A Winchester physician has been reprimanded following the 2019 death of a patient treated by him for a spinal procedure.
A consent order dated May 25, 2022, issued by Virginia Medical Board Deputy Executive Director Jennifer Deschenes, J.D., M.S., and signed by the physician, Dr. Michael J. Poss, states that he violated the law while performing nerve blocks on an elderly patient with morbid obesity and severe obstructive sleep apnea who died after complications arose with the doctor’s administration of anesthesia.
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 (“Board’s General 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 male with morbid obesity and severe obstructive sleep apnea (OSA).”
The order further states that “Dr. Poss failed to adequately evaluate Patient A’s conditions, his specific comorbidities that complicate anesthetic management, and the 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’ office for the nerve block procedure, which required sedation. The man, identified only as “Patient A” by the Board, had medical records that documented “several severe systemic diseases and substantive functional limitations elevating his risk of complications associated with anesthesia” as defined by the American Society of Anesthesiologists Physical Status Classification System. (“ASA Classification System”)
The Board maintained that although patients with severe systemic diseases such as Patient A should be ASA Class 3, due to elevated risk, Dr. Poss “improperly classified Patient 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 package insert warns that rapid bolus infusion dosing of elderly ASA Class 3 patients such as Patient A can lead to 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 which result from bolus dosing or rapid increases in infusion rates. An adequate interval (3 to 5 minutes) must be allowed between dose adjustments in order 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 13:40 and 13;42, after which Patient A’s carbon dioxide levels began rising, which can 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’s 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){l8) and 18 VAC 85-20-390 of the Board’s General Regulations.
Dr. Poss agreed that he will not provide intravenous sedation for interventional pain procedures performed by him in the future. He signed the consent order, admitting to the “Findings of Fact and Conclusions of Law contained” in the order, and waived his right to contest findings or sanctions imposed by the Board. He was represented by C. J. Steuart Thomas III, an attorney with the Staunton, VA firm of Timberlake, Smith, Thomas & Moses, P.C.
The Board ordered that Dr. Poss be reprimanded and gave him six months to complete at least 12 hours of Board-approved continuing medical education (“CME”) course(s) on the topic of office-based moderate procedural sedation. Once those courses have been completed the Board expects to close the matter. However, if the order is violated, Poss faces the suspension or revocation of his license to practice medicine in Virginia.
Poss is currently listed as a provider at the Winchester practice of Valley Pain Consultants; he is also listed as a provider/co-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 whole-body wellness.” Attempts to reach Poss for comment were unsuccessful.
Winchester Circuit Court records indicate that a wrongful death lawsuit was filed by the estate of Frederick County resident Richard J. Hart and his son, Richard J. Hart on September 13, 2019, naming Poss, the Virginia Pain and Spine Center and Kim C. Davis, R.N. as defendants in a medical malpractice suit.
Hart’s estate was represented by Les S. Bowers, an attorney with the Virginia firm of Michie-Hamlett. Bowers wrote in filing documents that there was a “gross violation of the standard of care.” He maintained that there was a time discrepancy of 10 minutes between Poss’ office and the Winchester Communications Center about when 911 was called after Hart began experiencing breathing issues and a drop in pulse. Bowers, citing the written report of a Winchester Fire Department EMT, maintained that CPR was not performed until 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” by Poss contributed to the death of Hart, 78. He maintained that “Mr. Hart would not have died on Feb. 18, 2019, had the defendants [promptly] and appropriately evaluated, treated, diagnosed and intervened [over] his condition.”
Hart, vice president of labor relations and human resources at Manhattan Construction Group, in Naples, Fla., left behind a wife and five children.
All three defendants in the case were represented by C. J. Steuart Thomas III; the lawsuit was settled for an undisclosed amount in September 2020.
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