"Whistleblower Lawsuit" to Be Continued
Manager Faces Hospital Over Safety Efforts, Skills
A surgical services manager who claims her hospital wrongfully dismissed her in direct retaliation for her attempts to enforce safety procedures will be back in court next year after a jury delivered a split verdict in her civil lawsuit.

In March, a jury rejected nurse Elizabeth Bashaw's claim that a surgeon engaged in a retaliatory campaign that influenced the hospital's decision to ask her to resign or face being fired. However, it split its decision on whether the hospital fired her in retaliation for her safety efforts and whether staff reprisals played a part in her forced resignation. Ms. Bashaw and South Peninsula Hospital, a two-OR, 16-bed facility in Homer, Alaska, are scheduled to return to court next March for a retrial. The hospital maintains that it asked Ms. Bashaw to resign because she lacked sufficient clinical and managerial skills and failed to acquire them. Ms. Bashaw claims that she was villified for confronting an institution over alleged failures that put patients at risk.

"What we're really battling is that...people are really protective of institutions," says lawyer Rick Friedman, JD, who represented Ms. Bashaw. In this case, the hospital isn't only the area's largest employer, it's also one of its only healthcare providers. "In that town, every juror can experience personal negative consequences for voting against the hospital."

In 2005, Ms. Bashaw sued South Peninsula, which hired her as its surgical services manager in June 2003 and saw her resign in Nov. 2004. Her lawsuit, which also named the Kenai Peninsula Borough - the hospital's owner - and two general surgeons on staff as defendants, sought damages in excess of $100,000 for retaliatory discharge and interference with her employment contract.

Ms. Bashaw alleges in her suit that hospital administration forced her to resign or face termination for efforts to enforce safety policies she said the hospital neglected, including consistent sponge and instrument counts during surgery and prohibitions on street clothes in sterile areas. These efforts, she says, met resistance and criticism from the surgeons, whom she accused of encouraging nurses and surgical staff to file complaints of incompetence and abusive behavior against her.

During the trial, lawyers for the hospital and general surgeon Paul Sayer, MD, FACS, presented a radically different view. Ms. Bashaw was asked to resign, they countered, because she lacked the skills to do the job. In a position that called for hands-on care, she wasn't ACLS certified and often had difficulty starting an IV, they said, adding that staff members who filed complaints were simply reacting to an incompetent, unprofessional and even abusive manager. (The borough was released from litigation and the second surgeon arranged a settlement before the case reached trial.)

After three-and-a-half weeks of testimony, the jury cleared Dr. Sayer of the allegations that he interfered with Ms. Bashaw's contract, but couldn't unanimously agree if the hospital fired her as payback for her safety efforts and whether she was forced to resign because of a retaliatory campaign marked by a staff-wide refusal to cooperate with her efforts to institute safety changes.

"What was well shown at trial was that if she was a whistleblower, she had nothing to blow the whistle about," says Dr. Sayer. "She concocted up a lot of stuff ? [and] when it came to it, things weren't exactly as she accused them of being." She'd misinterpreted the aims of several safety policies, he says, and the hospital had an above-average safety record.

The problem in Homer results from "not nipping behavioral problems in the bud," says Mr. Friedman, describing the hostile environment Ms. Bashaw claims to have worked in. "Letting people look the other way and hoping the situation will improve is probably not a good idea," but instead a "mutual dysfunction pact."

Dr. Sayer says that environment might have been prevented with due diligence. "Whoever hires people for supervisory positions should evaluate candidates well," investigating their professional, educational and even legal histories. "Otherwise you're negligent in hiring. You'd better be sure of who you're hiring," he says.

- David Bernard

A Gentler Propofol?
Researchers: Investigative Fospropofol Smooth and Predictable
Aprodrug of propofol is easier to recover from than fentanyl and midazolam and more predictable than conventional propofol, according to research at the Society of Gastroenterology Nurses and Associates meeting last month.

Fospropofol disodium (Aquavan injection), a significantly less active form of the familiar sedative, breaks down in the body after injection to release propofol, which anesthetizes the patient, and metabolites, which have no effect. "After IV administration, the plasma concentration profile of fospropofol-derived propofol is characterized by a smooth and predictable rise, rather than a rapid spike that is seen with the conventional lipid emulsion formulation (Diprivan)," say researchers.

