Calif. Anesthesiologist and Dentist Found Guilty of Malpractice

Dr Barry Friedberg Sets the Record Straight.

Fact #1 - I never knew anything about Dr. Teich's legal problems but naively assumed if he was licensed that he had met certain legal requirements; i.e. not being a convicted felon. So it never occurred to me to ask him if he was one.

Fact #2 - I did not administer Paula Kane's oral medication, as you reported.

Around 1:30 pm, I was asked to provide IV sedation after Ms. Kane demanded to be put to sleep.

Fact #3 - Ms. Kane did not suffer a respiratory arrest, as plaintiff's attorney asserted at trial.

It was undisputed that Ms. Kane suffered a primary cardiac arrest with a nearly uniformly fatal condition called PEA or pulseless electrical activity.

While the commonest cause of PEA is lack of oxygen typically recognized by a decrease on pulse oximeter tone. There was no such decrease in Ms. Kane.

Low oxygen events have been prevented by the use of the pulse oximeter, a device I insisted Michael Stephens, Hoag Hospital administrator, acquire in 1983, 7 years before it was deemed a ‘standard of care’ by the American Society of Anesthesiologists.

It is virtually impossible for a primary respiratory arrest to occur with a functioning pulse oximeter, as was the case until Kane's last heart beat.

After getting baseline vital signs and BIS readings, I administered the late Paula Kane’s propofol sedation monitored by both pulse oximetry & brain activity monitors.

She did not die from propofol overmedication as you reported.

Her sentinel event was an abrupt loss of pulse oximeter signal, the vast majority of times is caused by the sensor falling off the fingertip.

Her probable cause of death was the extremely rare cause of air embolism that, after 3 days, would have been undetectable by the coroner’s autopsy.

Air embolism is not predictable in dental implant surgery but has been reported.
http://www.springerlink.com/content/x6602350v24vp388/

Air embolism in dental surgery is not preventable or treatable.

Fact #4 I have been a board certified anesthesiologist since 1980, licensed by the California Medical Board since 1976 & recognized as an expert reviewer for the Board since 2005.

Unlike my Dental License for general anesthesia, my medical license has both the original date of issue & the expiration date.

The Dental Board never provided any notification of the expiration of my permit for GA.

Fact #5 - I have not been sued for malpractice since 1991, settled for $5,000 to cover a Hoag OB patient's medical expenses. She had nothing bad to say about my care.

I have spent my entire career in anesthesia as a patient safety advocate, starting with my introduction of the non-invasive blood pressure monitor to Hoag Hospital in 1979.

In March 1992, I developed propofol ketamine IV sedation in response to the challenge of caring for patients involved in the office death in Newport Beach in 1990.

http://articles.latimes.com/keyword/edward-j-domanskis

I was his expert witness in both his malpractice trial & with the CA Medical Board.

In 1997, I was the first Orange County anesthesiologist to routinely monitor propofol anesthesia depth with a BIS brain monitor.

Following the 2004 death of Olivia Goldsmith, author of ‘The First Wives’ Club,’ Cambridge University Press chose me first, among 40,000 US anesthesiologists, to write the first ever anesthesia textbook, ‘Anesthesia in Cosmetic Surgery.’

This book is the first anesthesia text with a brain monitor on the cover & first to define levels of sedation/anesthesia with numbers instead of words.

Also, in 2004, local US Congressman John Campbell presented Dr. Friedberg with a Congressional Recognition award for improving safety of wounded combat troops.

I thank you for taking time to read the facts.

Dr Barry Friedberg

Interesting case. Using the BIS for sedation though, wow, personally I would think that money would be better spent on end-tidal CO2 (NC in this case) - but that's just me. It's probably a good idea to put EKG leads on anyone getting sedation as well.

