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Endless Debate

April 18 2008 at 6:14 PM
Melody Maxim  (Login melmax)
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Response to Reply to Melody

Ben: If SA had failed to wash-out the blood, then that could be a source of blood on the board, even without vascular damage. So it is contradictory to claim that the only source of blood could have been from vascular damage when you are claiming that residual blood would be expected from an inadequate wash-out.

You are correct, in that I should have written "possible evidence," as the blood Andy described could have indicated several things. I believe SA over-pressurized the patient to the point of vascular damage, due to what I consider to be a mountain of evidence in the SA report, regarding alarms, the funeral director inquiring if the pump was on at the time of the spurt, etc., and the general inability of the team to address the pressure issues they were obviously experiencing, as well as my personal knowledge of the members of the team and their capabilities (or lack thereof), and my expertise in perfusion. I believe the patient was subsequently under-perfused, due to what I calculate to be a rather low average flow rate.

Ben: In any case -- as I pointed-out previously -- a clot associated with the stroke hemorrhage in the right hemisphere dislodged during the vitrification perfusion, and there was adequate release of blood to explain blood on the board.

Andy has already anticipated the question I was going to ask, here, and has stated that perfusion was continued, following the removal of the clot, until the effluent was clear, and that the board was subsequently clean. SA attempted to perfuse the entire patient (both head and body), and CI perfused the head a second time, but it seems that blood remained in the patient and drained later, indicating an incomplete washout. I have to agree with Andy, that it is more probable the blood came from the body, rather than the head that was perfused twice, and I can’t imagine you want to argue that CI didn’t do an adequate isolated perfusion of the head.

Why did the clot remain, following SA’s attempts to perform the washout procedure, anyway? What about the clot-dissolving medications (streptokinase) the SA team supposedly administered? Are you aware that streptokinase is contraindicated in stroke patients? "Streptokinase has not been shown to benefit patients with acute ischemic stroke, but it has been shown to increase their risk of intracranial hemorrhage and death. Of 3 major randomized controlled trials, all were terminated prematurely because streptokinase was associated with unacceptable rates of mortality." http://www.emedicine.com/EMERG/topic558.htm

Ben: My use of the word "fabrication" was meant in the sense of rationalization not intentional deception ("lie"). I believe the authors wrote that the blood spurt occurred under pressure from the ATP to rationalize or explain the spurt, without good evidence for this rationalization.

Where I come from, (the South), the word "fabrication" is a polite word for "lie." At any rate, there should be no tolerance of "rationalization," or "fabrication," in a medical case report. Of course, what can we expect from someone who excels at writing FICTION? (Not that there is anything wrong with fiction, when it is identified as such.) There’s a lot of other information that should not have been included in the SA case report, such as comments about an employee’s second job, and comments about a former employee, and I think you know the spirit in which those comments were made. I believe there has been a lot of "rationalization" at SA, in the past, "rationalization" that has perhaps led to quite a few ill-advised courses of action, the firing and resignations of capable persons, AND perhaps in people like you, Ben, believing in the capabilities of SA more than you should.

Ben: There would be no motive for the authors to intentionally deceive readers into believing that the ATP caused the blood spurt. That is the crux of your case that damage was caused.

You've hit the proverbial nail on the head, Ben. The authors could not possibly want to deceive people into believing they over-pressurized the patient. The point is: THEY DID NOT KNOW ENOUGH ABOUT PERFUSION TO REALIZE THE IMPLICATIONS OF WHAT THEY WERE WRITING!! The crux of my case that damage was caused are details in the report, and the fact that the SA team and case authors didn't have a clue as to what they were doing, or even writing. I think it's blatantly obvious they were too ignorant of perfusion technology to realize that what you now call a "rationalization" would strongly indicate damaging over-pressurization of the patient. Who in the world would create, and include, fabricated remarks in a report, that would indicate malpractice??? Only someone who was not knowledgeable enough to understand that what he was writing would indicate gross mistreatment of a patient. Why are you so willing to turn over the care of CI's patients to people who know so little about the medical procedures they claim to be capable of providing? How can you call them “experts,” and refer to their services as “state of the art,” when their staff members are extremely unqualified and they are decades behind, in regard to the quality of care provided in conventional medicine, in virtually identical procedures?

