- It's about time we react to the very first episode
of "Law and Order".
There's actually a lot of medicine in this,
of which I know a lot.
Law on the other hand, I don't.
That's where I brought in my good friend, the Legal Eagle.
- I'm back, baby.
It's time to talk about medical malpractice.
- I'm scared of that, but the eagle has landed.
So let's get started, whoop.
- Whoop.
- Been here 40 minutes, I just need to know where she is.
- Holy crap, it's Leo McGarry from the "West Wing".
Don't mess with that guy.
That guy's a rock star.
- [Devin] I have no idea who that is
or what we're talking about.
Who's Leo McGarry?
- You've never seen the West Wing?
- No. - Dude.
- Whoa, she can't breathe.
- Get the Ambu bag.
No pulse, call a code.
Come on, let's go, move.
I need a line in.
- Chest compressions, chest compressions,
chest compressions.
If someone's pulseless, you don't go get tools.
You start chest compressions.
- [Head Nurse] Get the defibrillator.
- I knew that wasn't right.
- Also, these chest compressions are absolutely poo.
What is this?
You have to put your whole body weight into it in order
to push two inches deep.
- It has to be to the rhythm of "Stayin' Alive",
even I know that, come on.
- Or Taylor Swift "Clean".
Just for my Swifties out there.
I just read that from the American Heart Association.
- Ah, now there's some privacy.
Oh, no more privacy. - No more privacy.
- No response, get me adrenaline.
- Excuse us. - Please, please wait outside.
We're doing everything
we can. - What's going on?
- Excuse us, please.
- It's my daughter.
- Please, you can't come in here.
This is off limits. - Don't even try.
What's going on?
- Let Leo McGarry see
his daughter. - That's what gets me.
- They're letting the entire ER see this poor woman
get coded, but they won't let the father into the room?
- Once you've violated HIPAA once, you might as well just-
- Just keep it going. - Keep it going.
- And that monitor is clearly saying she's flat lining.
So the purpose of getting the defibrillator
is really useless.
They did call for epinephrine, which is the medication
that you do give in flat line to hopefully
restart the heart.
- Okay. - Yeah.
So at least that was correct.
- Let's call it.
23:17.
- They went like one minute, please try a little harder.
- How long would it normally take?
- So there's no rule, but each round of CPR is two minutes,
because you're supposed to do chest compressions
for two minutes, and in between that time, give medications,
find out history, things that are reversible causes.
There's patients that I brought back after 15 minutes,
20 minutes, and they come back and they're great.
We get them back in fighting shape.
And I'm not saying that they're instantly great.
It takes time and they recover.
But just to say after a few minutes,
nah, we're calling it, that's not right.
- Yeah, so more like Ed Harris in "The Abyss"
than "Law and Order".
- I don't know these references.
Gimme like a SpongeBob reference.
- I'm so old.
- We're like two years apart.
How many years apart are we?
- More than that. - I'm 89.
- I'm more than that.
- Okay.
- What the hell happened?
- Your daughter had cardiac arrest.
- Well, resuscitate her, defib her.
- Please, please.
- Defib her, no, you can't shock flat lines.
- So the right course of action is not defibrillation
when there's a flat line, it's chest compressions?
- Yeah, so the purpose of the defibrillator is
to stop the heart and have it automatically restart.
The heart has its own natural pacemaker.
If that pacemaker is beating in a rhythm that is not viable
with having a healthy heart, sometimes it does something
called ventricular fibrillation, where it's beating,
but it's beating in a non-effective way.
Then the defibrillator comes in, shocks the heart, it stops,
and then hopefully it restarts with a normal rhythm.
But what's happening here is you have a heart
that has no rhythm.
Shocking it doesn't actually help the situation.
Here, you wanna give medications to hopefully get
the natural pacemaker to start up.
There's no such thing as jump starting a heart.
In fact, the defibrillator stops the heart
and it restarts on its own.
- Got it.
- Your daughter was killed at the hospital?
- Yeah, in the emergency room, and I wanna swear out
a murder complaint against the resident in charge of it.
- Oh wow.
- But she was at the hospital for treatment.
- Yeah, a sore throat, muscle aches.
She only went in to get a prescription for some antibiotics.
- Bro, can you repeat what he just said?
- She only went to the hospital for some anti-bee-otics.