I have safely been providing anesthesia in the dental office since 1977 after graduating from the UCLA HGH Anesthesiology Residency. I am a co-founder of the American Society of Dentist Anesthesiologists and the California Society of Dentist Anesthesiologists. I am Boarded by the American Dental Board of Anesthesiology and the National Dental Board of Anesthesiology. I am a general anesthesia evaluator for the CA Board of Dental Examiners. I have been an Assistant Professor at USC, UCLA and Loma Linda Universities. I did not attend Dr. Friedberg’s trial and have only read Superior Court Judgment After Jury Trial, May 22 2012. I hope that we can all see the full court testimony some day.

I find Dr. Friedberg’s comments to be a fascinating response by a physician who has just been found 50% negligent in the death of a patient under his care with the dentist garnishing the other 50%. It seems that from his point of view “stuff happens”. I am not aware of cases where patients just died suddenly due to no one’s fault and the anesthesiologist was still found negligent. Perhaps they have. He is certainly trying to make that point here. I would like to believe that if his comments were pertinent and accurate the Court and Jury would have found him “not guilty” instead of negligent in the death. Perhaps a terrible miscarriage of justice occurred?

Dr. Friedberg’s “Fact #1”: He says that he “naively assumed if he (Teich) was licensed that he had met certain legal requirements”. Actually it is Dr. Teich that is danger of losing his dental license because he naively did not ask Dr. Friedberg to produce a valid anesthesia permit thus meeting “certain legal requirements.”

He says “her probable cause of death was…air embolism, that after 3 days would have been undetectable…”. The anesthesia experts and the jury apparently did not agree with this interesting theory but instead believed the plaintiff’s attorney that it was “respiratory arrest”.


California passed AB 745 which allowed physicians to administer anesthesia in the dental office and it says in part: "This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to prevent unnecessary injury or death caused by a lack of training or misuse of general anesthesia in a dental office, it is necessary that this act take effect immediately."

His comments about BIS (not required by ASA or JCAH last time I looked) is interesting. A much better diagnostic safety monitor in my opinion which is required for this level of anesthesia by the ASA is ETCO2, which I use on all patients. He doesn’t mention using it. He also doesn’t mention ECG which is required for his technique by the Dental Board as well as continuous BP monitoring and a pre-tracheal stethoscope. But not having a permit for over 11 years he wasn’t likely to know that. It also seems that he had no prior knowledge of this patient until after she had been orally sedated and he was called in to give her a general anesthetic (any dose of propofol or Ketamine in CA requires a general anesthesia permit and although you can obviously sedate a patient with propofol, it is deemed a general anesthetic for CA dental legal purposes). No mention of a health history, consent (while under oral sedation?) or NPO status. I personally can't think of a time in the last 35 years where I would walk into a situation as describe and administer an anesthetic in the dental office for an elective procedure. I would have re-scheduled that patient and done a thorough work-up. My Chief of Anesthesia always said "Never back into a general". Wise words.

“Air embolism in dental surgery is not preventable or treatable.” Actually there are reports of air embolism from endodontic therapy as well as implant placement and those that are familiar with the surgery as dentist anesthesiologists are, know how to minimize if not prevent it which is the main reason it is rare. That is why it is so important that the anesthesiologist knows all about and has extensive knowledge in the surgery being performed. An anesthesiologist who is an expert in cardio-thoracic surgery could be downright dangerous during his first dental anesthesia surgery without proper training, as in all things.

“The Dental Board never provided any notification of the expiration of my permit for GA”. His permit did not expire, it was “cancelled” according to Board records about 11 years ago. You can type his name in HERE to verify.

It is interesting to note that the other 50-100 MDs with MGA permits and hundreds of dentists have had no trouble renewing or realizing that they needed to be renewed by examination every 5 years (B&P 1646.9 D2). It is made very clear to the doctor during the first application process. It’s in the law. I know that I get renewal notices as do every other anesthesiologist I know.