Ben: I could say that your arguments are self-serving because you have had bitter personal experiences with Charles Platt and you want to prove that he is an evil, incompetent man. It is better to stick to the evidence of the case than to challenge motives and character -- which too easily leads to acrimony.

I don't think I would call Charles, (or anyone), "evil," and I don't think he is "incompetent," in general. (I think you'll find me sincerely praising his writing skills, and other talents, on this forum, on a number of occasions.) However, I do believe he has no place in managing people, or in making decisions regarding medical procedures and/or the related equipment.

Are the motives and character of someone who exerts a significant amount of influence over major decisions of a company that is offering medical services irrelevant? I think not. What if their motives ARE self-interest, greed, or their own egotistical needs, more so than patient care or overall progress in the field?

If you consider someone who doesn't want cryopreservation to be “committing suicide,” as you seem to, then is a company providing less than optimal medical care, when they can afford quality professionals and equipment, not guilty of “negligent homicide,” at best? Why should a company send a fabricator to attempt a very dangerous medical procedure, when they pay him the same salary as a qualified person who could SAFELY perform the procedure? I have no idea how you can be supportive of this behavior, or how you don't see that the main focus of SA, for many years, has been certain "engineering" projects, rather than the provision of competent patient care. I believe this is clearly evidenced by the three inexperienced, unqualified people who showed up for the CI-81 case.

Ben: I think that what serves me best is to know the truth, whether this be mistakes or a job well done. The case reports I write disclose many mistakes, including mistakes made by me. The best way to avoid repeating future mistakes is to document them well and think about how to avoid making the same mistakes again in the future.

The best way for SA to avoid mistakes in perfusing a patient, would be to take the $77,000 being paid to one of the fabricators who was on the CI-81 team and pay it to a perfusionist. They can report perfusion mistakes until the earth gets swallowed up by the sun, but they are not going to be able to properly train laymen with a weekend trip to California, some videos, and one case in four years. Anyone who thinks they can doesn't have a proper understanding of perfusion technology.

Ben: I do not accept the claim that if a person perfusing a cryonics Patient has not had four years of perfusion training that that the patient will necessarily have experienced vascular damage

I certainly agree that I could have probably been a good perfusionist without the numerous hours of English, History, Government, Psychology, and other classes I was required to take for my degree, but I believe I would have killed quite a number of patients without my clinical experience. I performed 110 cases, on human patients, with an instructor standing over my shoulder, to prevent me from harming anyone, before I graduated perfusion school. This was after many months of classroom instruction on perfusion techniques, and with a good understanding of anatomy and physiology. How in the world can anyone as intelligent as you, believe Gary and Ken can walk out of the shop and safely perform perfusion? You can only think this because, as my husband says, "people don't know what they don't know." What you don't know about perfusion and the SA personnel allows you to believe they can safely perform whole body perfusion, but I believe I know better.

Ben: By that logic every cryonics patient ever perfused or given a wash-out by CI or Alcor would have experienced serious vascular damage -- more harm than good -- because they were not perfused or washed-out by a professional perfusionist. Why single-out the 81st patient?

It's wrong of you to say I assume every patient has experienced serious vascular damage, as there isn't much evidence of over-pressurization in CI's reports. The circuit pressures CI mistakenly recorded as patient pressures would have been significantly higher than the actual patient pressures, so I doubt any pressure-induced vascular damage occurred. In that situation, I would be more concerned with wondering if the pressure was high enough to adequately perfuse the brain. I single out the 81st patient because it's the only SA case report I've thoroughly reviewed, and as far as I know it is the only case performed by the current staff. As I’ve mentioned, many times before, my purpose is to expose what I believe to be irresponsible and unethical behavior at a company of which I have firsthand knowledge, so I have no idea why you think I would discuss Alcor, or CI cases, in which SA was not involved. There are a number of other reasons I single out the SA case, including the fact that SA can afford medical professionals, while Alcor and CI may not be able to.

