Lawsuits filed against Arizona CRNA after multiple patients die within a year during elective dental sedation

[drmwvr]

Wow wow wow. On their page, their selling point is that the dentist/surgeon will not be liable for the action of the anesthetist

If they believed that they deserve to be sued.

---

Members don't see this ad.

 

[Justice4all]

.

 

[jwk]

This will be an interesting one to follow along from several medico-legal perspectives. Although if the facts are anywhere close to what's in the complaint, it may be a matter of quietly writing checks with lots of zeroes from each defendant and we may never hear the final result.

 

[secretasianman]

The problem is most if not all these cases are so f’ed up that they all settle, sweeping the whole thing under the rug. No good institutional change or public awareness comes to light.

Dr Richmond, DNP, fake doctor.. is f’ed. Maybe don’t pretend to be something you’re not?

 

[coffeebythelake]

Sounds like they were "honestly mistaken"

The plaintiffs' attorneys are likely to open a can of whup ass on the dentist and their corporation

Sec 32-1634.04. Certified registered nurse anesthetist; scope of practice, Article 2. Licensing and Certification, Chapter 15. NURSING, Title 32. Professions and Occupations, Arizona Revised Statutes

The Arizona Revised Statutes contains Public Health and Safety Law, Criminal Law, Accountancy, Agriculture, Alcoholic Beverages, Banks, Children, Trusts and Estates, Education, Elections, Weapons and Explosives, Property, Tax.

az.elaws.us

Section R4-11-1301 - General Anesthesia and Deep Sedation, Ariz. Admin. Code § 4-11-1301 | Casetext Search + Citator

Read Section R4-11-1301 - General Anesthesia and Deep Sedation, Ariz. Admin. