This procedure depicts the microvascular anastomosis between the free anterolateral thigh (ALT) flap and the superficial temporal artery (STA) and superficial temporal vein (STV).
This procedure demonstrates the inset of the anterolateral thigh (ALT) flap into a large composite wound after oncologic resection.
Title: Full-thickness skin grafting for coverage of dorsal hand defect Authors: Vincent Riccelli, Brian Drolet MD, Elizabeth Lee MD Affiliations: Vanderbilt University Medical Center Corresponding Author: Vincent Riccelli (email@example.com)
Excision of Nailbed Remnant following Finger Amputation Authors: Vincent Riccelli M.D. Candidate, Brian Drolet M.D., F. Bennett Pearce M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Vincent Riccelli
Deep Inferior Epigastric Perforator Flap: Microvascular Anastomosis and Neurotization This video depicts the microvascular anastomosis of the deep inferior epigastric artery and vein to the internal mammary artery and vein in an anterograde fashion for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old female patient status post bilateral mastectomy for breast cancer. Authors: Vincent Riccelli M.D., Eva Niklinska B.S., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Eva Niklinska
This procedure depicts the harvest of the anterolateral thigh flap to be utilized in the reconstruction of a post-extirpative scalp defect.
Deep Inferior Epigastric Perforator Flap: Abdominal Flap Dissection This video depicts the abdominal flap dissection for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old female patient status post bilateral mastectomy for breast cancer. Authors: Eva Niklinska B.S., Vincent Riccelli M.D., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Eva Niklinska
Deep Inferior Epigastric Perforator Flap: Abdominal Closure and Flap Inset This video depicts the abdominal closure and DIEP flap inset for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old patient status post bilateral mastectomy for breast cancer. Authors: Eva Niklinska B.S., Vincent Riccelli M.D., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Eva Niklinska
DOI: http://dx.doi.org/10.17797/zn1m3e9e41 Editor Recruited By: Sanjay Parikh, MD, FACS
Contributors: Jacob B. Hunter, Reid C. Thompson and David S. Haynes Superior semicircular canal dehiscence (SCD) is a condition in which the bone overlying the superior semicircular canal is absent. The clinical presentation of SCD is highly variable and may include both auditory and vestibular manifestations. The more common symptoms include autophony, sound or pressure induced vertigo, hypersensitivity to sound, and low frequency conductive hearing loss. Repair can be accomplished via either transmastoid or middle fossa approaches, with numerous materials used to either plug or resurface the canal. Herein, we describe our resurfacing technique using a loose areolar tissue-bone pâté-loose areolar tissue sandwich through a middle fossa approach. DOI#: http://dx.doi.org/10.17797/kcwvab3b7r
Contributors: Larry Hartzell Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon. The goals of an acceptable repair must include precise continuity of the cupid's bow, maximizing philtral length, and establishing a mucosa lined sulcus. We present an example of a repair of the bilateral incomplete lip as described by Millard. DOI: http://dx.doi.org/10.17797/qefi9lqbam
In this video, we showcase the bilateral subcranial Le Fort III osteotomies with midface distraction using Kawamoto distractors. The surgery was performed in a 4-year-old boy with Crouzon Syndrome to correct his severe proptosis, increase the nasopharyngeal airway space and improve his severe negative overjet. Internal distractors were chosen to achieve maximum correction at this age. The patient undergoing surgery had no intraoperative or postoperative complications. A full separation of his facial bones was achieved. The patient had an uneventful recovery period, and there was a significant improvement in his proptosis and malocclusion. Santiago Gonzalez, BS, BA (1); Michael Golinko, MD, MS (2) 1. University of Arkansas for Medical Sciences – College of Medicine 4301 W. Markham, #550 Little Rock, AR 72205 2. Vanderbilt University Medical Center, Department of Plastic Surgery 2900 Children’s Way, 9th Floor Doctor’s Office Tower Nashville TN 37232
This video demonstrates an open anterior cranial vault reconstruction for metopic craniosynostosis on a 5-month-old female.
