Comments
Matthew Arant wrote:
Your hypothetical situations illustrate practitioners who don't provide care with integrity. I am confident that as a professional, you have reviewed AANA's Scope and Standards for Nurse Anesthesia Practice (http://www.aana.com/uploade...). By following these standards, CRNAs exhibit the professionalism with which we train and practice. Any healthcare professional practicing as you describe will no doubt wind up in court facing negligence and malpractice. Patient education is vitally important for informed decisions and consent and patient safety is the number one priority for all anesthesia providers. Please do not belittle anesthesia providers, CRNA or MDA, as a whole by casting the ignorance of a few across us corporately. The safety of anesthesia has higher standards because of the professional vigilance and diligence practitioners demonstrate on a daily basis.
24/02 21:29:28
Greg CRNA EJD wrote:
I would like your thoughts on a few things. First, 'supervision' as you know is a murky term. When used in statute it either denotes an Insurance reimbursement requirement, OR, denotes a working relationship between a CRNA and an MD, DDS, DO, Podiatrist, etc. In either scenario it NEVER imparts liability or responsibility for the practice of a CRNA on any physician, dentist, etc. In other words supervision in the law regarding CRNAs never means 'responsible for' or 'superior practitioner who is in charge of their practice'. No state requires an anesthesiologist be present for a CRNA to administer anesthesia.
That said, individual institutions may have a policy (the majority of larger institutions) which states that an anesthesiologist must be present in the OR during certain portions of the anesthesia (induction and emergence for example). You will find no basis in science or evidenced based medicine for this....it is PURELY an insurance billing issue. The required anesthesiologist presence coincides precisely with those required by Medicare and Medicaid for reimbursement of the anesthesiologist (they wrote that rule by he way).
Since an institution can create a standard they must follow where one would not have existed otherwise (that an anesthesiologist 'supervise'..just by walking in for 10 min), if this does not happen they have created their own liability for not following their policies.
No CRNA I know would represent that the anesthesiologist will be doing the anesthetic. Thus that misrepresentation, if the basis for action, lays liability at the feet of the anesthesiologist and the institution if found vicariously liable.
I note your comments that the article was intended to merely educate clients as to informed consent and create awareness. You must admit, the article did MORE than imply care by a CRNA is sub-par compared to an MD, and that problems are more likely to occur if a CRNA is left at the helm. "The non-MD practitioner may make a mistake which should not have been made and which injures the patient forever. "
Finally, and i am not being smart, i would be very interested in knowing of specific cases where a claim of misrepresentation of the anesthesia provider has been made and has made an impact on the outcome of the lawsuit. I have not heard of any (and I consult on a lot of cases).
That said, individual institutions may have a policy (the majority of larger institutions) which states that an anesthesiologist must be present in the OR during certain portions of the anesthesia (induction and emergence for example). You will find no basis in science or evidenced based medicine for this....it is PURELY an insurance billing issue. The required anesthesiologist presence coincides precisely with those required by Medicare and Medicaid for reimbursement of the anesthesiologist (they wrote that rule by he way).
Since an institution can create a standard they must follow where one would not have existed otherwise (that an anesthesiologist 'supervise'..just by walking in for 10 min), if this does not happen they have created their own liability for not following their policies.
No CRNA I know would represent that the anesthesiologist will be doing the anesthetic. Thus that misrepresentation, if the basis for action, lays liability at the feet of the anesthesiologist and the institution if found vicariously liable.
I note your comments that the article was intended to merely educate clients as to informed consent and create awareness. You must admit, the article did MORE than imply care by a CRNA is sub-par compared to an MD, and that problems are more likely to occur if a CRNA is left at the helm. "The non-MD practitioner may make a mistake which should not have been made and which injures the patient forever. "
Finally, and i am not being smart, i would be very interested in knowing of specific cases where a claim of misrepresentation of the anesthesia provider has been made and has made an impact on the outcome of the lawsuit. I have not heard of any (and I consult on a lot of cases).
12/02 21:32:48
Diongforce wrote:
Lawref,
Thank you for creating a dialogue which, in my opinion, is overdue. The lack of public understanding of Certified Registered Nurse Anesthetists (CRNAs) role and lack of CRNA identity is a common problem and magnifies an overlooked issue requiring further emphasis on public awareness. Despite the overwhelming CRNA’s contribution to perioperative treatment of patients, CRNA’s remain in anonymity. As a CRNA and Doctoral student I look forward to exploring this topic.