Ben: I acknowledge that improving perfusion quality is important, and I believe that Alcor, CI and SA are all making efforts to improve perfusion quality. The point at issue here is not whether perfusion in cryonics (or for the 81st patient) could have been better, but whether vascular damage was caused.

The REAL question I’m asking is: Why is SA not providing qualified, experienced perfusionists and EMTs or paramedics, when they can easily afford to? Why should they pay equivalent salaries to people who don't even understand the procedures enough to realize what their reports indicate, or worse yet, to people incapable of even authoring their own reports, due to their total lack of knowledge in regard to the procedures, and medicine and cryonics, in general?! With the salaries they pay, SA should be providing EXCELLENT, PROFESSIONAL medical services, not simply "better" than what has been available in cryonics, in the past.

I respectfully, but strongly, disagree with your comments in regard to SA's efforts to improve. I don't see any evidence of change, other than the last News Bulletin which indicated they have implemented a few suggestions Mathew, Aschwin and I made a long time ago, suggestions that were previously ignored, (BLS certification, lift gates, etc.) It also included news regarding the new "workshop" in California, which only leads me to believe the primary focus of SA remains the "engineering and design" projects of Charles Platt. We haven't heard anything from SA, in months. When you tell me SA is using the more than half-a-million-dollars I (conservatively) estimate they are spending, annually, on their payroll and consulting fees, to pay for medical professionals, as they should, I'll believe SA is making an effort to improve.

Ben: Even if a single spurt caused some harm (and this is questionable if a spurt would relieve pressure and the ATP was immediately turned-off) it does not constitute evidence that it resulted in such damage as to override the many benefits of the SA treatment for the patient.

WHAT BENEFITS, Ben??? Packing the patient in ice and performing chest compressions, or injecting meds into IVs that were, fortunately, left in place by hospital personnel? (I don't believe any of the three SA team members would have been able to gain IV access.) Almost anyone off the street could and would do those things, for not much more than minimum wage, so why does SA WASTE a payroll and consulting fees that are most certainly well over a half-a-million dollars a year on this??? (Again, I think this figure is conservative.) Don't you get my point that SA could have a qualified perfusionist, and medical personnel experienced at intubation and the insertion of IVs, for the amount of money they spend on employees and consultants?? And, why do you believe CI's clients should pay $60,000, (about three times the cost of open-heart surgery), for a bunch of rank amateurs to possibly harm them through the improper use of a perfusion circuit, rather than leaving that money to cryonics research, or their heirs?

Ben: I am not claiming to certain knowledge of what happened during the wash-out. Any scenario I can construct of the events associated with the blood spurt is like a jigsaw puzzle with a few pieces missing -- or pieces that don't fit. But although all the explanations have deficiencies, none of them can be used to make a convincing argument for vascular damage. This was the key point of my posting, and you did not address this point in your reply.

I think the report has more than enough circumstantial evidence that charges of gross negligence and malpractice, most likely including over-pressurization to the point of vascular damage, would hold up in court, if this were not a "legally dead" person.

Ben: I regret if anything I have had to say here strikes you as a personal offense.

Ditto. I also regret that we have such strong difference of opinion, in regard to the services of SA, but you know I will argue that I understand perfusion better than you, and that I have experience working with the SA staff and consultants, other than Ms. Baldwin. You don't offend me, but you disappoint me by continuing to endorse a company I feel has behaved unethically, and has shown little evidence of a change in strategy.

CI is, for the most part, SA’s only source of new clients and therefore holds the leverage to force that company to behave more responsibly by demanding they provide experienced, qualified personnel, (which would not affect their budget), yet you don’t do this. In my mind, there won't be significant change at SA, for as long as the staff and consultants remain the same, and you are helping to maintain the status quo. Unfortunately, I feel this endless debate could go back-and-forth, forever, so I think we are just going to have to agree to disagree.

**Edited out the blues (color, not emotion - some sort of link error)

This message has been edited by melmax on Apr 19, 2008 4:52 PM

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