] Charles Yingling presentation” that was promised in the title? I found the whole thing to be very confusing. So, I started doing some digging.
My first question was easily answered once I finally made my way to prezi.com. I found that the prezi was developed by Ryan Rosenhahn at Intranerve. Problem solved… but, I was still terribly confused by the whole “critical look” and “Charles Yingling Presentation” think. I’m still confused, actually, but I’m going to venture a guess. My guess is that Dr. Yingling served as an expert witness in this trial, and that he gave a presentation to Intranerve on the subject. Furthermore, I’m guessing that the prezi was meant to be a critical look at the Charles Yingling presentation, a presentation to which we don’t have access. These are all just guesses. Someone please correct me.
Anyway, I started digging around a little more on the internet, when I found something very interesting… another lawsuit in which Dr. Yingling served as an expert witness. This verdict was published online and entitled, Failure to notify surgeon of signal loss resulted in paralysis. Since it is published online and free for anyone to access, I don’t have a problem sharing the link.
What I find interesting is the many similarities that exist between the two cases. The surgical procedures are different (ACDF vs PSF), but other details are remarkably similar. Both lawsuits serve as an exposé of the incompetence that is rampant in the field of intraoperative neurophysiology. I encourage my readers to take a close look at both cases, because I’d love to hear your thoughts
Some interesting questions arise:
- It is interesting to note that, in both cases, the reading neurologist was not sued, not deposed, and not otherwise involved in the lawsuit. Contrary to popular belief, this is frequently the case. So, what is the point of having a neurologist online and “making decisions”, if the technologist is ultimately the one who usually gets sued? Who is protecting whom?
- No mention is made of whether or not the neurologist was knowledgeable about intraoperative neurophysiology. Was he/she board certified in intraoperative neurophysiology? Does it matter, or is it sufficient to be a neurologist?
- The online neurologist had seen 17 other patients and billed 21 hours of professional IONM time before 12:00 noon on the day of surgery? Is this common? Ethical? What do you think?
- The technologist had 7 years of experience in IONM. Do you think that “number of years experience ” is an important metric?
- The tech’s CNIM had recently expired, and there are tons of techs out there working in IONM without a CNIM. Does CNIM certification even matter?
- It was mentioned at trial that the tech failed the CNIM on first attempt. Is this even important? What if the person had failed 5 times?
- When signals were lost, the technologist thought the problem was technical. He called his boss who helped him troubleshoot over the phone. Is this acceptable? How should troubleshooting be provided…phone, internet, in-person?
- The IONM company’s clinical Policy and Procedure manual was subpoenaed and found to contain behavioral guidelines (how to act in the OR) and references to literature that were out-of-date. What do you think about that?
- In the second link that I provided, the IONM company was dismissed from the lawsuit. The defendants were IONM technologists. They were ordered to pay $22 million in damages. Most IONM companies carry $4 million in liability insurance for each technologist. What are the financial implications for the individual when (s)he loses a lawsuit of this magnitude?
- My final question is this: Do we have a standard of care in the field of intraoperative neurophysiology? By definition, standard of care is how similarly qualified practitioners would have managed the patient’s care under the same or similar circumstances. That’s the legal definition, anyway. So, who defines our standard of care…?
I could go on and on, but I think these are good questions to start with. I’m really interested in hearing your comments.