December 2001
Volume 65 |
Number 12
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LETTERS
TO THE EDITOR
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| Locked Cart Rule Unrealistic
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Locked Cart Rule Unrealistic
I wish to lend my support to the feelings of Martin S. Bogetz,
M.D., whose letter appeared in the September 2001 NEWSLETTER.
I believe the placing of locked carts containing drugs and
syringes in the operating and delivery rooms is a danger. Our
operating rooms recently have had automatically locking carts
installed, which lock after a set time. The necessity of obtaining
medications, especially when your hands are full, in an emergency
is vital. With Murphy’s Law, it is probable that the cart
will have locked itself when it is most needed to be open.
These wonderful “enhancements” to our operating rooms
were likely the bright idea of some committee sitting in an office
with no experience in the real world of the operating room. These
devices should be done away with.
Robert F. LaPorta, M.D.
Dix Hills, New York
JCAHO Needs Real World Lesson
I am writing in reference to the letter of Martin S. Bogetz,
M.D., in the September 2001 NEWSLETTER. I do believe that
the Anesthesia Patient Safety Foundation may have a role in educating,
advising or otherwise informing the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) leadership on issues such
as locked carts, which become the bane of every anesthesia department
undergoing inspection. In a prior position, I went through two
JCAHO inspections in which the inspectors insisted that we lock
up ALL potential drugs of abuse including Pentothal™ and
propofol using the same rationale mentioned by Dr. Bogetz. We
basically dared them to make us, stating that we would lodge an
official protest with JCAHO, and fortunately they relented. In
one of those two inspections another issue came up, one of “sterility
of endotracheal tubes.” The inspectors asked to see a “typical”
room set up, and I took them to our designated “emergency”
room for the day. The inspectors took great exception to the fact
that we had two endotracheal tubes obviously opened with a syringe
attached to the cuff line. They asked me if I was ignorant of
the possibility of transmitting germs into the lungs. With very
great restraint, I informed them that by the time I passed the
tube through the oral cavity, it would be full of germs regardless
of when the sterile seal on the wrapper was broken. In this instance,
we also had to politely inform the inspectors that we would demand
direct instructions from JCAHO stating that endotracheal tubes
had to be kept sealed up to the time of intubation before we would
change our practice. This sort of thing should not have to happen
if JCAHO inspectors were better informed with regard to reasonable
practices in the areas they are inspecting.
Alvin R. Manalaysay, M.D.
St. Louis, Missouri
Resident at Ground Zero Says NEWSLETTER
on Shaky Ground
I am replying to your “Ventilations” in the October
2001 ASA NEWSLETTER.
I am a CA-3 resident at a Washington, D.C., hospital that received
burn victims from the terrorist attack on the Pentagon. I personally
took care of two of these victims, one in the emergency room where
we triaged the patients as they arrived and one in the operating
room where he underwent an escharotomy. On the list of Pentagon
victims, I recognized some of the names as being former patients
of mine. My fiancée lost four coworkers in the tragedy.
I find your editorial exceptionally disturbing not only because
it demonstrates a lack of compassion to those who were killed
or maimed in this tragedy, but it also lacks compassion for those
who now are widows or widowers and especially those children who
are fatherless or motherless. To think that “a supernatural
intervention” was brought upon us because “the world
was becoming a modern-day Sodom and Gomorrah” is not only
heartless but also absurd and offensive.
I would like to hope that as practitioners of medicine, anesthesiologists
would be among the most compassionate of physicians. We treat
the sickest of the sick in the intensive care unit, we alleviate
and sometimes even cure acute and chronic pain, we assure scared
children that their operations will not hurt, and we are at the
mother’s side during the joy of childbirth.
I am very sad to see the ASA NEWSLETTER promote the idea
that we “deserved our punishment.” This newsletter and
your editorials have provided me many insights and offered me
timely news for the past three years and has been a valuable resource
for me. However, this editorial was heartless and uncompassionate,
completely unrepresentative of what I, and hopefully ASA, value.
Grant C. Lynde, M.D.
Rockville, Maryland
A Genesis of Religious Opinions?
Having become accustomed to the insight and rationality of Dr.
Lema’s monthly editorials, I was shocked by his religiously
biased conjectures concerning the events of September 11, 2001,
in the October “Ventilations.” These are certainly opinions
to which he is entitled, but the use of them as a preface to the
ASA NEWSLETTER is tantamount to reducing this publication
to the propagation of personal religious ideas. I question the
use of this NEWSLETTER as a forum for religious thought
and hope that Dr. Lema’s editorial does not become precedential.
Betty H. Johnson, M.D.
Wilmington, North Carolina
Whose God Will Win New War?
In your October 2001 “Ventilations,” you talk about
the events of September 11 being a message to our society to change
its direction, to re-emphasize “religion, community and afterlife.”
Well and good, but isn’t that just what our adversaries are
fighting for? I think we have to be quite precise about our aims,
otherwise, we risk turning into a Western version of the Taliban.