Thank you for creating a dialogue which, in my opinion, is overdue. The lack of public understanding of Certified Registered Nurse Anesthetists (CRNAs) role and lack of CRNA identity is a common problem and magnifies an overlooked issue requiring further emphasis on public awareness. Despite the overwhelming CRNA’s contribution to perioperative treatment of patients, CRNA’s remain in anonymity. As a CRNA and Doctoral student I look forward to exploring this topic.
12/02 16:54:17
Janet wrote:
If a patient does not understand when introduced to a CRNA who along with an anesthesiologist will provide their anesthesia care. Most likely the anesthsia providers did not represented themselves as an anesthesia care team. The ACT approach usually assuages any confusion and provides necessary clarity.
11/02 00:15:50
refadmin wrote:
Suffice it to say that CRNAs have commented on this site and indicated their dispute and offense taken with the information. Their comments are not posted because the article is not to induce debate, but to more or less say, patients should be proactive in procuring informed consent about their medical treatment. No further comments by me will be posted on this page about this topic.
An article about the difference between an anesthesiologist and a CRNA will be coming soon.
An article about the difference between an anesthesiologist and a CRNA will be coming soon.
09/02 09:16:58
refadmin wrote:
09/02 08:06:16
Morgan wrote:
I am put in this position about once a week where I introduce myself as a nurse anesthetist (every patient I take care of), and the patient says "thanks doctor", or the surgeon, who knows better says "hes a good anesthesiologist". I can tell you in every instance I have been aware of this happening I have attempted to correct the patient / or surgeon, or RN until they get it straight. It is a major annoyance to me that people don't pay attention these important details. Most CRNAs I know practice the same code of ethic, as we believe that an educated public will request their anesthesia be given by a CRNA.
08/02 23:05:21
Ann wrote:
I am a CRNA and have practiced in this field for more than 10 years. It is a failure of our healthcare system that the patients don't know who is caring for them. CRNA's provide more than 50% of all anesthetics that are administered in this country and nurse anesthetists provided anesthesia services under the direction of surgeons long before there was ever such a specialty as MDA. I practice in rural hospitals all over the country. In many of these hospitals there is not a physician anesthesiologist even on staff. I spent more than 7 years in school to get the training I have and in addition I was a skilled, caring and compassionate nurse for 10 years before specializing in anesthesia. I tell every patient that I am a nurse anesthetist and "I will be at the head of their bed for the entire procedure" I assure every patient that I will never leave them. No matter if I am working in a location where there are anesthesiologists or not this is my practice with all patients.
07/02 13:34:38
refadmin wrote:
I published a writing about a hypothetical scenario which I encountered repeatedly in my Michigan based practice of law DEFENDING hospitals and CRNAs. If that is offensive to the CRNA population, then redress is to be found within that population.
I defended the CRNAs, nurses, and PAs in the hospital setting where supervision was required. The patients testified that they never knew that (with respect to the CRNA and PA for example) the person treating them was not a physician. There was a difference in the outcome, the MDA and MD typically blamed the CRNA or PA for missing the diagnosis or providing too much anesthesia or failing to monitor, etc. This is what happens practically speaking and it would be the physician group or anesthesia group's insurance that took the financial hit with the hospital throwing in for any damages above the insurance coverage.
I defended the CRNAs, nurses, and PAs in the hospital setting where supervision was required. The patients testified that they never knew that (with respect to the CRNA and PA for example) the person treating them was not a physician. There was a difference in the outcome, the MDA and MD typically blamed the CRNA or PA for missing the diagnosis or providing too much anesthesia or failing to monitor, etc. This is what happens practically speaking and it would be the physician group or anesthesia group's insurance that took the financial hit with the hospital throwing in for any damages above the insurance coverage.