The purpose of this examination is to make sure the anesthesiologist (MD or DDS) has the proper monitoring equipment, drugs, supplies and knowledge of emergencies that might occur under general anesthesia in the dental office. Some physician anesthesiologists initially find the dental setting uncomfortable since they do not have the “back-up and support” systems in place that they are used to in the hospital and the surgery is in the airway forcing them near the feet of the patient. Working in a dental office is not the same as working in the hospital operating room. However, most physicians adapt quickly and safely.

“In March 1992, I developed propofol ketamine IV sedation in response to the challenge of caring for patients involved in the office death in Newport Beach in 1990.” While developing a technique to reduce deaths by physicians in offices is a noble enterprise I beg to differ about him being the first to use the technique. Many anesthesiologists including myself were using that technique years earlier. It was certainly not “invented” by Dr. Friedberg. And I don’t understand the logic. He claims that he has been using a certain drug combination for many years, which he says, didn’t cause the problem anyway so that means it’s not his fault? The Court and expert witnesses disagreed with him.

A tragic case with a tragic outcome. No one is above the law. Ignorance of the law is no excuse. Everyone administering anesthesia in the dental office must submit to routine examinations and receive a permit to prove competence. Dr. Friedberg mentions Dr. Teich’s felony convictions (mail fraud), which had nothing to do with Dr. Friedberg’s anesthesia delivery. However, this is a cautionary tale for other dentists since the law is very specific that if a dentist allows anyone without a valid anesthesia permit to administer anesthesia in their office (good or bad outcomes are irrelevant) the Dental Board has the authority to revoke the dentist’s license. This case is the “poster child” for why the law was written and I expect that the law will be enforced to the full extent and Dr. Teich will surrender his dental license in the near future. Every dental patient deserves a competent, permitted and evaluated anesthesia provider. No excuses.
Sincerely,
Ronald O. Davies, DDS
www.DentalAnesthesia.com

Although Dr. Davies has a very impressive resume, it is obvious that he has never read either of Dr. Freidberg's books, never read the court's transcript which he admits is not yet available, and has NO knowledge or expertise in the use of the BIS monitor. It must also be pointed out that Dr. Davies is somewhat of a competitor of Dr. Friedberg.

If Dr. Davies had bothered to read either of Dr. Friedberg's books, he would have learned that all monitors considered to be the standard of care are used in conjunction with the BIS monitor in his technique. The reason the BIS monitor is not the standard of care at present is that not everyone in the field of anesthesia knows how to use or fully understands the BIS monitor. The BIS is just another tool to be used by the clinician while monitoring the patient. With the BIS monitor, the anesthsia provider knows exactly his patient's level of anesthesia. I predict that the monitoring of the patient's brain activity will soon be the standard of care.

Dr. Friedberg has safely used his technique in over 20,000 (twenty thousand) cases. He lectures on his technique (aka Goldilocks technique, PK method, or minimally inavasinve anesthesia) across the country and around the world. He has been an expert witness on the issues of patient safety, office based anesthesia, and considered to be one of the top experts on the use of Propofol. Through his foundation, he is a crusader for the care and safety of the patient.

I have been administering anesthesia for over thirty years and presently use Dr. Friedberg's anesthesia technique in my solo office based anesthesia practice. I have used the technique in hundreds of cases, about half of these for dental procedures. I can attest that this THE best anesthesia technique that I have ever used in all my years of practice.

There is an old saying: By the grace of God, there go I. Administering anesthesia is like walking through a mine field. Regardless of how competent you are or think you might be, sooner or later you are going to step on one. I find Dr. Davies comments to be very condescending to say the least. I think it is he that should examine his anesthesia expertise and maybe move forward into the 21st century. One bad case doesn't make a bad anesthesiologist.








Fact #1 - I never knew anything about Dr. Teich's legal problems but naively assumed if he was licensed that he had met certain legal requirements; i.e. not being a convicted felon. So it never occurred to me to ask him if he was one.

Fact #2 - I did not administer Paula Kane's oral medication, as you reported.

