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(NYPost)   Incompetent doctor on an NCL cruise ship caused an employee to require amputation   ( nypost.com) divider line
    More: Scary, Cruise ship, Loncar, Intravenous therapy, Loncar's arm, Ilija Loncar, cruise ship, Pharmacology, Cruise ship doctor  
•       •       •

6013 clicks; posted to Main » on 14 Sep 2018 at 8:39 PM (11 days ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2018-09-14 06:58:01 PM  
You don't generally end up working on a cruise ship by being the best doc around.
 
2018-09-14 07:16:27 PM  
I have some friends who love going on cruises, and come back sick every time. One of them picked up something that took 18 months and massive antibiotics to cure. No, nope, and hell no.
 
2018-09-14 07:23:55 PM  
Sorry, saw NCL and immediately thought about the Federation New Light Cruiser from Star Fleef Battles.  And the leader variant, the light lemon.
That games was never as fun as I wanted it to be, but damn I wasted many an afternoon looking at SSDs and dreaming of battles.
/NCL also means Norwegian Cruise Line
 
2018-09-14 07:40:07 PM  
Finally, an article that I don't have to guess what dumbass medical mistake or fubar was made. There is/was a holy hell ton of shiatbag mistakes and poor care from all of the "medical" staff aboard that ship.
Promethazine is an oldy but goody drug that is perfect for select circumstances, BUT, is rarely used in modern health care when other drugs are safer and better. In this case the "doctor" was so stupid and the mistakes of injecting it into an farking artery would make a beautiful lawsuit almost anywhere. Even Dimenhydrinate (gravol) could have been tried before the more expensive Zofran.
What a cluster.
Lastly, I don't cruise simply because of being trapped with a thousand humans in a confined space where simple handwashing is probably not practiced. Ugh.
 
2018-09-14 07:45:37 PM  
Please, if you go on NCL, talk them into upgrading to a "free" drink package and live of the watered down alcohol on the cruise ship.  Only eat at restaurants in port, and you'll have a much better cruise.

\never got sick on NCL
\\two cruises with them
\\\Baltic was the best
 
2018-09-14 08:03:13 PM  
Ilija Loncar was employed as a waiter

img.fark.netView Full Size


he'll get his revenge
 
2018-09-14 08:27:19 PM  
Shouldn't have shaved his belly with a rusty razor
 
2018-09-14 08:42:19 PM  
img.fark.netView Full Size
 
2018-09-14 08:48:05 PM  
Serbian waiter on cruise line....

New doctor from Colombia...

3.3million in Miami.

Well done guys. All it took was half an arm. Welcome to America!
 
2018-09-14 08:48:12 PM  
I took a cruise on that ship in 2016 and I still have all my limbs.

Same ship where a crewmember was killed during a lifeboat drill.
 
2018-09-14 08:51:58 PM  
Cruse Ship Doctors are Cruse Ship Doctors because they suck so bad no one else will hire them.
 
2018-09-14 08:55:22 PM  

Hagbardr: I took a cruise on that ship in 2016 and I still have all my limbs.

Same ship where a crewmember was killed during a lifeboat drill.


maybe part of the drill was recovering dead bodies??
 
2018-09-14 08:56:06 PM  

WeedBong420: 3.3million in Miami.

Well done guys. All it took was half an arm. Welcome to America!


$3.3 million award from an arbitrator, presumably as part of a clause in a contract designed to screw employees with the arbitrator selected and paid for by the company. That's amazing!
 
2018-09-14 08:57:24 PM  
Enjoy the rest of the cruise!

media.giphy.comView Full Size
 
2018-09-14 09:02:10 PM  

mrmopar5287: WeedBong420: 3.3million in Miami.

Well done guys. All it took was half an arm. Welcome to America!

$3.3 million award from an arbitrator, presumably as part of a clause in a contract designed to screw employees with the arbitrator selected and paid for by the company. That's amazing!


a step up from an arbitrator from whatever flag of convenience they use
 
2018-09-14 09:02:24 PM  

dougermouse: Sorry, saw NCL and immediately thought about the Federation New Light Cruiser from Star Fleef Battles.  And the leader variant, the light lemon.
That games was never as fun as I wanted it to be, but damn I wasted many an afternoon looking at SSDs and dreaming of battles.
/NCL also means Norwegian Cruise Line


Star Fleef?
 