- Director of the Center for Minimally Invasive Surgery
Dr. George W. Holcomb, III was born in Osaka, Japan on December 11, 1953. He was raised in Nashville, Tennessee and attended elementary and high school in Nashville. He attended the University of Virginia for college and then Vanderbilt Medical School. His general surgery training was at Vanderbilt University Medical School and his pediatric surgery training was at the Children’s Hospital of Philadelphia. He began his pediatric surgery practice in 1988 as an Assistant and subsequently Associate Professor of Surgery in the Department of Pediatric Surgery at Vanderbilt University School of Medicine. In 1999, he was recruited to replace Dr. Keith Aschraft as Surgeon-in-Chief at Children’s Mercy Hospital in Kansas City, Missouri. In addition to being the Surgeon-in-Chief, he is also the Director of the Center for Minimally Invasive Surgery.
Dr. Holcomb is best known for his interest in minimally invasive surgery in infants and children and his emphasis on evidence-based medicine. He is the author of over 240 peer-reviewed publications and 50 book chapters, and has been the editor of 5 textbooks.
- Director, Emory Voice Center
- Associate Professor
- Department of Otolaryngology
Dr. Johns is a graduate of Johns Hopkins School of Medicine. He completed his residency in Otolaryngology at the University of Michigan and trained as a research fellow through a National Institute of Health program. He then pursued a fellowship in laryngology and care of the professional voice at the Vanderbilt Voice Center at Vanderbilt University. Dr. Johns was awarded the highest honors during his academic career, including membership in Phi Beta Kappa and Alpha Omega Alpha medical honor society. He is the director of the Emory Voice Center at Emory University, pursing research, teaching and clinical care, with a specific interest in geriatric laryngology and the aging voice.
- Professor and Vice Chair
- Department of Head and Neck Surgery
Ehab Hanna, M.D., FACS, is an internationally recognized head and neck surgeon and expert in the treatment of patients with skull base tumors and head and neck cancer. He is Professor and Vice Chair of the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. After earning his medical degree, he completed a surgery internship at Vanderbilt University, and residency in Otolaryngology-Head and Neck Surgery at The Cleveland Clinic in Cleveland, Ohio. He received advanced fellowship training in skull base surgery and head and neck surgical oncology at the University of Pittsburgh Medical Center. He joined the MD Anderson faculty in 2004 with a joint appointment at Baylor College of Medicine. He is the medical director of the Multidisciplinary Head and Neck Center and co- director of the Skull Base Tumor program at MD Anderson. Dr. Hanna recently served as President of the North American Skull Base Society (NASBS) which was founded in 1989, and is a professional medical society that facilitates communication worldwide between individuals pursuing clinical and research excellence in skull base surgery. Dr. Hanna is leading the development of minimally invasive and robotic applications in skull base surgery. He has consistently been named one of America’s Top Doctors by the Castle Connolly Guide. In addition to patient care, Dr. Hanna is actively engaged in clinical and translational research with emphasis on skull base tumors. He is the Editor-in-Chief of the journal of Head & Neck, which is the official journal of the International Federation of Head and Neck Societies. He also co-edited a text book on “Comprehensive Management of Skull Base Tumors”.
Join us in the journey of the legend as he gives us insights into his life and his achievements. Join us to be inspired by one of the best physicians in his field.
Most known for being the first Maness Professor and chair of Otolaryngology and for his role in founding the Vanderbilt Voice Center in 1991, Dr. Ossoff has held an array of positions since he joined Vanderbilt’s faculty in July 1986, including the first director for the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, associate vice chancellor for Health Affairs, chief of staff for Vanderbilt University Adult Hospital, assistant vice chancellor of Compliance and Corporate Integrity and executive medical director for the Vanderbilt Voice Center. He was also highly involved with the creation of the Free Electron Laser Center at Vanderbilt University, bringing with him knowledge he gained during his residency and faculty appointment at Northwestern University in Chicago.