- Does he also call them dee-ah-bee-tus?
- Just had my first day off in two weeks.
There is a world out there.
- [Policeman] You're the intern who treated
a young girl named-
- That's one cocky intern.
- I know, right?
- For an intern, I thought he was the head
of the hospital for a second.
- I just, I wanna punch that intern so bad.
- Yeah.
(fist smacking bag)
- Yeah, she's the last patient I admitted before I took off.
Bronchitis; she dramatized her symptoms a bit.
- So "Law and Order" is famous for like having random actors
pick up crates and like load them.
And I feel like putting on the white lab coat while
you're talking to police in a murder investigation,
that's the doctor equivalent of, yeah, I remember that guy.
- Right now we're doing a routine investigation
of her death.
- Death? - Using my acting skills.
- You sound surprised.
- Why else would the police be there?
- Don't people croak here every day?
- She wasn't that sick.
You don't die from bronchitis.
- Well, you can.
- Suzanne Morton, she had pneumonia.
The sputum examination and blood culture were indicative.
- So sputum culture and blood culture check
for bacteria growing in both of those sources.
The way we see it is we actually grow the bacteria
and then we put different antibiotics on that bacteria
to see which of those antibiotics it's resistant to,
to make sure that if I give an antibiotic, I don't give one
that the bacteria will be like safe from.
- Would you also check to see if anti-bee-otics
works against the culture?
- Especially anti-bee-otics. - Okay.
- [Policeman] Suzanne Morton?
- Yes, if you see Mr. Morton, please extend my condolences.
- Dr. Rasa, were you on rounds when they reached her?
- Yes, yes, that is right.
I came right away.
- Why?
I didn't think she was that sick.
We heard bronchitis, maybe pneumonia.
- No, no, no, no, no, she was very sick.
- Oh, snap, that's a real, "why did you order
"the Santiago off the island if your orders are
always followed" right there?
Like why did you come quickly if she was in perfect health?
- Yeah, that's a good question.
- Sneaky. - You solve every case
you work on?
- We can tell a felony from a traffic ticket.
- If a patient walks in with a headache,
does she have a subarachnoid hemorrhage,
a buried aneurysm, a retro-orbital tumor?
Or does she just have a headache?
- It's a valid question.
You have to distinguish between the levels of acuity
based on signs and symptoms that the patient's showing.
Subarachnoid hemorrhage is one of those conditions
where we call it as a thunderclap headache,
where patients come in, they say, I'm having
the worst headache of my life.
And that's bleeding into the brain, basically.
- I saw that girl in the emergency room on rounds.
She was in the hands of competent staff.
- The girl is dead.
- Well, people like to believe that medicine
is pure science.
Medicine is a science, but doctors know it's also a lottery.
- I heard the art of component of that statement before.
I've never heard of the lottery.
- Wow, does every patient that walks into your office
just like pulling a lottery ticket,
whether they're gonna walk out?
- It just shows you have no regard for human life.
- Proceed, Sherlock.
- Back in the day of paper, handwritten notes.
Some hospitals that I trained in as a student,
I still wrote handwritten notes like this.
But now everything's on the computer.
Everything's electronic, for good and bad.
Electronic health records add a lot of secretarial work
to what we do day in and day out so that we end up spending
more time on administrative tasks,
rather than taking care of patients.
- Hey, what do you do when you make a mistake?
Use Wite-out?
- Uh-uh, you cross it out and initial it.
This ain't no letter to Dear Abby.
These charts gotta show everything,
Or there could be serious legal repercussions.
- "If you didn't document it, it didn't happen"
is everyone's very famous medical saying.
And if you make a mistake,
you always cross it out and you initial.
- Yeah, and if you're using Wite-out to hide something,
before, that's just laying a literal paper trail
of the crimes that you have committed.
- Now, on top of the Wite-out, it says acetaminophen,
a common, everyday pain killer.
- But Tylenol. - Underneath the Wite-out,
it said meperidine.
- That's a very strong opioid medication.
So very big difference, Tylenol and meperidine.
- Is that the kind of medication
that would stop someone's heart?
- So opioids, one of their nasty side effects is that
they slow breathing down, and you could slow it so much so
that the person stops breathing.
Then there's, in cases where you're giving someone
comfort care at end of life and they're struggling
because they have air hunger.
We actually give morphine not for pain in that situation,
but for that air hunger sensation.
So they don't feel like they're struggling,
and we could naturally slow their breathing down,
even though that's not quote unquote extending their life.
But at that moment it's about comfort rather than
prolonging the few hours that they have.
- Yeah. - Interesting
medical use there.
- She had a headache and a low grade fever, nothing more.
I gave her an antibiotic and an antihistamine.
No doctor would've done anything more.
Her psychiatrist had her on Phenelzine Sulfate.
- This is monoamine oxidase inhibitor,
very unique medication.
A lot of interactions with, not just foods,
but also medicines.
So we've kind of strayed away from it,
but there are instances where we still do prescribe it.
- Okay, the tox screen shows acetaminophen.
It shows aspirin and it shows an antihistamine.
- So there's no sign of meperidine.
- We ran the standard gas and chromatography.
- Well, we know the girl was on something called Phenelzine.
- Not a trace.
- Meperidine, Phenelzine, recreational drugs.
Do another tox screen.
- I think you're wasting your nickel.
- (laughs) This guy's acting is hilarious too.
- But can they do that?
Can they order more tests?
- Yeah, sure.
- Nobody takes meperidine and phenelzine,
unless they wanna risk ending up here.
It can be a fatal combination.
- Yeah, why do you think the police are asking you
to run that screen?
- I don't know specifically the interactions
between those two medications, but giving an opioid
medication plus an MAOI, medication could create
respiratory depression, cardiac issues, neurotoxicity,
and most importantly, there's a condition
called Serotonin syndrome, where by taking both
of those medications, you can have so much serotonin
that it creates your, like an overheating of your body,
and that breaks everything down.
And that's why, when I start a patient on an antidepressant
and we start adding other meds or they're already on meds,
that's when we say we need a psychiatrist on board
to manage these interactions.
- Yeah, all these have evening rounds at 6:00,
6:30 and the night that Suzanne Morton died,
rounds were after 9:00.
- If you hear hoof beats,
it's probably a horse, not a zebra.
- That's a very common saying,
and I wish we'd stop saying it.
It's good in one sense, because frequently what happens
when you have med students, they study all these
obscure diseases for tests, and then they come into,
you know, a patient's exam room and the patient says
they have a headache and they start naming all
of the rarest conditions that cause headaches.
So as an attending, you have to remind them
that if you see a headache, it's probably just a headache,
not some rare condition, a zebra.
- Which is really funny because in the prior scene
this doctor was like, it coulda been like
this other life-threatening tumor.
- And now he's like, oh, just a horse.
- Stop looking for zebras.
Where would you even get that notion?
- You gentlemen are on a zebra hunt.
- Again, that guy is
so nonchalant. - Either a zebra
or a horse using Wite-out.
- (laughs) Maybe Dr. Rasa made a mistake in the chart.
- Maybe he made a mistake in the emergency room.
- How can you just brush it off?
- Man, yeah.
- If you were there and you watched them make the mistake
and you say, no, I saw him, he did it.
But he's just assuming.
- Again, he's completely nonchalant.
And while talking to the New York Police Department
homicide detectives, and he's completely dismissive
of the possibility that anyone on his staff
- Made a mistake. - Coulda possibly
done anything wrong.
- So what happened that night?
Why were rounds so late?
- We waited for the chief of medicine.
- Dr. Auster.
- God on high descending.
Well, he descended late.
- He was there. - He said he'd been delayed
at some retirement party for one of the service chiefs.
Seemed like Dr. Auster had a good time.
- Was he drunk? - Oh snap.
- It smelled like he had been drinking.
- Criminal negligence.
- Yeah, that seems really bad that you don't want
an attending physician if he's drunk from a party.
That seems less than ideal.
- Not less than ideal, I mean that's illegal
and a crime and wrong and you should be fired
and not practice medicine.
There's a lot of things that should happen there.
- Don't drink and conduct rounds, kids.
- (laughs) Or perform surgery.
(sirens blaring)
- You guys just supply bartenders?
- Crates, just movin' crates.
Even in the first episode, they had to shoehorn
in a guy moving crates. - Moving crates, yep.
- I was there.
Two waitresses and Rory, another bartender.
- Remember this guy?
- [Supply Man] Yeah, Jim.
- In a party with like dozens or hundreds of people.