2018-09-14 09:06:45 PM  
Only 3.3 million? For multiple instances of gross negligence resulting in a life-threatening illness and loss of a limb?
 
2018-09-14 09:06:59 PM  
Think the doc visits his med school alma mater on Caribbean ports of call?
 
2018-09-14 09:07:38 PM  
What is NCL? Is that like CSI?

CSI: Miami
CSI: Las Vegas
CSI: NY
CSI: Cruise Ship
 
2018-09-14 09:07:53 PM  
Well, thanks for this submission.  I've been dreading any cruise just because I believe I'll be the special friend of an insurance sales representative.  Now, I have a second thing to worry about.   (The insurance people are still at the top.)
img.fark.netView Full Size
 
2018-09-14 09:09:36 PM  
img.fark.netView Full Size
 
2018-09-14 09:14:55 PM  
Did the cruise company cut relations with the doctor ?
 
2018-09-14 09:18:53 PM  
Good thing the guy didn't have a headache.
 
2018-09-14 09:22:14 PM  

not enough beer: You don't generally end up working on a cruise ship by being the best doc around.


stuffy: Cruse Ship Doctors are Cruse Ship Doctors because they suck so bad no one else will hire them.


What's the deal here? Do cruise companies just not want to pay appropriate salaries for doctors, or is there some industry wide contest for who can find the worst one?
 
2018-09-14 09:22:37 PM  

Dead for Tax Reasons: mrmopar5287: WeedBong420: 3.3million in Miami.

Well done guys. All it took was half an arm. Welcome to America!

$3.3 million award from an arbitrator, presumably as part of a clause in a contract designed to screw employees with the arbitrator selected and paid for by the company. That's amazing!

a step up from an arbitrator from whatever flag of convenience they use


I'm surprised something from admiralty law wasn't dredged up to something vessel on navigable waters something gold fringe on the flag something not liable because something.
 
2018-09-14 09:27:10 PM  

mrmopar5287: WeedBong420: 3.3million in Miami.

Well done guys. All it took was half an arm. Welcome to America!

$3.3 million award from an arbitrator, presumably as part of a clause in a contract designed to screw employees with the arbitrator selected and paid for by the company. That's amazing!


Geez, I'd give my right arm for $3.3 million.

... wait.
 
2018-09-14 09:29:17 PM  
The drug had also allegedly been injected intravenously into Loncar's arm, instead of intramuscularly in his buttocks, which is the recommended technique.

Sounds like the arm was a best case scenario if the massive dose resulted in amputation. Hemispherectomy otherwise?
 
2018-09-14 09:31:03 PM  

Dead for Tax Reasons: [img.fark.net image 454x384]


Username checks out.
 
2018-09-14 09:38:45 PM  
"... Oracion missed the median cubital vein altogether and instead injected the drug into the ulnar artery in that forearm ..."

The defense argued that Loncar had a "venous anomaly" which made him vulnerable to the reaction he suffered.


It is highly unlikely that anybody would mistake the ulnar artery for the medial cubital vein.

The brachial artery usually branches off into the radial and ulnar arteries a bit more distal than that location, but there's some anatomic variability.

The vein is superficial. The typical ulnar artery is not only deep to the vein, it's also deep to the more superficial flexor musculature, so an airball into the ulnar artery would be a significant miss.

I'll concede I've seen a few ulnar arteries at the elbow/proximal firearm with unusually proximal takeoffs, and that those are unusually superficial, but they've always been subfascial (i.e. within the muscular compartment) so still unlikely to be mistaken for a vein.

And finally, arterial pressure would have caused sanguineous backfill in a syringe; unless the patient's blood pressure were unusually low, and/or the doc were using a very small gauge needle, that would be a tip-off.
 
2018-09-14 09:41:38 PM  

Hagbardr: I took a cruise on that ship in 2016 and I still have all my limbs.

Same ship where a crewmember was killed during a lifeboat drill.
---


omg - how did he/she get killed during a lifeboat drill?
 
