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January 16, 2013

BehindTheMedspeak: Why PCA (Patient-Controlled Analgesia) is a failed technology

Long story short: It kills people.

No medical advance — no matter how much relief and improvement in overall well-being it brings to the many — is worth subjecting a healthy person to the risk of death as collateral damage to benefitting a far larger cohort.

PCA pumps fail.

They malfunction.

They are computer-driven.

Software glitches occur.

Not to mention mechanical breakdowns and health-care practitioners — doctors and nurses — ignoring or overriding limits as well as the routine practice of disabling alarms and fail-safes.

I've reviewed too many medical records in the course of seven- and eight-figure lawsuits to remain silent any longer.

So let me say it again: PCA (patient-controlled analgesia) is a failed technology.

I wouldn't use it or let a loved one have it if it were my call.

I don't care much HOW MUCH it hurts: morphine worked fine for the Greeks and Romans and 10mg IM will still work perfectly well on Mars.

Caveat doctor.

January 16, 2013 at 04:01 PM | Permalink


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Considering patient satisfaction surveys are going to decide how much a hospital gets reimbursed, it's gonna be tough to leave them in pain and go bankrupt. Patients should have better expectations that if your body gets cut by a scalpel, you're not going to be pain free afterwards. Either way, to be cynical, a 7 figure lawsuit sounds like it was a pretty soft case and probably easier to settle. I feel that like with anything in the hospital, anything can be problematic if not used properly.

Posted by: ismelllikepoop | Jan 17, 2013 5:49:28 PM

Never been on one myself. I have had my spouse and my mother-in-law on PCA pumps. Just like their predecessor devices like the ivac and imed pumps (way old - I'm long out of the field) failure is always a possibility.

How the failure takes place is the issue. Failing to administer is one class of error. Failing to administer the proper dose is another class of error. With the first class of error you wind up with a patient in pain. With the second class you may have a patient with enough CNS suppression that they respiratory arrest. I'm betting that the second class is the one that you are referring to, Joe.

Now we face a few problems with the interaction of law and medicine: Congress passed and the Executive signed into law immunity from liability for FDA approved medical devices. Toss the "Class Action Fairness Act" into the mix (hint: that act isn't fair) and you will continue to see individual suits for the rest of your life.

Few of the BOJ readers are aware of the nature and scope of Anestheasia practice. You are the expert's expert where pain is concerned.

I'll decline the PCA on your sound advice.

Posted by: 6.02*10^23 | Jan 16, 2013 5:54:12 PM

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