A Winchester doctor received a reprimand following the 2019 death of a patient he treated for a spinal procedure.
A consent order dated May 25, 2022, issued by Virginia Medical Board Deputy Executive Director Jennifer Deschenes, JD, MS, and signed by the physician, Michael J. Poss, MD, states that he violated the law when performing nerve blocks in an elderly patient with morbid obesity and severe obstructive sleep apnea who died after complications arising from the administration of anesthesia by the doctor.
The order states that “Dr. Poss violated Virginia Code § 54.l-2915(A)(3), (13), (16), and (18), and the Regulations governing the practice of medicine, osteopathy, podiatry, and chiropractic (“General Board Regulations”), on February 18, 2019, while performing bilateral L3-4, L4-5, and L5-S l lumbar facet joint nerve blocks on Patient A, a 78-year-old man with morbid obesity and severe obstructive sleep apnea (OSA).”
The order further states that “Dr. Poss failed to adequately assess Patient A’s conditions, his specific comorbidities that complicate anesthetic management, and specific intrinsic risks to the patient, in violation of 18 VAC 85-20340(B)(2) of the Board’s General Regulations.”
The patient went to Poss’s office for the nerve block procedure, which required sedation. The man, identified only as “Patient A” by the Board, had medical records documenting “several serious systemic illnesses and substantial functional limitations that elevated his risk of anesthesia-associated complications,” as defined by the Physical Status Classification System. of the American Society of Anesthesiologists. (“ASA Classification System”)
The Board held that although patients with serious systemic illnesses, such as Patient A, should be ASA Class 3, because of the elevated risk, Dr. Poss “incorrectly classified Patient as AASA Class 2 on the day of the procedure.” .
The Board wrote in the order that Dr. Poss ordered and supervised “the administration by a registered nurse to Patient A of four doses of propofol via rapid bolus administration in eleven minutes, although the FDA-approved label warns that rapid bolus infusion dosing of ASA in elderly Class 3 patients, such as patient A, may result in apnea.”
The FDA warning further stated: “Steady-state propofol blood concentrations are generally proportional to infusion rates. Undesirable side effects, such as cardiorespiratory depression, are likely to occur at higher blood concentrations resulting from bolus dosing or rapid increases in infusion rates. An adequate interval (3 to 5 minutes) should be allowed between dose adjustments to assess clinical effects.”
Despite the FDA warning, medical records show that on February 18, 2019, Dr. Poss ordered the first two doses of propofol two minutes apart, at 1:40 p.m. and 1:42 p.m., after from which patient A’s carbon dioxide levels began to rise, which may signify hypoventilation and/or airway obstruction. The third and fourth doses of propofol were administered at 13:47 and 13:51, respectively.
Patient A’s medical records show that despite Dr. Poss’s emergency interventions, Patient A continued to deteriorate and died later that day after being transported to a nearby hospital emergency department.
The Board wrote in the order that because Poss failed to report Patient A’s death to the Board within 30 days, he had violated 3. Dr. Poss violated Virginia Code§ 54.1-2915(A)(18) and 18 VAC 85-20-390 of the General Regulations of the Board.
Dr. Poss agreed that he will not provide IV sedation for future interventional pain procedures performed by him. He signed the consent order, admitting the “Findings of Law and Fact Contained” in the order, and waived his right to challenge the findings or sanctions imposed by the Board. He was represented by CJ Steuart Thomas III, an attorney with the Staunton, VA firm of Timberlake, Smith, Thomas & Moses, PC.
The Board ordered that Dr. Poss be reprimanded and given six months to complete at least 12 hours of Board-approved continuing medical education (“CME”) courses on the subject of moderate office sedation. Once those courses have been completed, the Board hopes to close the matter. However, if the order is violated, Poss faces suspension or revocation of his license to practice medicine in Virginia.
Poss is currently listed as a provider in the Winchester practice of Valley Pain Consultants; he is also listed as a provider/part owner at Virginia Regenerative Medicine & Spa in Marshall, VA. According to the business website, the office specializes in “regenerative medicine for orthopedics, aesthetics, sexual health, and full-body wellness.” Attempts to reach Poss for comment were unsuccessful.
Winchester Circuit Court records indicate that the estate of Frederick County resident Richard J. Hart and his son, Richard J. Hart, and his son, Richard J. Hart, filed a wrongful death lawsuit on 13 September 2019, naming Poss, the Virginia Pain and Spine Center, and Kim C. Davis, RN as defendants in a medical malpractice lawsuit.
Hart’s estate was represented by Les S. Bowers, an attorney with the Virginia firm of Michie-Hamlett. Bowers wrote in the filed documents that there was a “serious violation of the standard of care.” He contended there was a 10-minute time discrepancy between Poss’s office and the Winchester Communications Center when 911 was called after Hart began experiencing breathing problems and a drop in pulse. Bowers, citing the written report of a Winchester Fire Department EMT, maintained that CPR was not performed until the EMTs arrived. Mr. Hart was transported to Winchester Medical Center, where he was pronounced dead that afternoon.
Bowers wrote in the lawsuit that “gross medical negligence” on Poss’s part contributed to the death of the 78-year-old Hart. He maintained that “Mr. Hart would not have died on February 18, 2019 if the defendants [promptly] and adequately evaluated, treated, diagnosed and intervened [over] Your condition.”
Hart, vice president of labor relations and human resources for Manhattan Construction Group, in Naples, Fla., left behind a wife and five children.
All three defendants in the case were represented by CJ Steuart Thomas III; the suit was settled for an undisclosed amount in September 2020.