2018-09-14 09:43:46 PM  
The drug had also allegedly been injected intravenously into Loncar's arm, instead of intramuscularly in his buttocks, which is the recommended technique.

The answer is always butt stuff. If only they had done the butt stuff.
 
2018-09-14 09:48:41 PM  

Dead for Tax Reasons: [img.fark.net image 454x384]


I don't even think Dr. Nick would give an IM drug by IV.
 
2018-09-14 09:53:54 PM  

nanim: Hagbardr: I took a cruise on that ship in 2016 and I still have all my limbs.

Same ship where a crewmember was killed during a lifeboat drill.
---

omg - how did he/she get killed during a lifeboat drill?


The sacrifice to the gods of safety and the sea.
 
2018-09-14 09:54:56 PM  
He was on a ship called the breakaway, which is what kinda happened to his arm.
 
2018-09-14 09:56:03 PM  

Nidiot: not enough beer: You don't generally end up working on a cruise ship by being the best doc around.

stuffy: Cruse Ship Doctors are Cruse Ship Doctors because they suck so bad no one else will hire them.

What's the deal here? Do cruise companies just not want to pay appropriate salaries for doctors, or is there some industry wide contest for who can find the worst one?


Whynotboth.jpg
 
2018-09-14 10:10:40 PM  

nanim: Hagbardr: I took a cruise on that ship in 2016 and I still have all my limbs.

Same ship where a crewmember was killed during a lifeboat drill.
---

omg - how did he/she get killed during a lifeboat drill?


Applied the wrong definition of drill.
 
drp
2018-09-14 10:14:11 PM  

Dumski: Finally, an article that I don't have to guess what dumbass medical mistake or fubar was made. There is/was a holy hell ton of shiatbag mistakes and poor care from all of the "medical" staff aboard that ship.
Promethazine is an oldy but goody drug that is perfect for select circumstances, BUT, is rarely used in modern health care when other drugs are safer and better. In this case the "doctor" was so stupid and the mistakes of injecting it into an farking artery would make a beautiful lawsuit almost anywhere. Even Dimenhydrinate (gravol) could have been tried before the more expensive Zofran.
What a cluster.


That's overstating things a little. The lawyer's allegation that the drug was unsuitable is bullshiat, as is 98% of everything any plaintiff lawyer says in any malpractice suit.

Promethazine is in the standard postop order set for nausea in every hospital I work in. The usual place I work, the default dose and route are 12.5 mg IV. I always edit the order to 6.25 mg, and direct it to be diluted and given through a free-flowing IV - but that's more defensive medicine than anything indicated by actual data. I'll grant that 25 mg is a big dose, but it's not outrageous. The main reason we don't use that much routinely is because it's a very sedating drug. If you look up all of the really horrible case reports, the vast majority are intra-arterial injections. Nobody loses an arm because a venous or extravasation injury.

Anyway, it's an excellent drug. Cheap, and very effective. Ondansetron/Zofran is the typical first line drug, but after that, there isn't much else that's really very good.

Droperidol used to be great, until the FDA put that bullshiat black box warning on it, and these days most hospitals won't stock it. Haldol is a nice alternative, but unfortunately it freaks out most nurses when you order it for nausea. Scopalamine patches are OK, but they make people loopy and give them blurry vision. All of these drugs are sedating, which limits their usefulness.

Anyway. Promethazine is an excellent drug, if you don't inject it into an artery.
 
2018-09-14 10:17:30 PM  
What do you call the person who graduates last in his medical class? Doctor.
 
2018-09-14 10:19:21 PM  
Cruise ships have a certain reputation for being health cae hell-holes, and disease incubators for a reason.
 
2018-09-14 10:20:38 PM  
cae = care = too much whiskey = lack of typing and/or spelling skilz.
 
2018-09-14 10:20:52 PM  

Jgok: Only 3.3 million? For multiple instances of gross negligence resulting in a life-threatening illness and loss of a limb?


Some people don't get 3.3 million for dying. That seems like a considerable amount for an arm.
 
drp
2018-09-14 10:22:49 PM  
Russ1642:I don't even think Dr. Nick would give an IM drug by IV.

