90 year old dad had surgery for basal cell carcinoma on his nose without family being notified because the dermatologist had a cancellation.

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90 year old dad had surgery for basal cell carcinoma on his nose without family being notified because the dermatologist had a cancellation.

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Let me explain...my dad had an appointment with the PA at the dermatologist office to discuss the possibility of another surgery on his nose. The doctor who did the original treatment moved and a new dermatologist took his place. When my dad went to his appointment he was informed that because of a cancelation they could do the procedure immediately. I believe he made the decision to comply only because he was blindsided. This was done at the office on a 90 year old man who is on Plavix and aspirin (he has three carotid artery stents, along with other medical concerns). Four hours later he was told to leave and was fine to drive himself home. My mom with dementia was home alone for over five hours. After three hours dad had to return for an emergency visit to receive more stitches since he was bleeding profusely. I knew nothing of this until I called to do my morning check with my parents. My brother took him in for the emergency visit....but that's another vent. Dad has a follow up on Monday....I will take him and voice my concerns but I think the doctor was negligent.....I feel this should have been done in an environment equipped to handle emergency's and proper arrangements should have been made prior to surgery. His entire face is black and blue and eyes are nearly closed due to bruising. In addition he was given Oxy for pain relief. Anyone's thoughts on this will be appreciated.

Care Decisions Medical Care Senior Health

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Abby:

The bigger issue here, one that you have been posting about for several months here, is that this is a clear indication that your parents are, as a unit, no longer competent to live alone.

Did dad think " my demented wife is home alone, what if this surgery goes wrong and I end up admitted to the hospital?" Did he think to consult with anyone about whether this was a good idea to have this surgery without someone accompanying him? Did he think to say to the doc, "I'm on blood thinners, is that okay?" He may have been asked about meds and answered inaccurately.

Use this incident with dad's PCP to force some action. Like informing APS about this incident.

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Oh Barb....you know I totally agree and that was one of the first things to come to mind. My dad has taken a downturn since caring for mom over this past year and it's been a rollercoaster for my sister and me. I worry that the worse possible will happen to shut this down and we can move them to a safe environment. I understand the desire to stay in place, but I question the logic (whatever that might be at this point) behind it. As always, your advice is much appreciated.

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Abby, if he had Mohs surgery, that’s why the procedure took so long. That’s what my DH has (in his dermatologist surgeons surgery room). The smallest area and depth of affected tissue is removed, and perimeter skin cells are examined right then in their lab to make sure all cancer is removed. The patient waits during this. If it’s found that more needs to be removed, the doctor keeps taking and examining small amounts until they are assured there’s no remaining cancer. DH is there for hours and now I understand your Dads long time in the office as that is typical. It’s an ordeal, but it saves the doctor from cutting out huge hunks of skin “just to be sure” and return trips. So the good part of your Dads experience is that the cancer is gone, and this is just over sooner than you expected, if you want to look at the bright side.

But, my question to the doctor, how did they miss he’s on Plavex? Every doctors office I’ve ever been to reviews my medication list with me right off the bat at the start of the visit. Did they not review meds, or was your Dad confused about it or deny being on it? That’s the question I would want answered.

We understand that you couldn’t make this particular appointment with him, and you think he’s usually astute, but I think this is a wake up call that he might not be as clear thinking or able to advocate for himself as well as he seems. So I’m not sure I’d put this episode entirely on the doctor. Except for the Plavex part.

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I agree.

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Speaks to lack of proper consideration of his medical records. I'd be furious at their handling of this.

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Thank you...I am in complete agreement.

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Absolutely, informed consent requires full understanding of what to expect risks etc.. very careless and arrogant for doctor to prioritise his own schedule & income over your Dads safety. Would make a written complaint as well & photos. I hope is recovering, it must have been very upsetting for him to undergo such treatment.

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My thoughts as well...from my understanding he his young and most probably inexperienced. On the job training is a poor excuse for competency.

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Search for: Connecticut Medical Malpractice Laws & Statutory Rules
online.

Obtain a physical exam with EKG (heart) to determine if he is okay.
My response is usually the nuclear option, but there are other options.

One can confront, correct, offer to put a negligent doctor out of business and report to administration, or keep stress at a minimum for you and your Dad.

You have choices here.

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Yes....I'm with you....stress aside.....This young buck needs to be aware of the empathy and knowledge necessary to deal with the very elderly since they have their own set of considerations. He ignored this in totality.

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The whole situation was handled poorly and I don’t think Dad should be trusted to go to any appointments alone anymore. However the bruising, however scary looking, is normal. My DH has had basal cell surgery on his face multiple times and always ends up with black eyes. Especially when it’s his nose he’ll have 2 bad shiners that will last for days. But the bleeding from the Plavex is obviously not right and must be addressed.

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Your father left your mother with Alzheimer's home alone, drove himself to the doctor's office and gave consent. If anyone was obligated to notify you it was your father and, in my opinion, you are angry at the wrong person/people. There is no indication to stop Plavix or aspirin for minor skin surgery.

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Mom's doctors feel it's okay to leave her for short periods of time. A typical visit with the dermatologist with travel time is about an hour. He was there only for a consult.......he was blindsided by the offer to do the surgery then and there. I stated that even though he is competent he does get confused when processing information to make split second decisions. I agree....dad should have called....but under the circumstances he also should have been questioned by staff if a family member should be contacted.

Dad has bleeding issues with or without plavix......his vascular surgeon made it clear that not under any circumstances should procedures be done while taking the plavix/aspirin combination (including anything above the shoulders). I don't feel any medical establishment should put the very elderly in a compromising situation.

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Drove home, age 90, after local anesthesia and oxy???

My thought would not be printable. Get a background check on this "doctor".

Hoping your Mom was okay, and that Dad is better.

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Mom managed through somehow.....and to think my dad's PC expressed concern over doing the procedure to begin with. Dad is the same.

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Has your dad been seen by his own PCP or ER doc since this happened?

I would get him to the ER for immediate documentation. You want to make sure that your father's platelet level is sufficient for healing, I think.

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Sadly, no. My brother was called and he took him back to the physicians office after hours to control the bleeding. The ER would have been the better choice for documentation. I will take him for follow up tomorrow and will request the necessary lab work. Thanks for the suggestion.

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Abby,
The bruising may be normal.
However the bleeding from the suture site was not.

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The bruising is normal. I had basal cell removed from my nose. I looked like I had been beat up for about two weeks!😓

90 year old dad had surgery for basal cell carcinoma on his nose without family being notified because the dermatologist had a cancellation.

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