Around 1:30 pm, I was asked to provide IV sedation after Ms. Kane demanded to be put to sleep.

Fact #3 - Ms. Kane did not suffer a respiratory arrest, as plaintiff's attorney asserted at trial.

It was undisputed that Ms. Kane suffered a primary cardiac arrest with a nearly uniformly fatal condition called PEA or pulseless electrical activity.

While the commonest cause of PEA is lack of oxygen typically recognized by a decrease on pulse oximeter tone. There was no such decrease in Ms. Kane.

Low oxygen events have been prevented by the use of the pulse oximeter, a device I insisted Michael Stephens, Hoag Hospital administrator, acquire in 1983, 7 years before it was deemed a ‘standard of care’ by the American Society of Anesthesiologists.

It is virtually impossible for a primary respiratory arrest to occur with a functioning pulse oximeter, as was the case until Kane's last heart beat.

After getting baseline vital signs and BIS readings, I administered the late Paula Kane’s propofol sedation monitored by both pulse oximetry & brain activity monitors.

She did not die from propofol overmedication as you reported.

Her sentinel event was an abrupt loss of pulse oximeter signal, the vast majority of times is caused by the sensor falling off the fingertip.

Her probable cause of death was the extremely rare cause of air embolism that, after 3 days, would have been undetectable by the coroner’s autopsy.

Air embolism is not predictable in dental implant surgery but has been reported.
http://www.springerlink.com/content/x6602350v24vp388/

Air embolism in dental surgery is not preventable or treatable.

Fact #4 I have been a board certified anesthesiologist since 1980, licensed by the California Medical Board since 1976 & recognized as an expert reviewer for the Board since 2005.

Unlike my Dental License for general anesthesia, my medical license has both the original date of issue & the expiration date.

The Dental Board never provided any notification of the expiration of my permit for GA.

Fact #5 - I have not been sued for malpractice since 1991, settled for $5,000 to cover a Hoag OB patient's medical expenses. She had nothing bad to say about my care.

I have spent my entire career in anesthesia as a patient safety advocate, starting with my introduction of the non-invasive blood pressure monitor to Hoag Hospital in 1979.

In March 1992, I developed propofol ketamine IV sedation in response to the challenge of caring for patients involved in the office death in Newport Beach in 1990.

http://articles.latimes.com/keyword/edward-j-domanskis

I was his expert witness in both his malpractice trial & with the CA Medical Board.

In 1997, I was the first Orange County anesthesiologist to routinely monitor propofol anesthesia depth with a BIS brain monitor.

Following the 2004 death of Olivia Goldsmith, author of ‘The First Wives’ Club,’ Cambridge University Press chose me first, among 40,000 US anesthesiologists, to write the first ever anesthesia textbook, ‘Anesthesia in Cosmetic Surgery.’

This book is the first anesthesia text with a brain monitor on the cover & first to define levels of sedation/anesthesia with numbers instead of words.

Also, in 2004, local US Congressman John Campbell presented Dr. Friedberg with a Congressional Recognition award for improving safety of wounded combat troops.

I thank you for taking time to read the facts.

Dr Barry Friedberg[/QUOTE]

Originally Posted by William F. Reid

Although Dr. Davies has a very impressive resume, it is obvious that he has never read either of Dr. Freidberg's books, never read the court's transcript which he admits is not yet available, and has NO knowledge or expertise in the use of the BIS monitor. It must also be pointed out that Dr. Davies is somewhat of a competitor of Dr. Friedberg.

If Dr. Davies had bothered to read either of Dr. Friedberg's books, he would have learned that all monitors considered to be the standard of care are used in conjunction with the BIS monitor in his technique. The reason the BIS monitor is not the standard of care at present is that not everyone in the field of anesthesia knows how to use or fully understands the BIS monitor. The BIS is just another tool to be used by the clinician while monitoring the patient. With the BIS monitor, the anesthsia provider knows exactly his patient's level of anesthesia. I predict that the monitoring of the patient's brain activity will soon be the standard of care.