It's not an IM drug. First two vials, you can't see the whole label, but the third one clearly states "deep IM or IV use". The fourth one has double the concentration (50 mg/mL) and shouldn't be given IV.

img.fark.netView Full Size


Label showing "for deep intramuscular or intravenous use":
img.fark.netView Full Size
 
drp
2018-09-14 10:30:15 PM  

cantsleep: What do you call the person who graduates last in his medical class? Doctor.


These days there aren't enough residency positions to go around, so odds are good that guy won't be able to finish training. You can't get a medical license in the USA without at least an internship, and many states two years of residency to be eligible for a license.

You can still call him doctor, though, but it'd be the way you'd call a bum in the park "sir" ...

:-)
 
2018-09-14 10:34:46 PM  
eteknix-eteknixltd.netdna-ssl.comView Full Size
 
2018-09-14 10:46:24 PM  

WeedBong420: Serbian waiter on cruise line....

New doctor from Colombia...

3.3million in Miami.

Well done guys. All it took was half an arm. Welcome to America!


FTA: "The doctor, Sebastian Campuzano, had been hired by the cruise line just a few months prior and was described as a "young, inexperienced, Columbia-trained physician."

I'm glad to see Farkers know better than the writer the difference between Columbia and Colombia
 
2018-09-14 10:47:30 PM  
At least the doctor had a good bedside manner, with a disarming smile.
 
2018-09-14 11:02:42 PM  
Star Fleet Battles, just in case anybody still cares.
 
2018-09-14 11:05:31 PM  
i.imgur.comView Full Size

i.pinimg.comView Full Size
 
2018-09-14 11:06:04 PM  

drp: Dumski: Finally, an article that I don't have to guess what dumbass medical mistake or fubar was made. There is/was a holy hell ton of shiatbag mistakes and poor care from all of the "medical" staff aboard that ship.
Promethazine is an oldy but goody drug that is perfect for select circumstances, BUT, is rarely used in modern health care when other drugs are safer and better. In this case the "doctor" was so stupid and the mistakes of injecting it into an farking artery would make a beautiful lawsuit almost anywhere. Even Dimenhydrinate (gravol) could have been tried before the more expensive Zofran.
What a cluster.

That's overstating things a little. The lawyer's allegation that the drug was unsuitable is bullshiat, as is 98% of everything any plaintiff lawyer says in any malpractice suit.

Promethazine is in the standard postop order set for nausea in every hospital I work in. The usual place I work, the default dose and route are 12.5 mg IV. I always edit the order to 6.25 mg, and direct it to be diluted and given through a free-flowing IV - but that's more defensive medicine than anything indicated by actual data. I'll grant that 25 mg is a big dose, but it's not outrageous. The main reason we don't use that much routinely is because it's a very sedating drug. If you look up all of the really horrible case reports, the vast majority are intra-arterial injections. Nobody loses an arm because a venous or extravasation injury.

Anyway, it's an excellent drug. Cheap, and very effective. Ondansetron/Zofran is the typical first line drug, but after that, there isn't much else that's really very good.

Droperidol used to be great, until the FDA put that bullshiat black box warning on it, and these days most hospitals won't stock it. Haldol is a nice alternative, but unfortunately it freaks out most nurses when you order it for nausea. Scopalamine patches are OK, but they make people loopy and give them blurry vision. All of these drugs are sedating, which limits their usefulness.

Anyway. Promethazine is an excellent drug, if you don't inject it into an artery.


Yay, someone with a goddamn bit of sense in this thread.  25 mg of IV promethazine is probably a bit much but it's within the standard of care.  I personally try to avoid it because I think it just knocks people out so they stop complaining about their nausea rather than actually fixing their nausea, but that is something that falls more under the art of medicine rather than the science.

What I'm really impressed with is that the guy was able to hit the ulnar artery.  I would probably struggle to do that if I was trying.  Injecting that medicine into their artery is the malpractice, not the rest of their nonsense.

Oh and since I keep getting called out in this thread, hi everybody, etc etc.
 