Dr. Ossoff will be joined by Dr. Michael Johns, Director, USC Voice Center, Dr, Albert Merati, Chief of Laryngology, UW Medicine’s Head and Neck Surgery Center, and Dr. Gaelyn Garrett, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center.
Dr Gitta Madani, FRCR, MRCS, MBBS, FDSRCS, BDS
Consultant Radiologist and Honorary Senior Lecturer
Imperial College Healthcare NHS Trust and Imperial College London
Gitta Madani is a Consultant Radiologist with a specialist interest in all aspects of head and neck and skull base radiology and performs image-guided procedures in the head and neck. She is an Honorary Lecturer at Imperial College London and involved in research, training and teaching. She has authored several book chapters, various peer-reviewed articles and national imaging guidelines.
Ali Zul Jiwani, MD, MSc, DAABIP
Director of Interventional Pulmonology
Orlando Health Cancer Institute
Dr. Jiwani, is a board-certified interventional pulmonologist with the Rod Taylor Thoracic Care Center at Orlando Health Cancer Institute where he also leads the institute’s lung cancer screening program. As an interventional pulmonologist he specializes in minimally invasive diagnostic and therapeutic endoscopy and other procedures to treat malignant and benign conditions of the airway, lungs and thorax plus pleural diseases.
David E. Rosow, MD, FACS
Director, Division of Laryngology and Voice / Associate Professor, Dept. of Otolaryngology
University of Miami Miller School of Medicine
Dr. Rosow is Associate Professor of Otolaryngology at the University of Miami Miller School of Medicine, where he has led the Division of Laryngology and Voice for over 10 years. His research and clinical interests include laryngeal cancer, recurrent respiratory papillomatosis, vocal fold paralysis, laryngotracheal stenosis and airway reconstruction, and spasmodic dysphonia. In addition to scientific publications in these areas, he has also written and edited a textbook on evidence-based practice in Laryngology.
Professor Stephen R Durham MD FRCP
Professor of Allergy and Respiratory Medicinec
National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London
Professor Durham is Head of Allergy and Clinical Immunology at NHLI and has run a joint Nose Clinic with Professor Hesham Saleh for many years. His research interests include allergic rhinitis, asthma and translational studies in allergen immunotherapy. He is a member of the Steering Committee, Immune Tolerance Network, National Institutes of Allergy and Infectious Diseases, NIH, USA.
Professor Jane Setterfield
Professor of Oral & Dermatological Medicine
Guy's & St Thomas Hospital & King's College London
Jane Setterfield is Professor of Oral and Dermatological Medicine at King’s College London and Consultant in Dermatology at St John’s Institute of Dermatology, Guy’s & St Thomas Hospitals. She leads the Oral Dermatology Service both at St John’s Institute and the Department Oral Medicine Guy’s Dental Institute. Her areas of clinical interest include immunobullous diseases, lichenoid disorders vulval dermatoses and mucocutaneous diseases. Her research areas include diagnostic techniques, pathogenic mechanisms, clinical outcome measures and optimising therapeutic approaches for mucocutaneous diseases.
Laura Matrka, MD
Ohio State University Wexner Medical Center Department of Otolaryngology - Head and Neck Surgery
Laura Matrka, MD, is an Associate Professor at the Ohio State University Wexner Medical Department of Otolaryngology – Head & Neck Surgery. She graduated magna cum laude from Dartmouth College with a BA in English and concentrations in Anthropology and Spanish, completed medical school at University of Cincinnati College of Medicine, completed her residency in Otolaryngology at The Ohio State University, and completed a Laryngology fellowship at the University of Texas Health Sciences Center, San Antonio. She is a full-time clinician who devotes significant additional time to clinical research, focusing on complicated airway management, tracheostomy complications, dysphagia after anterior cervical spine surgery, recurrent respiratory papillomatosis, gender-affirming health care, and opioid-related research, among other topics. She was inducted into the American Laryngologic Association in 2020, the Triological Society in 2019, and the American Bronchoesophageal Association in 2015.