Bigotry and chauvinism aren’t the sole reserve of Muslim
terrorists after all. Aren’t almost all wars fought for religion
(broadly defined) or economics, God or land?
Sanford M. Miller, M.D.
New York, New York
God Will Heal Our Nation
Thanks for your comments in the October 2001 “Ventilations.”
I agree with you and Kurt Becker [Executive Director of the New
York State Society of Anesthesiologists]. I thought that you might
find this quote from the Bible to be somewhat prophetic in view
of your remarks.
“If My people, who are called by My name, will humble themselves
and pray and seek My face and turn from their wicked ways, then
will I hear from heaven and will forgive their sin and will heal
their land.” 2 Chronicles 7: 14.
May God bless this nation.
Daniel C. Mitchell, M.D.
Long Grove, Illinois
Editor’s Religious Claims in Need
of Disclaimer
It was with growing dismay that I read “Ventilations”
in the October 2001 issue of the ASA NEWSLETTER. While
I support Dr. Lema’s right to express his religious views,
I highly doubt that the editorial page of the official newsletter
of our Society was the proper place for him to espouse them.
Dr. Lema’s message seems peripheral at best to “general
topics and current issues affecting anesthesiology.” Because
of its prominent position in the issue, and because its relation
to the practice of medicine or the professional business of our
Society is far from clear, it is too easily taken for an “ex
cathedra” statement despite the disclaimer “the views
expressed herein are those of the authors” in fine print
on the inside front cover.
Your faith is your own, as mine is my own, and I do not begrudge
you the chance to find a forum for your views. But again, I feel
that your editorial was too easily mistaken for an official position
of ASA. At minimum, a firmer disclaimer to this effect was in
order.
F. Todd Tamburine, M.D.
Hollister, California
‘Ventilations’ a Revelation
to Reader
In the October 2001 NEWSLETTER, Dr. Lema’s “Ventilations”
crossed the line from conservative musing to fringe rant. In decrying
that “the world was becoming a modern-day Sodom and Gomorrah,”
he puts himself squarely in Jerry Falwell’s theater where
“Good and Evil” take center stage and become a substitute
for the complexity most of us recognize as human behavior. Confronted
with the responsibility of analysis, Dr. Lema abandons a rational
and historical perspective for a “biblical” one. Those
of us out here in this messy, open society expect more depth from
our leaders in the anesthesia community and elsewhere. If Dr.
Lema is not up to the task, I suggest he confine his attentions
to matters where he has already demonstrated great personal knowledge
and experience, e.g., keeping the world safe from the casually
attired physician.
Brian J. Marsh, M.D.
Portland, Oregon
Are Drs. Falwell and Lema on Same Page?
Your October “Ventilations” contains references to
religious views that I feel have no place in the publication.
I do not object because I am not nonreligious, but the thinking
is incomplete. Though your views are milder than those of Dr.
Jerry Falwell, they are of the same sort. Both failed to carry
the thinking to the next level. If there was a divine reaction
to the social status, there would be a recognition that (actively
or passively) God is backing mass murderers. I think this would
be offensive to any with even mild religious feelings. Similarly,
if you blame Satan, you again downgrade God to at best the same
level as Satan, if not lesser.
Name withheld on request
NEWSLETTER No Place
for God
I have always enjoyed the insightful viewpoints of Dr. Lema’s
“Ventilations.” Moreover, I wholeheartedly endorse his
message regarding morality and medicine in the October issue.
While it is necessary to discuss politics in this publication,
there was no reason to broach the subject of religion.
I do not want to open the official newsletter of ASA and find
proselytizing. While references to “God,” “Satan
incarnate,” “faith-shaking assaults” and “God
displaying displeasure” should not be prohibited, it was
not necessary for Dr. Lema to invoke these phrases to make his
point.
It should not be necessary to propose a resolution that “separation
of church and ASA” be added to the agenda at the next Annual
Meeting, but I ask that Dr. Lema show some restraint regarding
the above. As a New York City native, I would say that the acts
of September 11 were barbaric, groundless and misguided and inflicted
untold misery on our population. I would go so far as to say that
we as a people should hunt down the perpetrators and their allies
and give them their just desserts. I would stop short of discussing
religion in our newsletter, however. There is enough division
in ASA without introducing an inflammatory topic unnecessarily.
Keep up the good work, Dr. Lema!
David M. Glener, M.D.
Palm City, Florida
The views and opinions expressed in the “Letters
to the Editor” are those of the authors and do not necessarily
reflect the views of ASA or the NEWSLETTER Editorial Board. Letters
submitted for consideration should not exceed 300 words in length.
The Editor has the authority to accept or reject any letter submitted
for publication. Personal correspondence to the Editor by letter
or e-mail must be clearly indicated as “Not for Publication”
by the sender. Letters must be signed (although name may be withheld
on request) and are subject to editing and abridgment.
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