2018-09-15 12:01:17 AM  
I had a great medical center experience on NCL Pearl, that I previously wrote up on cruise critic.  Excerpted here:

The scene: NCL Pearl, a blustery June Saturday morning on the Pacific Coast of Canada, en route from Ketchikan to Victoria. Our author, well fed and rested after the first six days of his seven day Alaskan voyage, woke much earlier than planned in his mini-suite. He awoke not due to the dulcet tones of his children snoring, or due to the light Pacific swell rocking Pearl's 93,530 Gross Tons too and fro, but due to the throbbing pain in his big toe. The pain, which had first appeared with an inflamed ingrown toenail following Monday's shore excursion in Juneau, had grown familiar over the course of the week. But each day it grew a little worse than the day before. And each day the inflammation spread. Our author walked with annoyance through Skagway. Limped his way around the deck while taking in the sights of Glacier Bay. Then hobbled his way along the incredible shore of Nooya Lake in the Misty Fjords after the float plane ride of a lifetime (thanks Island Wings!). But it was still cruising as normal. 

Then came Saturday morning. Let's just say that healthy toes aren't supposed to seep anything. And they're supposed to bend at the major joints. And not be bigger on one foot than the other. Over night, however, this one had turned the color of red wine, become unbendable, and had gone all...icky -- in ways best not posted on a genteel forum such as Cruise Critic. So, at 8:30 AM, our author left a note for his sleeping family, hopped down the hall to the elevator, and headed down to the uncharted reaches of the medical center on Deck 4 in search of antibiotics and perhaps a bottle of whiskey and a bone saw to cut the darned thing off, Battle of Trafalgar style (non-English naval history types, go look it up). 

Pearl's medical center had all the charm of your typical suburban doctor's office. Without the fish tank or old magazines. But with watertight doors. It was small, impeccably clean, and smelled like...comforting antiseptic things that you use to kill things that make you sick. It was staffed by an incredibly friendly nurse / receptionist, who seemed to understand that most of her clientele tends to freak the heck out when they see the bill at the end of their visit. So she made clear that the visit itself would be $149, in addition to any procedures performed and supplies used, and provided an itemized sheet of all the potential charges. The same sheet is posted on their door. While a person might not be in the best position to do the math at the time they come in, or realize just how many of those boxes might get checked for a single procedure, the pricing was basically transparent [except for the medicine; more on that in a bit].

Enter Dr. A [name protected for privacy, although the dude is a hard core practical skills physician to whom your author owe great thanks and appreciation]. Dr. A took one look at the offending toe -- and yes, it was offending in every sense of the word -- and asked in a Spanish accent that was somehow fitting to the whole triage medicine-on-the-high-seas situation, "So, are you ready for some pain?" Now, those words can be asked in a couple different ways. And not all of those ways come through in print. The way he said it? It was conveyed with warmth and sincerity, and with honesty. It was a subtle message of "I know my business. I know I will fix you. But to fix you, first I must seek out and destroy that which offends you. With cold sharp things. And some pinchy / proddy / yank-y things too."

We went back into the examination room / operating theater / medical storage space. Again clean, well organized, and more like small hospital ER than anything else. A portable X-ray machine stood in one corner. A reclining table stood to the side. Shelves and drawers contained most all of the implements of basic emergency medicine. There was even a drawer labeled with what seemed to be intubation supplies. Not that anyone wants to be intubated at sea, but hey sometimes there's no choosing these things. 

Dr. A went to work. Bigly. He communicated well about what was to occur next. He tried less invasive things, before going to more invasive. He tried without having to numb the toe first, because that was a separate line item on the bill [more on that later too]. He delivered on the pain. And he dug out the infection. Your author was not, in any respect, ready. As the people on Deck 7 likely heard. Anyone on the June 25 sailing of Pearl who heard shrieks on the last day at sea? Yeah, my bad. 

Within 24 hours, though, and after some hard core oral antibiotics and an antibiotic topical creme, the offending toe, partially nail-less, no longer offended. It only whimpered softly under its band-aid. Its removal was no longer contemplated. Nor was death at sea from sepsis. Thanks again, Dr. A!

[Final cost was $979, all covered by my AIG trip insurance.   The toe healed really well.]
 
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