Teen Surgery Tragedy: How You Can Protect Yourself from MH
Press release by Darshan Shah, MD, Plastic and Reconstructive Surgeon
With family and friends still in shock after the death of a Florida teen during breast surgery, plastic surgeons are speaking out to educate the public about malignant hyperthermia (MH)…and why your best protection is choosing an accredited facility as well as a surgeon and support staff trained in emergency procedures.
Bakersfield, CA, April 2, 2008—Amidst the shock and sorrow surrounding the recent death of Florida high school senior, Stephanie Kuleba, leaders in the plastic surgery community are speaking out in an effort to educate the public as to what went wrong and how patients can ensure their own safety during surgical procedures.
What went wrong?
According to ABC News, 18-year-old Kuleba was undergoing surgery at an outpatient center in Boca Raton, FL in an effort to correct asymmetrical breasts and an inverted areola. Nearly two hours into the procedure, she developed symptoms of the rare, malignant hyperthermia (MH) and was rushed to nearby Delray Medical Center, where she passed away 24 hours later.
What is malignant hyperthermia (MH)?
According to information distributed by the Accreditation Association for Ambulatory Health Care (AAAHC), malignant hyperthermia is an extremely rare, inherited disorder that is triggered by agents found in the anesthesia used in surgical procedures; one of its most recognizable symptoms is a body temperature that can reach up to 110 degrees Fahrenheit. While most surgeons have never encountered a case, if it is triggered, and the proper protocol is not followed, MH can result in rapid death.
Averting tragedy
As explained by MSNBC.com, “There is an antidote called Dantrolene that can reverse the effects of malignant hyperthermia if administered in proper dosages in a timely fashion. An autopsy report on Stephanie has not been completed and the cause of death has not been officially listed, but the family’s attorney, Roberto Stanziale, said that her doctor, Steven Schuster, and anesthesiologist, Dr. Peter Warheit, administered one dose of Dantrolene when at least eight doses of the drug were required.”
Leading surgeons, like Dr. Darshan Shah, of Beautologie by Dr. Shah in Bakersfield, California, want the public to understand that checking the facility where the surgery will be performed is equally as important as researching your doctor. “There has been so much attention focused on the certifications and training of the surgeon, which is of course a step in the right direction. However, no one is talking about the accreditation of the surgery facility itself, the support staff, or the training of the surgeon in ambulatory (or emergency) procedures and protocol.”
According to Shah, any doctor performing surgery in an outpatient surgery center should be trained in emergency procedures, and the center itself should be accredited by the AAAHC or other national certifying organization. Since determinative pre-screening requires a muscle biopsy (which is not routinely administered unless a genetic disposition is uncovered), centers need to be skilled in trauma protocol in the rare event that MH was to occur during the course of surgery. In the Kuleba case for example, the surgeon and anesthesiologist would have been trained to recognize the initial signs of MH as well as how and when to treat, nurses would have been properly trained and familiar with administration of Dantrolene, and the center would have been equipped with the necessary amount of the lifesaving antidote.
Safe surgery centers
Professionals like Shah feel it is unfortunate that it takes a tragedy of this nature to bring awareness to the importance of proper emergency training and surgery center accreditation. Surgery centers provide many benefits not offered by traditional hospital settings—including a germ-free environment, privacy, no risk of cosmetic surgeries being rescheduled due to emergency (involuntary) procedures, and a staff trained to provide a superior level of personal care; however, some centers do not have the same emergency procedures in place that one would find in a hospital…which is where certification comes into play.
Protecting against MH—what does it mean to be accredited by the AAAHC?
Medical facilities, like Beautologie surgery center, which gain AAAHC accreditation have met specific standards, undergone rigorous training (including MH-specific education), and submit to periodic on-site surveys. AAAHC accreditation involves:
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Facility surveys. The surgery center undergoes comprehensive assessment of compliance with the Accreditation Association standards. |
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Site evaluation. At the conclusion of the on-site review, surveyors confer to present their findings to AAAHC national representatives who then comment on the findings, as well as the entire survey itself. Only then does the center receive accreditation. |
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Rigorous training. The center surgeons and support staff participate in months of training, classes, and self-study courses in order to prepare for survey and evaluation.
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Specific MH education. Training includes how to screen for MH, recognizing the first signs, dosing and administering the antidote, and other lifesaving information regarding malignant hyperthermia. |
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Emergency MH drills. Vigilant facilities, such as Beautologie surgery center, choose to conduct practice exercises to ensure that all staff members are fully prepared in the unlikely event that a patient displays signs of MH. |
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Pre-operative screening for MH. Risk evaluation is done by questioning all patients preoperatively about their past surgical experiences and any relatives who have had, or may have had, malignant hyperthermia or its symptoms. Anyone who is determined to be at risk would be referred out for the muscle biopsy. |
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Ambulatory-trained staff. The support staff participates in the overall emergency training as well as periodic MH drills. Certain centers, like Beautologie, go above and beyond by only employing actual emergency room trauma nurses in their surgery suite. |
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Trauma equipment. Beautologie and other accredited surgery centers house the same emergency equipment as hospitals, enabling them to save a person’s life in catastrophic situations such as MH. |
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Follow-up surveys to maintain accreditation. Emergency/ambulatory accreditation is not a one-time event. Centers who meet the stringent standards for accreditation must submit to follow-up visits at least once every three years to ensure continued compliance. |
The truth of the situation is that while malignant hyperthermia is extremely rare, one death is one too many. According to Dr. Shah, the good news for the public is that they need not rely on the rarity of the condition for protection: “Plastic and reconstructive procedures continue to be very safe…as long as you research both the surgeon as well as the ability of the center as a whole to handle an emergency such as MH.”
For more information on the Accreditation Association for Ambulatory Health Care (AAAHC), visit www.AAAHC.org.
To speak to Dr. Shah or a member of his team, or to schedule a free consultation to discuss whether cosmetic surgery is a viable option for you, call (661) 865-5009 or visit www.drshah.com for a preliminary virtual consultation.
Dr. Darshan Shah, MD, FACS, is one of the industry’s most widely respected plastic and reconstructive surgeons. With offices in Bakersfield and Beverly Hills, California, he specializes in breast and body procedures including tummy tucks, liposuction, breast augmentation, and breast lifts. Dr. Shah’s credentials include Board Certification by the American College of Surgeons (FACS) and specialized training in Plastic and Reconstructive Surgery at the prestigious Mayo Clinic. His extensive training, combined with the experience of over 8000 surgical procedures, has earned him the “Best in Bakersfield” title in 2005, 2006, and 2007. At the Kern Medical Center—University of California, San Diego, his work in breast cancer surgery earned him the Helfert award, given only to the most outstanding surgical chief resident; he is currently ranked among the top 10 breast augmentation surgeons statewide and has been featured on television shows including “Dr. Phil Show,” “Cutting Edge MDs 3,” “Extreme Makeover,” and “The Wellness Hour” as well as in numerous magazine and newspaper articles.
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