Alexander Gelbard, MD
Vanderbilt Center for Complex Airway Reconstruction (AeroVU)
Dr. Gelbard is a board certified Otolaryngologist at Vanderbilt University in Nashville Tennessee specializing in adult laryngeal and tracheal disease. He completed his undergraduate education at Stanford University, medical school at Tulane School of Medicine, and internship and residency at the Baylor College of Medicine in Houston Texas. Dr. Gelbard completed a postdoctoral research fellowship in Immunology at the MD Anderson Cancer Center as well as a clinical fellowship in Laryngeal Surgery at Vanderbilt School of Medicine. He has authored numerous peer-reviewed articles and book chapters and lectures internationally on adult airway disease. He currently is Co-director of the Vanderbilt Center for Complex Airway Reconstruction (AeroVU). Additionally, he is a NIH-funded principle investigator studying the immunologic mechanisms underlying benign laryngeal and tracheal disease. He is also PI of an externally funded prospective multi-institutional study of idiopathic subglottic stenosis (iSGS) and managing director of the North American Airway Collaborative (NoAAC). NoAAC is a funded, multi-institutional consortium with 40 participating centers in the United States and Europe that works to exchange information concerning the treatment of adult airway disease. It is composed of outstanding collaborators who pursue a unique combination of genetic, molecular, and epidemiologic based approaches to investigate the critical factors underlying the pathogenesis and outcomes of laryngotracheal stenosis.
Taner Yilmaz, MD
Professor of Otolaryngology-Head & Neck Surgery
Hacettepe University Faculty of Medicine, Ankara, Turkey
Dr. Yilmaz has worked in laryngology since 2000. He is a member of ELS, ALA and IAP, publishing 94 international manuscripts which received 1100 citations. On top of those achieveiments, he also has two patents for a laryngoscope for arytenoidectomies and an epiglottis holding forceps for grasping a floppy epiglottis that folds inside the larynx during larygoscopy.
Edward J. Damrose, MD, FACS
Professor of Otolaryngology-Head & Neck Surgery
Stanford University School of Medicine
Dr. Damrose is Professor of Otolaryngology/Head and Neck Surgery and (by courtesy) of Anesthesiology, Perioperative & Pain Medicine in the Stanford University School of Medicine. He is the founding Chief of the Division of Laryngology and Program Director of the Stanford Fellowship in Laryngology & Laryngeal Surgery. He is member of the American Laryngological Association as well as the Triological Society, and has authored or coauthored more than 80 peer reviewed publications and 16 book chapters.
Kate Heathcote, MBBS, FRCS
University Hospitals Dorset
Kate Heathcote established the Robert White Centre for Airway, Voice and Swallow to provide a comprehensive diagnostic and treatment service. She has lectured and trained surgeons nationally and internationally in cutting edge laryngology techniques.
Phillip Song, MD
Division Director in Laryngology
Imperial College LonMassachusetts Eye and Ear Infirmary
Dr Song is the Division Director of Laryngology at Massachusetts Eye and Ear Infirmary and Assistant Professor of Otolaryngology and Head and Neck Surgery at Harvard Medical School. He specializes in laryngology with a special interest in neurolaryngology and central airway disease.
Brianna Crawley, MD
Associate Professor, Co-Director
Loma Linda University Voice and Swallowing Center
Dr. Crawley is a board-certified otolaryngologist and member of the Academy of Otolaryngology- Head and Neck Surgery, the ABEA, and the post-grad ALA. Her interests include neurolaryngology, swallowing disorders, performing voice and the surgical airway. She continues to work in new fields of research focusing on presbylarynx and presbyphonia, neurolaryngology, and understanding the patient experience.
Ramon Franco Jr, MD
Medical Director, Voice and Speech Lab, Senior Laryngologist
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston MA, USA
Dr. Ramon Franco is a board-certified laryngologist who specializes in voice, swallowing, and breathing disorders. His main areas of expertise are in the diagnosis and treatment of voice disorders, airway stenosis, laryngeal cancer, and neurological disorders affecting the voice box. He also has special interests in the medical and surgical care of the professional voice. He serves as an Executive Board Member for the Massachusetts Society of Otolaryngology and is a fellow for the Triological Society and the American Laryngological Association.