Dr. Friedberg has safely used his technique in over 20,000 (twenty thousand) cases. He lectures on his technique (aka Goldilocks technique, PK method, or minimally inavasinve anesthesia) across the country and around the world. He has been an expert witness on the issues of patient safety, office based anesthesia, and considered to be one of the top experts on the use of Propofol. Through his foundation, he is a crusader for the care and safety of the patient.

I have been administering anesthesia for over thirty years and presently use Dr. Friedberg's anesthesia technique in my solo office based anesthesia practice. I have used the technique in hundreds of cases, about half of these for dental procedures. I can attest that this THE best anesthesia technique that I have ever used in all my years of practice.

There is an old saying: By the grace of God, there go I. Administering anesthesia is like walking through a mine field. Regardless of how competent you are or think you might be, sooner or later you are going to step on one. I find Dr. Davies comments to be very condescending to say the least. I think it is he that should examine his anesthesia expertise and maybe move forward into the 21st century. One bad case doesn't make a bad anesthesiologist.

and by not using the BIS must mean that the majority of anesthesia providers out there must also not be in the 21st century? please. sounds like you and BIS and Friedberg migh have a three-ringed circus going on somewhere.

I can't wait to see your response when it happens to you.

I think that Dr. Reid has entirely missed the point in attacking the messenger. I only commented on the fact that Dr. Freidberg was found guilty in the death and that both the prosecution and jury did not buy any of his points in his "setting the record straight". I did not say that his technique was faulty or poor, just that his mention of it had nothing to do with the case. He practiced illegally without an MGA permit for years. I even said that I have used his technique for many years myself and Dr. Friedberg certainly did not invent it although he promotes it. I researched using BIS years ago and found that the ASA considers the BIS as a useful tool for Anesthesia Residents but not for experience anesthesiologists. It has errors and it has its uses. Hospitals would love to mandate it on all patients if they could bill for and collect for using it. ETCO2 is mandated.

A google search will confirm what I've said. But again, both issues are irrelevant. Res Ipsa Loquitur. The act speaks for itself.

PS I hope that Dr. Reid has not been delivering anesthesia in CA dental offices because his name does not show up as ever having a valid MGA permit either.

Dr. Ron Davies

Originally Posted by William F. Reid

Although Dr. Davies has a very impressive resume, it is obvious that he has never read either of Dr. Freidberg's books, never read the court's transcript which he admits is not yet available, and has NO knowledge or expertise in the use of the BIS monitor. It must also be pointed out that Dr. Davies is somewhat of a competitor of Dr. Friedberg.

If Dr. Davies had bothered to read either of Dr. Friedberg's books, he would have learned that all monitors considered to be the standard of care are used in conjunction with the BIS monitor in his technique. The reason the BIS monitor is not the standard of care at present is that not everyone in the field of anesthesia knows how to use or fully understands the BIS monitor. The BIS is just another tool to be used by the clinician while monitoring the patient. With the BIS monitor, the anesthsia provider knows exactly his patient's level of anesthesia. I predict that the monitoring of the patient's brain activity will soon be the standard of care.

Dr. Friedberg has safely used his technique in over 20,000 (twenty thousand) cases. He lectures on his technique (aka Goldilocks technique, PK method, or minimally inavasinve anesthesia) across the country and around the world. He has been an expert witness on the issues of patient safety, office based anesthesia, and considered to be one of the top experts on the use of Propofol. Through his foundation, he is a crusader for the care and safety of the patient.

I have been administering anesthesia for over thirty years and presently use Dr. Friedberg's anesthesia technique in my solo office based anesthesia practice. I have used the technique in hundreds of cases, about half of these for dental procedures. I can attest that this THE best anesthesia technique that I have ever used in all my years of practice.