06/02 13:28:52
Carrie Bowman wrote:
I am a CRNA who administers anesthesia in Washington DC. I am deeply offended by your incorrect assumptions regarding my education and my ability to provide safe, high quality care to my patients. After receiving an undergraduate degree at the University of Washington, I pursued my MS degree from Georgetown University. Between getting my BSN and MS, I worked in a trauma unit and intensive care unit as an RN for 3 years. To earn my license to practice as a nurse anesthetist and my masters degree from Georgetown, I trained and studied 70-80 hours a week for 27 straight months. (A similar time commitment to 3 years in law school considering your summer semester is utilized to gain work experience - see my ICU background). I took biochemistry, anatomy and physiology taught by the same pHD professors that teach in the medical school. In the 4 years that I have practiced nurse anesthesia I have NEVER had a single complaint about the care I have provided and I certainly have never deceived my patients. I am proud to administer quality anesthesia care and you better believe I will not let anyone take credit for my work. Although I am NOT required by law to practice with an anesthesiologist, I am proud to have wonderful working relationships with anesthesiologists and find the team approach protects patients - i.e. two sets of eyes on a patient increase the chances that an error will be detected. Many Georgetown surgeons and anesthesiologists who have required anesthesia for themselves or their loved ones have requested me or one of my CRNA colleagues to care for them . Also, if you look in the literature there is NOT a single well designed study that demonstrates adverse outcomes when a CRNA is involved in the care of a patient compared with MDA care alone. If you are truly a guardian of the people you must consider what impact your comments would have on a person undergoing anesthesia. Surgery and anesthesia are very anxiety producing for patients and they deserve accurate information regarding their care. When you scare them like this with false allegations and assumptions you are certainly doing more harm than good which I am sure is not your intention. Thank you for your consideration - from one professional woman to another.
06/02 11:48:47
refadmin wrote:
MCL 333.17210 provides as to nurses that, the board of nursing may issue a specialty certification to a registered professional nurse who has advanced training beyond that required for initial licensure and who has demonstrated competency through examination or other evaluative processes and who practices in 1 of the following health profession specialty fields: nurse midwifery, nurse anesthetist, or nurse practitioner.
28/01 18:09:12
David Cain, BSN, SRNA wrote:
CRNA's would fall under the guidelines for an advanced practice nurse, not a regular nurse.
28/01 17:00:41
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30/05: Medical Malpractice - Who is Treating You?
Do you know who is treating you? Patients are often unaware that the professional treating them is not a physician. Here is a situation of which I became enlightened to in my practice defending hospitals, physicians and nurses. Hypothetically speaking: Patient goes to the hospital for a routine outpatient procedure under which they are to be sedated with anesthesia. The anesthesiologist M.D. (MDA) greets the patient briefly and asks some history and may perform a short examination. This takes place after another professional, likely a Certified Registered Nurse Anesthetist (CRNA) and/or a nurse has taken a history from the patient. The MDA may not do a real thorough job taking the history or performing an examination because he assumes this has been done by the nurse and/or CRNA. He is present to sedate the patient and once sedated, leaves the operating room giving control over to the CRNA. The patient may have no idea that this is taking place and that they are not being cared for by the MDA. If something goes wrong during the surgery with the anesthesia, the CRNA is allowed to use discretion to take care of the patient and may give more anesthesia without speaking with the supervising MDA.What sometimes happens? The non-MD practitioner may make a mistake which should not have been made and which injures the patient forever.
Another example involves physician assistants (PAs) who routinely treat patients in the ER. The patient may make assumptions that the person giving the orders and treatment is a physician and does not know to inquire further. He may be unaware that he is not being treated by a physician assistant and if he is, he may be unaware of the importance of the distinction. Specifically, he may not be aware that the physician assistant is again loosely supervised by the physician in charge who may or may not look at the patient's chart until after, and in some cases, well after, the patient has been discharged. Then, it may be too late as for example, in a hypothetical case in which the patient presents to the ER for back pain, gets examined, treated, and ultimately discharged by a physician assistant who diagnoses back strain. Turns out, the back pain was a symptom of a heart attack and the patient goes home and dies of another massive heart attack. At deposition, the physician may testify that he did nothing wrong and it was no breach to allow the physician assistant to make the decisions he did and for the physician to sign off on the chart days later, having never been aware of the patient or the treatment prior to his death.
(See MCL 333.16215, MCL 333.17049)
This article is posted to inform patients that they should inquire about who is treating them. In my deposition experience defending treaters, the patient would testify that they did not know that the treater was not a physician. The plaintiff attorney prosecuting the case would go after the treater who could have been a RN, CRNA or PA for example, the physicians supervising them, and the hospital for failing to supervise and have proper protocols in place. These were cases involving missed diagnoses by someone other than the doctor, which were nearly fatal. Please know however that in the practice of medical malpractice defense, we see the rare cases. Medical malpractice is not the norm.