Clark A. Rosen, MD
Co-Director / Chief - Division of Laryngology
UCSF Voice and Swallowing Center
Clark Rosen, MD is a Co-Director of the UCSF Voice and Swallowing Center, Chief of the Division of Laryngology, Professor of Otolaryngology-Head and Neck Surgery and the F Lewis Morrison MD Endowed chair of Laryngology. Dr. Rosen inaugurated modern laryngology at the University of Pittsburgh beginning in 1995 creating a dedicated center of excellence in Laryngology: University of Pittsburgh Voice Center. Dr. Rosen originated the outstanding Fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh in 2002 and trained over 15 fellows in Larynogology and numerous visiting Otolaryngologists until 2018. He is now the director of the Laryngology fellowship at the UCSF Voice and Swallowing Center. Dr. Rosen has been a sought after speaker internationally and has had major service to multiple publications and professional societies. He is a founding member of the Fall Voice Conference, was the Vice Chair of the Annual Meeting Program Committee for the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS), and was the Treasurer of the American Laryngological Association (ALA) and is now president of the ALA.
Dr. Vyvy Young
Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery
University of California – San Francisco
VyVy Young, MD, is an Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery at the University of California – San Francisco. Dr. Young received her undergraduate and medical degrees from the University of Louisville, in Louisville, Kentucky, where she also pursued her Otolaryngology training. She then completed a fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh Voice Center. She currently serves the American Academy of Otolaryngology – Head and Neck Surgery as member of the Annual Meeting Program Committee and Executive Committee for ENThealth.org. She is immediate past-chair of the Voice Committee and the Women in Otolaryngology Communications Committee and was recently selected as chair of the Finance and Audit Committee of the American Broncho-Esophagological Association.
Justin Roe, PhD, FRCSLT
Clinical Service Lead - Speech and Language Therapy – National Centre for Airway Reconstruction
Imperial College Healthcare NHS Trust
Dr. Roe is a clinical-academic and service lead, specialising in dysphagia in benign and malignant head and neck disease. He leads the speech and language therapy service for the National Centre for Airway Reconstruction at Imperial College Healthcare NHS Trust and is a consultant and service lead at the Royal Marsden NHS Foundation Trust. He is an Honorary Clinical Senior Lecturer at Imperial College London and an investigator on a number of NIHR portfolio studies. He is currently on an NIHR Imperial Biomedical Research Centre/ Imperial Health Charity funded post-doctoral research fellowship. He is an elected council member for the British Laryngological Association and British Association of Head and Neck Oncologists.
Professor Anil Patel MBBS PhD FRCA
Clinical Anaesthetist / Chairman of Department of Anaesthesia
Royal National ENT & Eastman Dental Hospital
Professor Anil Patel graduated from University College London in 1991. He is a clinical anaesthetist and continues to develop and refine the largest experience of anaesthetising adult airway patients under general anaesthesia (> 6,000 procedures) in the UK, probably Europe and possibly the world. His research interests include all aspects of shared airway and difficult airway management. Professor Patel has been an invited speaker to over 300 national and international meetings in 38 countries. He has over 130+ peer reviewed publications, 25 book chapters, over 4,500 citations and an h-index of 25.
Robbi A. Kupfer, MD
Associate Professor, Department of Otolaryngology-Head & Neck Surgery
University of Michigan
Dr. Kupfer is an Associate Professor of Otolaryngology-Head & Neck Surgery at the University of Michigan who specializes in Laryngology and Bronchoesophagology. She is the Program Director for the Laryngology Fellowship as well as the Otolaryngology Residency at the University of Michigan.
Alexander T. Hillel, MD, FACS
Johns Hopkins University School of Medicine
Dr. Alexander Hillel is a Laryngologist, Residency Program Director, and Vice Director of Education in the Johns Hopkins Department of Otolaryngology – Head & Neck Surgery. His clinical practice and research centers on the treatment, prevention, and causes of laryngotracheal stenosis (LTS).