There is an old saying: By the grace of God, there go I. Administering anesthesia is like walking through a mine field. Regardless of how competent you are or think you might be, sooner or later you are going to step on one. I find Dr. Davies comments to be very condescending to say the least. I think it is he that should examine his anesthesia expertise and maybe move forward into the 21st century. One bad case doesn't make a bad anesthesiologist.








Fact #1 - I never knew anything about Dr. Teich's legal problems but naively assumed if he was licensed that he had met certain legal requirements; i.e. not being a convicted felon. So it never occurred to me to ask him if he was one.

Fact #2 - I did not administer Paula Kane's oral medication, as you reported.

Around 1:30 pm, I was asked to provide IV sedation after Ms. Kane demanded to be put to sleep.

Fact #3 - Ms. Kane did not suffer a respiratory arrest, as plaintiff's attorney asserted at trial.

It was undisputed that Ms. Kane suffered a primary cardiac arrest with a nearly uniformly fatal condition called PEA or pulseless electrical activity.

While the commonest cause of PEA is lack of oxygen typically recognized by a decrease on pulse oximeter tone. There was no such decrease in Ms. Kane.

Low oxygen events have been prevented by the use of the pulse oximeter, a device I insisted Michael Stephens, Hoag Hospital administrator, acquire in 1983, 7 years before it was deemed a ‘standard of care’ by the American Society of Anesthesiologists.

It is virtually impossible for a primary respiratory arrest to occur with a functioning pulse oximeter, as was the case until Kane's last heart beat.

After getting baseline vital signs and BIS readings, I administered the late Paula Kane’s propofol sedation monitored by both pulse oximetry & brain activity monitors.

She did not die from propofol overmedication as you reported.

Her sentinel event was an abrupt loss of pulse oximeter signal, the vast majority of times is caused by the sensor falling off the fingertip.

Her probable cause of death was the extremely rare cause of air embolism that, after 3 days, would have been undetectable by the coroner’s autopsy.

Air embolism is not predictable in dental implant surgery but has been reported.
http://www.springerlink.com/content/x6602350v24vp388/

Air embolism in dental surgery is not preventable or treatable.

Fact #4 I have been a board certified anesthesiologist since 1980, licensed by the California Medical Board since 1976 & recognized as an expert reviewer for the Board since 2005.

Unlike my Dental License for general anesthesia, my medical license has both the original date of issue & the expiration date.

The Dental Board never provided any notification of the expiration of my permit for GA.

Fact #5 - I have not been sued for malpractice since 1991, settled for $5,000 to cover a Hoag OB patient's medical expenses. She had nothing bad to say about my care.

I have spent my entire career in anesthesia as a patient safety advocate, starting with my introduction of the non-invasive blood pressure monitor to Hoag Hospital in 1979.

In March 1992, I developed propofol ketamine IV sedation in response to the challenge of caring for patients involved in the office death in Newport Beach in 1990.

http://articles.latimes.com/keyword/edward-j-domanskis

I was his expert witness in both his malpractice trial & with the CA Medical Board.

In 1997, I was the first Orange County anesthesiologist to routinely monitor propofol anesthesia depth with a BIS brain monitor.

Following the 2004 death of Olivia Goldsmith, author of ‘The First Wives’ Club,’ Cambridge University Press chose me first, among 40,000 US anesthesiologists, to write the first ever anesthesia textbook, ‘Anesthesia in Cosmetic Surgery.’

This book is the first anesthesia text with a brain monitor on the cover & first to define levels of sedation/anesthesia with numbers instead of words.

Also, in 2004, local US Congressman John Campbell presented Dr. Friedberg with a Congressional Recognition award for improving safety of wounded combat troops.

I thank you for taking time to read the facts.