Yeah, I remember that old white guy at a doctor's party.
I mean, good for him.
That guy has a great memory.
- Edward Auster?
- No, no, Jim Green.
The bourbon?
That's what he drank, on the rocks, one every five minutes.
- Did Jim Beam come in green?
I think he means Johnny Walker Green.
- Did he say Jim Bean Green?
- He said Jim, Jim Green. - Jim Green.
- I think they can't say the brand,
so he made up a fake Jim Beam.
Jim Breen or Green, whatever he said.
- I'm begging you, don't make me torpedo my career.
- We need a second witness.
- Do they really need a second witness?
- It would definitely help
for sure. - Really?
- But also, if this guy failed to do anything
because the chief of medicine was completely blackout drunk,
I assume his career is probably over.
He's gonna get sued to death.
This guy is not worried about the right things
at this point.
- My question is, how can they prove that he was drunk,
delivering care when you can't retroactively
go back and test him.
Is it enough to get witnesses to say that he drank,
that he smelled, that he acted weird?
That's enough?
- Oh, a hundred percent.
And that's one of those reasons why circumstantial evidence
is often the strongest evidence you have.
If you have the testimony of the bartender who says,
I serve this guy a dozen drinks.
Well, that's not direct evidence.
It's not, you know, a blood test
of their blood alcohol level.
But that's pretty strong evidence that a guy
that's like 170 pounds is probably pretty drunk.
- Yeah, true.
- I came to New York because of him.
Do you know what it means to be able to say,
I studied under Dr. Edward Auster?
He could destroy - There ya go.
- The rest of my career.
- What career?
- He was drunk.
- That's not that much stronger of evidence
than the bartender saying,
I personally served him this many drinks.
It takes more of a link to be able to say that this doctor
has the expertise to know when someone is drunk
and how drunk they are.
- The girl had muscle pains.
Doctor ordered Meperidine
and the resident said something about phenelzine.
I don't think he even heard.
He took the meperidine.
He injected it himself.
- What? - You try to stop him?
- What are we gonna do, wrestle Dr. Edward Auster
to the floor?
- I mean, yeah, probably, right?
- Yeah, if you're watching someone get murdered.
What, are we gonna wrestle him if he took a knife out
and started stabbing the patient?
- Yeah, I mean, so this is tricky because I'm trying
to figure out what crime this guy might be responsible for.
I think that the act of not stopping a doctor from doing
a clearly wrong medical treatment that would
a hundred percent kill someone is probably negligence.
- He clearly didn't have the intent to join a conspiracy.
So it would be hard to convict this person
of anything criminal.
But I think it would, you'd have a much better chance
suing this guy civilly. - Civilly, yeah.
- Yeah. I, think he's probably on the hook.
- The David's kid already made the turn once.
Said flat out, Auster was drunk.
- I wanna go in with more than a nervous resident.
- Hell, the bartender says Auster drank
like a fish at the party.
- You need more than that?
That sounds pretty solid to me.
- Well, okay, so there is a wrinkle here that they haven't
gotten to because I think you and I had the same reaction
that, okay, this guy is really, really drunk
and he's administering care.
But this guy is I guess a generalist of some kind.
He's not a surgeon.
Certainly if you drink before conducting surgery,
almost certainly reckless homicide.
So imagine, for example, if a radiologist gets drunk
before reading scans. - Reading scans.
- That's not the kind of medicine where you're going to-
- Actively end up causing
their demise. - Exactly.
You might miss something.
- And it might lead to- - Exactly.
And that's certainly negligence.
This doctor is somewhere in between.
He can prescribe medicine that might have a really
adverse effect, but he is also not, you know,
cutting someone open and performing heart surgery.
And so it's possible that this guy is a, I hate to say it,
but a really high functioning alcoholic and therefore
is able to offer a high level of medical treatment
even under that kind of condition.
- Interesting.
That would be cool to argue in a court of law.
Hey, I'm really good when I'm drunk.
- Yeah, boy, I would not want to make that argument
or have to make that argument on behalf of a client,
but yeah, I think that's the argument you'd have to make.
- Edward Auster.
- He looks drunk right now.
- We have a warrant for your arrest.
- The arrest has been made.
This is where the legalities kick in.
Continue by watching the rest of our reaction right here.
- Part two on "Legal Eagles".
- Yeah.
(intense music)