Dale Ekbom, MD
Associate Professor of Otolaryngology / Director of Voice Disorders/Laryngology
Residency in Otolaryngology/Head and Neck Surgery at the University of Michigan with a fellowship in Laryngology/Care of the Professional Voice at Vanderbilt University Medical Center. Clinically specializing in voice, especially management of vocal fold paralysis, Zenker’s diverticulum and Cricopharyngeal muscle dysfunction, early laryngeal cancer, and airway compromise due to laryngeal, subglottic, and tracheal stenosis. Research interests include idiopathic subglottic stenosis and GPA with surgical and medical management of the airway, vocal fold paralysis, new injectables using Jellyfish collagen.
Dr. Ricky Thakrar
Consultant Chest Physician
University College London Hospital
Dr. Ricky Thakrar qualified in Medicine from Imperial College London. He trained in Respiratory Medicine at the Royal Brompton Hospital and completed his training in Northwest London. He was appointed to a three-year academic fellowship at UCL where his PhD examined state of the art bronchoscopy techniques for managing cancers arising in central airways and lung. He is a Consultant in Thoracic Medicine and his main interests are in interventional bronchoscopy procedures (laser resection, airway stenting, cryotherapy, photodynamic therapy and brachytherapy) for pre-malignant and malignant disease of the tracheobronchial tree.
Dr. Michael Rutter
Director of the Aerodigestive Center
Cincinnati Children's Hospital
Dr. Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Always a problem-solver, he strives to involve the patient in their own care by having them help evaluate the issue and then craft a solution together. He was drawn to his career by the challenge and highly individualized nature of pediatric airway problems and management. Dr. Rutter enjoys working in a multidisciplinary team setting and focusing on coordinated care for complex childhood airway conditions. He was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology. In addition to caring for patients, he is also dedicated to his research trying to find improvements in airway management.
Christopher T. Wootten, MD, MMHC
Director, Pediatric Otolaryngology—Head and Neck Surgery
Vanderbilt University Medical Center
Dr. Wootten has a longstanding interest in surgical management of congenital and acquired airway disorders. To better equip himself to lead the Pediatric ENT service through expansion, evolution of practice models, and differentiation into multidisciplinary care, Dr. Wootten obtained a Masters of Management in Health Care at Vanderbilt’s Owen School of Business in 2017. Areas of his professional research emphasis include airway obstruction in children and adults and aerodigestive care. He innovates minimally invasive surgical techniques in the head and neck. Dr. Wootten is actively investigating the role of eosinophil and mast cell-based inflammation in the pediatric larynx.
Karla O'Dell, M.D.
Assistant Professor / Co-director
USC Voice Center, Caruso Department of Otolaryngology Head and Neck Surgery @ University of Southern California / USC Center for Airway Intervention and Reconstruction
Karla O’Dell, MD, specializes in head and neck surgery and disorders of the voice, airway and swallowing. She is cofounder and codirector of the USC Airway Intervention & Reconstruction Center (USC Air Center).
Jeanne L. Hatcher, MD, FACS
Co-Director of the Emory Voice Center and Associate Professor of Otolaryngology
Emory University School of Medicine
Dr. Hatcher has been at Emory since 2014 after completing her laryngology fellowship with Dr. Blake Simpson; she specializes in open and endoscopic airway surgery as well as voice disorders. Dr. Hatcher is a member of the ABEA and post-graduate member of the ALA and also serves on the Ethics and Voice Committees for the American Academy of Otolaryngology Head and Neck Surgery.
Mr. Lee Aspland
Patient / Freelance Artist
Lee Aspland Photography
Lee Aspland is a photographer, author and mindful practitioner who creates photography that reflects his feelings about living in such a glorious world. He specializes in Mindful Photography, capturing a fleeting feeling or thought, a hope or fear, a frozen single moment in time.
