Questions linger in Fishbein death

By Bill Scanlon, Rocky Mountain News (Contact)

Originally published 09:22 a.m., May 2, 2008
Updated 11:44 p.m., May 2, 2008

Leslie Ann Fishbein, 55, died two weeks after going into cardiac arrest.

The family of Leslie Fishbein will continue to investigate whether her death was caused by substandard care, a lawyer for the family said Friday, one day after the Denver medical examiner categorized the death as accidental.

Fishbein, 55, longtime TV spokeswoman for the family business Kacey Fine Furniture, died March 19, two weeks after suffering seizures when a doctor injected her spine with pain medication.

"The autopsy says her death was accidental, but that simply means the doctor didn't intend for her to die," attorney Jim Leventhal said.

"They didn't even make an attempt to see whether her death was a result of substandard care," he said, noting that that is not a coroner's job.

"Did he put the needle someplace it shouldn't be? That would be accidental, but still substandard care," which could spark a lawsuit, Leventhal said.

Leventhal says he needs to examine Fishbein's medical records to see if the doctor followed the instructions on the label of Marcaine, the pain medication, and decide whether to recommend to family members that they file a suit.

"Anybody who says this was just an accident doesn't get it," Leventhal said.

Denver Medical Examiner Dr. Amy Martin noted that while uncommon, injections in the spine have been known to lead to cardiac arrest.

She also said that Fishbein's low level of potassium might have contributed to the problems leading to her death.

The low potassium level, called hypokalemia, is associated with paralysis, muscle weakness and a greater risk for arrhythmia and heart problems.

• May 2, 2008

  10:16 a.m.

  Suggest removal

  socialobserver writes:

  I posted this blog with regards to an earlier story of the coroner’s report; before the story was updated to reflect the family of Ms. Fishbein is continuing its investigation into her death.

  Although I understand the mechanism of Ms. Fishbein's death, there is one important facet I've failed to read in any account of her unfortunate passing. This unreported facet was confirmed by the investigation Jim Leventhal, the attorney representing the Fishbein’s, is now conducting.

  As someone who works in medicine, I have encountered medical offices that perform in-office procedures, but are yet unprepared for adverse, life-threatening emergencies. Did the office that treated Ms. Fishbein have an appropriately stocked crash cart at hand, replete with all the required cardiac arrest/arrhythmia medications; ambu-bag; and defibrillator? Was Ms. Fishbein’s physician and his/her staff properly trained in resuscitation procedures?

  I would not only advocate further investigation into Ms. Fishbein's death, i.e., was the office prepared for such life threatening emergencies, I would advocate to ANYONE -- regardless of the procedure they're having performed in a medical office -- to query the office regarding their emergency response preparedness. Do they have a crash cart? Do they have all the appropriate medications at hand; are such medications within their expiration date? Has their defibrillator been calibrated and checked per manufacturer schedule? What training has the staff received, i.e., CPR, to deal with such emergencies?

  Although any in-office procedure may appear innocent and harmless at face value, it still behooves all of us to know – should an emergency arise – the office is fully prepared and trained to handle it. In a day and age when physicians are scrambling to find other means to create revenue lost through insurance reimbursement, we often find ourselves at their mercy…performing procedures they’re ill-prepared to perform; outside the realm of their expertise; unable to respond to life-threatening emergencies.

  I wonder if the office that treated Ms. Fishbein was prepared to handle the adverse reaction she experienced from the Marcaine injection she received?

• May 2, 2008

  10:48 a.m.

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  buzzman writes:

  They have a case--no crash cart-guaranteed.
  A baseline serology would have been appropriate every 6 months-

• May 2, 2008

  11:04 a.m.

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  Queen_Gorgo writes:

  buzzman,

  You sound like quite the expert. Are you a paid plaintiff's witness by any chance? How can you GUARANTEE there was no crash cart when you don't even know the difference between serology and chemistry?

• May 2, 2008

  11:50 a.m.

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  socialobserver writes:

  I have no doubt an appropriate investigation will determine whether or not a crash cart was at hand, whether or not the physician/staff was appropriately trained in emergency resuscitation procedures; whether or not the physician followed the IFU (Instructions For Use Sheet) provided by the manufacturer of Marcaine. Given the previous omission in the media of other potentially extenuating circumstances, I am glad to hear the Fishbein family is indeed investigating the circumstances surrounding her death further. My heart goes out to them during this time of tragic loss.

  Buzzman, you raise a valid point. Why wasn't Ms. Fishbein's potassium level determined prior to her Marcaine injection?

  Because -- unless the IFU that accompanies medical devices and medications -- in this case Marcaine -- indicated the necessity for such pre-screening procedures -- physicians would not be obligated to perform such pre-screening tests. Furthermore, if this pre-screening weren’t indicated for the administration of Marcaine, would the insurance companies reimburse for pre-screening, or....would it be the responsibility of the consumer to pay out-of-pocket? Undoubtedly, few insurers would pay for this pre-screening test, especially if the incidence of the type of reaction Ms. Fishbein experienced is indeed not very common. From the insurer level, such widespread pre-screening (for any number of procedures) would undoubtedly have a direct impact on the ever-escalating medical costs we as consumers face. If it came down to the consumer having to pay for it, how many actually would (or could afford to)?

  The facts of this case, as they become better known, should indeed prove quite telling and interesting. I for one will be following further developments closely; what further investigation uncovers and determines.

  In the meantime, I again urge those considering in-office procedures to assess the risk they're taking, and to do everything possible to know what those risks are; how the office is prepared to handle any potential complications should such arise during their procedure. As the paradigm of medical care has shifted significantly over the years to the consumer, it is our responsibility to know what risk we’re putting ourselves at; to offset that risk however possible through knowledge and positing the appropriate questions to the health care professionals we entrust with our lives.

• May 2, 2008

  12:10 p.m.

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  LazyR writes:

  The safest way to administer those drugs is in a hospital setting. Even properly trained professionals can do a poor job of resuscitation if they rarely or have never done it.

• May 2, 2008

  12:15 p.m.

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  socialobserver writes:

  LazyR. Good counterpoint. But until the day comes when procedures such as these are required to be performed in a hospital setting (don't hold your breath waiting), we as consumers need to remain as vigilant as possible.

• May 2, 2008

  12:15 p.m.

  Suggest removal

  Seabreezes writes:

  I don't know about here, but in Texas (at least 3 years ago), Dr offices were required to have a crash cart no more than 40 feet from their office. You go in to have a pimple removed by the dermatologist, there's a cart outside the door....just in case. I'm so sorry for Leslie's family.

• May 2, 2008

  1:17 p.m.

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  socialobserver writes:

  Hi Seabreezes. I don't know what the requirements are here in Colorardo, but it would certainly behoove our legislature to investigate them. Should no legislative requirements exist in Colorado, the legislature should enact laws that requires ANY medical office performing in-office procedures to have a crash cart readily available at all times, it is properly stocked, and any/all applicable office personnel are well-trained in emergency resuscitative procedures. Furthermore, such legislation should allow for spot checks to ensure all such offices are compliant at any given time.

• May 2, 2008

  6:47 p.m.

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  lissmth writes:

  What needs to be investigated is why her potassium was so low. Somebody was missing something in her medical care. There are medical conditions that cause low potassium.

• May 3, 2008

  9:06 a.m.

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  Vector049 writes:

  Litigation, n. A machine which you go into as a pig and come out of as a sausage.
  A. Bierce (1842-1914?), The Devil's Dictionary

  May this sweet lady Rest in Peace.