Champagne for Saline

Via Grahamazon (and yes, it makes me nostalgic when I start a post like that) comes this rich tale of a doctor who subbed saline for spinal fluid:
A former emergency room doctor fired for sending saline rather than spinal fluid to a laboratory was reprimanded for that incident Tuesday by the Maine Board of Licensure in Medicine.

Dr. Cesar O. Garcia, who had lived in Hampden while working at MaineGeneral Medical Center in Waterville and Augusta, was fired by the hospital in July 2004, shortly after the mistake was discovered.

I'm intrigued by this story -- because I think this subterfuge has crossed every ED doc's mind at some point. When you're confronted with tapping a morbidly obese patient, with poor landmarks and a low threshold for pain, for instance -- or an insanely busy shift where a patients' "worst headache ever" got better with one tylenol...

Fortunately, no harm was done to the patient. But really, I don't understand how this doc thought he could get away with this, to begin with. Sure, sending saline could reassure the patient that there's no excess of blood cells in the CSF, no bacteria... but can anyone get around ordering glucose and protein, things that saline might lack? Wouldn't the chloride level be off?