Gemma Clunie, MSc, BA (Hon), MRCSLT
Clinical Specialist Speech-Language Pathologist (Airways/ENT) and HEE/NIHR Clinical Doctoral Research Fellow
Imperial College Healthcare NHS Trust/ Imperial College London, Department of Surgery & Cancer
Gemma is a Clinical Specialist Speech and Language Therapist with an interest in voice and swallowing disorders that is particularly focused on the benign ENT, head and neck, respiratory and critical care populations. Gemma is a current NIHR/HEE Clinical Doctoral Research Fellow at Imperial College London. Her PhD studies focus on the voice and swallowing difficulties of airway stenosis patients. She is based at Charing Cross Hospital in London where she has worked for the last six years as part of the National Centre for Airway Reconstruction, Europe’s largest centre for the management of airway disorders.
Niall C. Anderson, CPsychol, MSc, BSc
Lead Psychologist (formerly Respiratory Highly Specialist Health Psychologist)
Bart's Health NHS Trust (formerly Central & North West London NHS Foundation Trust)
Niall is a HCPC Registered & BPS Chartered Practitioner Health Psychologist, and BPS RAPPS Registered Supervisor. Niall has specialist experience of working within healthcare systems with people with long-term health conditions at all system levels to support physical, psychological and social wellbeing. Niall worked in the Airway Service at Charing Cross Hospital (London, UK) between January-December 2021 in order to develop and implement the Airway Psychology Service.
RaDonda Vaught’s conviction set a dangerous precedent for patient safety, but is also driving a push for better protections for nurses.
RaDonda Vaught, whose criminal prosecution for a fatal medical error made her case a flashpoint in national conversations about nursing shortages and patient safety, was sentenced on Friday to three years of probation in a Nashville criminal court. After the probationary period, she could ultimately have her conviction dismissed.
Vaught had been convicted of criminally negligent homicide and gross neglect of an impaired adult, which together carried a potential prison sentence of up to eight years.
In late 2017, Vaught, a nurse, mistakenly administered the wrong medication to patient Charlene Murphey while Murphey awaited a radiologic study at Vanderbilt University Medical Center. Murphey died as a consequence of the error, and an investigation later found that multiple patient safeguards that should have existed in the hospital had been absent or failing at the time of the event and were partially responsible for her death.
Vaught’s errors included removing the wrong medication from one of the hospital’s electronic prescribing cabinets, overlooking several warnings on the medication vial, and not monitoring Murphey’s vital signs after administering the medication.
What made Vaught’s case notable was that she was prosecuted in criminal court, a decision made by the Nashville district attorney. Most nursing malpractice cases are disciplined through state nursing boards, which can revoke professional licenses. If legal action is taken in nursing errors, it is generally through civil courts, where patients and families can obtain financial compensation.
Vaught’s case was also notable because while she was charged with a crime, her employer — Vanderbilt University Medical Center — faced fewer consequences.
While the hospital settled a civil case out of court with Murphey’s family, it has not been held criminally liable. And while the Tennessee health department revoked Vaught’s license, it did not punish the hospital, although the Tennessee Bureau of Investigation found multiple instances of wrongdoing and cover-ups on the hospital’s part.
Although the sentencing was lenient, patient safety advocates and nursing groups are upset about the case, and say it sets a bad precedent: because Vaught individually took the fall for a systematic failure.
Punishing individuals for systemic safety failures is concerning to patient safety advocates because it is ultimately detrimental to patient safety.
Why punishing nurses for medication errors can make patients less safe
For decades, scholars have understood that keeping patients safe requires continually improving the systems that prevent and catch medical errors before they happen. Critically, those systems cannot improve if the people within them don’t feel safe reporting problems.
One of the biggest concerns among patient safety experts is that severe punishment for medical errors — as in Vaught’s case — will lead to reduced error reporting by other nurses due to fear of being fired, or fear of prosecution. That could lead systemic problems to persist unfixed, which would be worse for patient safety.