Dr Barry Friedberg

[/QUOTE]

Originally Posted by RDavies

I think that Dr. Reid has entirely missed the point in attacking the messenger. I only commented on the fact that Dr. Freidberg was found guilty in the death and that both the prosecution and jury did not buy any of his points in his "setting the record straight". I did not say that his technique was faulty or poor, just that his mention of it had nothing to do with the case. He practiced illegally without an MGA permit for years. I even said that I have used his technique for many years myself and Dr. Friedberg certainly did not invent it although he promotes it. I researched using BIS years ago and found that the ASA considers the BIS as a useful tool for Anesthesia Residents but not for experience anesthesiologists. It has errors and it has its uses. Hospitals would love to mandate it on all patients if they could bill for and collect for using it. ETCO2 is mandated.

A google search will confirm what I've said. But again, both issues are irrelevant. Res Ipsa Loquitur. The act speaks for itself.

PS I hope that Dr. Reid has not been delivering anesthesia in CA dental offices because his name does not show up as ever having a valid MGA permit either.

Dr. Ron Davies

[/QUOTE]

I would like to make it clear that I never "cast the first stone" as I certainly am not perfect. We all walk the tightrope but safety takes more effort. I never condemned Dr. Friedberg for the death per se or his propofol/ketamine technique. But instead of publishing a mea culpa, he published a list of reasons that he was, in his mind, not guilty. No remorse that I could see in his comments at all. When he made those comments on a public Forum he became open to honest, accurate non-judgmental rebuttal. Should I ever make the ultimate anesthesia mistake, I will not post on a thread all of the reasons the Court, prosecutor and Jury were wrong and list ten reasons I normally deliver great anesthesia so therefore I did nothing wrong this time. With no offense meant to Dr. Friedberg, a good adage to live by is "It is better to be thought a fool than to open your mouth and remove all doubt". Dr. Davies

Update on the death by Dr. Barry Friedberg at the office of Dr. Teich in Newport Beach three years ago. The Dental Board of California has filed a “First Amended Accusation” against Dr. Teich. The link is below. It gives much more information than has been available before.

http://www.dbc.ca.gov/public/dds4968...117_amaccu.pdf

page 7 of the complaint: patient received diazepam 5mg, halcyon .25mg, lorazepam 2mg, hydroxyzine 50 mg. 7 carpules of lidocaine with 1:100,000 epi.

An hour later patient received another 10mg Diazapan and 4mg lorazepam! All from a dentist without a permit to administer oral sedation.

Enter Dr. Friedberg because this dose was “deemed inadequate” by the dentist.
Dr. Friedberg did not obtain a consent for general anesthesia from the patient but began administration of ketamine, propofol and Robinul apparently without bothering with even the lowest standard of care in monitoring.

“Before and during the procedure, …failed to chart…monitoring parameters such as her baseline vital signs, pulse oximetry reading, respiration rate, physical status, and an airway assessment.”

911 was not called for 10 minutes after the cardiac arrest. 10 minutes!

Worse yet, “paramedics found no evidence of a cardiac monitor or crash cart, or laryngoscope.”

The paramedics were not given the victim’s medical history, and a list of medications that had been administered.

So to Dr. Reid who said that this could happen to anyone, I say poppycock.

I dare any anesthesiologist to post on this website that they would have treated this elective hypertensive patient on this day without a permit to do so, without a consent, with multiple drugs already on board, without a cardiac monitor, crash cart or laryngoscope and then fail to keep records of baseline vital signs, pulse oximetry, respiratory rate, etc. And that is why Dr. Friedberg was found guilty in the patient’s death. I am an evaluator for the dental board for general anesthesia permits. Dr. Friedberg would have failed the evaluation badly. In fact, I would not have allowed the case to start.

No laryngoscope

Originally Posted by J-Dubya

No laryngoscope

I feel like I stepped into Bizarro World reading all of that.

Originally Posted by RDavies

Update on the death by Dr. Barry Friedberg at the office of Dr. Teich in Newport Beach three years ago.

Thank you for this important update. It certainly sheds some light into why he was found guilty.

whoa...