While most gastroenterologists are satisfied with their sedation regimen, they're less than thrilled with procedure-related discomfort and slow onset of action, according to a survey researchers cited. "Benzodiazepines can produce prolonged sedation and hangover effects [and] there is wide interpatient variability in metabolic activity (of midazolam) and drug-drug interactions," say researchers.

Here's a look at the findings of the randomized, double-blind, multi-center, phase three study:

• Patient recovery status. Patients receiving fospropofol 6.5mg/kg demonstrated better memory retention than patients receiving midazolam 0.02mg/kg. Both fospropofol doses - 6.5mg/kg and 2.0mg/kg - resulted in similar time to fully alert and time to discharge readiness when compared to midazolam; however, fospropofol provided more clear-headed recovery than midazolam.
• Patient-physician satisfaction. A 6.5mg/kg fospropofol dosing regimen achieves a high level of sedation success; a higher level of patient satisfaction and more willingness to be treated again with fospropofol than with midazolam; and a higher level of physician satisfaction compared with midazolam.
• Safety and effectiveness. Fospropofol was well-tolerated with no major or serious treatment-related adverse events and no adverse event-related procedure discontinuations. The mean time from the first 6.5mg/kg dose to sedation was 8.6 minutes ( /- 5 minutes) 55 percent of patients required supplemental analgesic medication.

- Stephanie Wasek

Personalized Propofol Delivery
A clinical trial is underway to measure the safety and effectiveness of a computer-assisted personalized sedation device designed to let GI docs and nurses deliver predictable and personalized doses of propofol for routine endoscopies. Propofol labeling includes a warning stating that the drug should be administered only by persons trained in the administration of general anesthesia. Many feel it's impractical for anesthesia professionals to be present for all endoscopy procedures requiring sedation.

Feasibility studies of the CAPS device, completed last year, demonstrated its ability to facilitate the administration of minimal to moderate propofol sedation appropriate to individual patient needs while achieving high clinician and patient satisfaction and rapid recovery times. Now a prospective, randomized and controlled study of 1,000 patients at up to 12 sites will compare the CAPS device to the current standard of care for routine EGD and colonoscopy procedures. Effectiveness will be assessed based on clinician and patient satisfaction and sedation recovery time, while safety will be determined by the incidence, duration and depth of desaturation and the amount of time subjects spend in deep sedation/general anesthesia. Ethicon Endo-Surgery will submit the results to the FDA for potential pre-market approval.

The CAPS device continually monitors and records seven patient parameters: oxygen saturation, respiratory rate, heart rate, blood pressure, end-tidal carbon dioxide, patient responsiveness and ECG. It delivers oxygen and automatically reacts to signs of over-sedation (oxygen desaturation and low respiratory rate/apnea) by stopping or reducing propofol delivery, increasing oxygen delivery and instructing patients to take a deep breath.

- Dan O'Connor

In the Know
From the Show Floor. With the busy spring conference season behind us, it's time to tally up some numbers.

• AORN says 6,281 attendees and 588 exhibits were at its March conference in Orlando.
• FASA says just fewer than 2,000 attendees and about 120 exhibits were at its April conference in New Orleans. FASA blames the comparatively low number of exhibitor booths to space limitations in the exhibit hall, due to a contract signed years ago when FASA meetings were smaller, says a spokeswoman.
• AAASC says 905 attendees and 146 exhibits were at its May conference in Denver.

Take a TO. June 20 marks the fourth annual National Time Out Day, which the Joint Commission and the American College of Surgeons will join AORN in observing this year. "Partnering on National Time Out Day from our surgical and accreditation partners symbolizes the collective effort required by every member of the surgical team to practice a time out and ensure correct patient, correct procedure, and correct site every time," says AORN President Mary Jo Steiert, RN, BSN, CNOR.

Surgical robot maker lauded. Intuitive Surgical, makers of the da Vinci Surgical System, is number 32 on Business 2.0's list of the 100 Fastest Growing Tech Companies for 2007.

Surgery Through Natural Orifices. Interest in passing instruments through the mouth, rectum or vagina to get into the abdomen to perform surgery is said to have heightened after doctors from India made a video in 2004 showing an appendix being taken out through a patient's mouth. The patient had abdominal scars that would have made conventional surgery difficult. Now a study is underway to find out whether people will fare better if abdominal surgery is performed through natural openings in the body rather than cuts in the belly. See the Natural Orifice Surgery Consortium for Assessment and Research Web site at www.noscar.org.