In an April interview, Robert Gatter, a health law expert at Saint Louis University, said Vaught’s prosecution was a smokescreen that distracted from her employer’s inadequate safety systems. “They can forever now point to this person and say, ‘Wow, she is so bad,’” he said, rather than being held accountable for having a broken patient safety infrastructure.
Vaught’s case is one of several recent cases in which criminal charges were levied against nurses in settings ranging from jails to nursing homes. Many nurses say this trend, combined with the stresses of the pandemic and preexisting nursing shortages, has exacerbated already low morale among nurses.
Kedar Mate, a physician who is president of the Institute for Healthcare Improvement, recalls a recent anecdotal example of the case’s potential chilling effect among medical professionals. He was in an audience for a talk on patient safety in a room full of doctors and nurses. When the speaker asked how many of the attendees had reported a medical error, most of the hands in the room went up — and when he asked how many would do it now, in light of the Vaught case, most of the hands went down. “It’s had a very significant effect,” he said, although there isn’t hard data to cite here.https://e578181f53bd8b03e1e33f82a408238f.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Mate said several hospital CEOs — for example, the leadership of Northern Virginia’s Inova Health — are trying to head off that concern by communicating directly with employees. “Health system leaders are issuing statements, supporting their staff to come forward transparently to report — in essence, saying that ‘We hear and see what’s going on in Tennessee. In our system, we value transparent, candid, open, honest reporting of near misses and adverse events.’”
It’s hard to know what the outcome of that outreach will be. Rates of medical errors — and measures of staff willingness to report them — are only revealed over time.
“We’re not going to know for a little while whether this is going to have an effect,” said Mate of Vaught’s case.
The case is inspiring calls for policies that support nurses, and patients
American nurses are under enormous strain, and Vaught’s sentencing is unlikely to help. However, the case has directed attention to policies and legislations that would help prevent medical errors in the first place.
For one, the case has energized efforts to establish a National Patient Safety Board (NPSB), which would function much the way the National Transportation Safety Board does by reviewing data on medical errors and close calls with the highest likelihood of causing patient harm. The NPSB would then make recommendations for solutions and corrective actions that would prevent further bad outcomes for patients.
Karen Feinstein, leader of the advocacy coalition supporting the board’s creation, said she now uses Vaught’s case as an example of why the agency is necessary. “If you had an NPSB,” she said, “I don’t believe an accident like this would happen.”
An estimated 7,000 to 9,000 people die in the US each year as a result of a medication error. With a national board in place, many factors that contributed to the error that killed Charlene Murphey could have been identified in advance, including persistent software problems that weakened automated safety checks during medication dispensing, and Vaught’s distraction by an orientee (Vaught had been multitasking when the error occurred, helping with nursing needs across her unit and orienting a new employee).
Nurse-to-patient ratios are an important determinant of patient safety, and bills aimed at ensuring safer staffing ratios are making their way through the House and Senate. At the National Nurses March in Washington, DC, yesterday, many of those marching expressed support for the bills. The powerful hospital lobby is likely to oppose the legislation, lowering its chances of success, said a senior congressional staffer who requested anonymity to speak candidly about the bill. But nurses and nurses unions in several states are advocating for its passage.
On the day of the sentencing, hundreds of nurses gathered across the street from the Nashville municipal courthouse to support Vaught, a purple banner reading “We are nurses not criminals” on display. They held hands as they listened to a live broadcast of Judge Jennifer Smith’s decision, and erupted in cheers as the sentence was read.
Julie Griffin, a Florida nurse who was fired in 2018 after making complaints about unsafe staffing and monitoring procedures at the medical center where she worked, attended the rally. After the sentence was handed down, she said she felt ambivalent. “I mean, it’s a great verdict,” she said, “on a charge that should never have been imposed.”
The sentence notwithstanding, the case had already done damage to the nursing profession, said Griffin. Nurses were walking away from the profession before Vaught’s April verdict, but the case has intensified the sense of alienation for many, she said.
“The health care system needs to look in towards itself and start promoting a culture where nurses are allowed to speak up — to effect change before these things happen,” she said.
Read the source material for this article on vox.com.
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