Note: The original headline incorrectly stated Dr. Spillers had admitted to using Facebook and texting during Milne's surgery. It has been changed to more accurately reflect his testimony.
Mary Roseann Milne, 61, checked into Medical City Dallas on April 13, 2011 for an operation to correct an irregular heartbeat. The procedure, an AV node ablation, is routine, at least as far as heart surgeries go, but something went wrong. Ten hours after her surgery began, Milne was pronounced dead.
The family has filed a medical malpractice suit against Medical City and two individual doctors involved in the procedure: surgeon Dr. Robert Rinkenberger and anesthesiologist Dr. Christopher Spillers. It's set to go before a Dallas County jury in September.
One of the claims the jury will decide is whether Milne was a victim of "distracted doctoring" on the part of Spillers, a point that was pushed hard by the family's attorney, Maria Wormington, during depositions in the case. The depositions provide a clear window into the roles personal technology and social media can play in the operating room.
In her interrogation of surgeon Rinkenberger, he said that Spillers, the anesthesiologist, failed to notice Milne's dangerously low blood-oxygen levels until "15 or 20 minutes" after she turned blue. Until then, Rinkenberger said, Spillers had provided numbers showing that the patient's blood-oxygen levels were normal.
From the deposition:
Rinkenberger: I think the saturations as written are incorrect.
Wormnington: Do you think Dr. Spillers made them up?
R: Most likely.
W: Why would he do that?
R: Don't know.
W: Was he reading a book or talking on the phone or surfing the internet when he was managing Mrs. Milne's anesthesia?
W: Tell me all of the things he was doing.
R: I don't know. I was busy working.
W: How do you know that he was engaged in other activity?
R: Well, he's working in front of me and I can see what he's doing, and he was.
W: All three of those things?
R: I can't answer that. That was — he was — he was doing something.
W: On a piece of equipment?
R: On — on a piece — either his phone or cell phone or pad or something.
W. All right. So the anesthesiologist was on his cell phone or on his iPad —
R: I believe so, yes.
W: — playing games or surfing the internet?
R: I can't answer that.
W: But he wasn't watching Mrs. Milne?
W: How many times did you look up and see him doing that?
R: You know, I was — I was trying to finish up the case. I don't — I can't tell you that.
W: Well, you remember at least one time? How many other —
Rinkenberger goes on to testify that it's fairly routine for anesthesiologists to check their phones during procedures, though he would prefer that they didn't.
R: You know, we see this sort of thing with these procedures. I mean, they're long procedures. We see this kind of thing, and usually I — it's not — doesn't seem to be a problem especially with relatively short procedures. What can I say? I mean, it happens.
Wormington took Rinkenberger's deposition last April. When she interviewed Spillers on February 28 of this year, he confirmed much of the surgeon's testimony about his device usage, but he forcefully denied that it's common or poses a danger to patients.
Wormington: Do you routinely play games on your phone while managing anesthetic care?
W: Do you surf the Internet?
S: Well, depending on your definition of surf. I do not spend an extended period of time accessing the Internet. I have logged on to the Internet before especially if — specifically if I have a question about the patient's medications, about the procedure, yes, we'll often, you know, do a search and find out information pertaining to the case. I will occasionally check e-mail. I will occasionally check scheduling for the office. But in general, no, I — the time spent on the Internet during a case is, you know, very brief, a couple, three minutes.
W: Do you post on Facebook while you're managing anesthetic?
W: Do you think that would be an unsafe thing to do?
S: To post on Facebook, would it be unsafe? It wouldn't be recommended.
W: Why not?
S: Well, because you're supposed to be monitoring the patient. You wouldn't want to be spending time in extraneous activities that were not related to patient care. Is it possible to do so safely? Yes, because we have ways of monitoring the patient. But I don't do that.
W: You never do that?
S: Post on Facebook during a case?
W: (Nods head up and down.)
W: Because you feel it would be unsafe?
S: Yes, it — well, it's — I don't do it. I'm — it's — I'm doing my job. I'm not there to post on Facebook. I could do it safely, but I don't.
W: Do you read the paper or read books or do anything else other than monitor the patient?
S: I'm always monitoring the patient. There have been times when I have read materials in the OR. Occasionally I've read a book during a long case but not very often. But even when I'm doing so, I'm always listening to the pulse ox, always checking the blood pressure, always — you know, at least every five minutes. I'm looking at the monitor at least every 30 seconds, looking at the patient at least every 15 minutes. But, no, it's not a common occurrence.
He reads the books — some fiction, some nonfiction — on his iPad. Occasionally, Spillers says, he'll fire off a quick text. During the Milne case, he might have exchanged a few texts and possibly checked his email, but there was no Internet surfing, no literature, and definitely no Facebook posts, which would be inappropriate.
None of this proves that Spillers was negligent, either in Milne's case or in other procedures. Anesthesiologists have a ton of down time. It does, however, set up an incredible gotcha moment toward the end of his testimony, when Wormington introduces posts from Spillers' personal Facebook page:
Wormington: Can you read the highlighted portion?
Spillers: Oh, wow. Yes. Okay.
W: Can you read it?
S: "After enduring the shittiest Friday I've had in a while, I just found out my next patient has lice. Freakin lice. I didn't even know they still made those. Help."
W: So I think you told me earlier it would be inappropriate to post something on Facebook about your patients.
S: Yes, I did. I was — the point of it was the lice, but yes.
W: As at the corporate representative for Tx-An (the company Spillers works for), do you approve or disapprove of your decision to make that posting?
S: I disapprove. I would discourage it.
W: Are you going to implement some policies to help yourself not make these postings in the future?
S: Yes. I will never do it again.
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The next exhibit is another Facebook post:
W: Can you read the highlighted portion?
S: Okay. "Just sitting here — sitting here watching the tube on Christmas morning. Ho, ho, ho."
W: And what is the photograph of?
S: An anesthesia monitor.
W: Is that anesthesia monitor hooked up to a patient?
W: Are — is the data on the anesthesia monitor that of a patient?
S: Is the data — like the vital signs? The vital signs are, but there's no identification of the patient.
W: And I think you told me earlier in your deposition that it would be inappropriate to post anything about a patient on your Facebook.
S: Well, specifically, but these are just numbers and there's no way to really identify it with a particular patient.
W: So do you think it is appropriate to post the anesthesia monitor with patient data on it on your Facebook?
S: Well, there's no specific patient data. It's just numbers.
W: So I'm — so you don't have a problem with it; you think it's okay?
S: No. It's okay.
W: Now, I think you told me earlier that you never post on Facebook while you're doing anesthesia — while you're managing anesthesia.
S: Not to my recollection.
W: Well, clearly you do post on Facebook sometimes when you're managing anesthesia because you were managing anesthesia at that moment.
S: Well, not necessarily because I took the picture but that doesn't mean I posted it at that time, because you can take a picture and then go to your pictures and then upload it onto Facebook after —
W: Okay. So —
S: — wards.
W: — where it says "just sitting here watching the tube on Christmas morning," you are clearly referring to the fact that you have to be doing an anes — managing an anesthetic procedure on Christmas morning and you're watching the anesthetic monitor, fair?
W: So obviously —
We contacted Spillers' attorney on Monday for a response but haven't heard back.
Send your story tips to the author, Eric Nicholson.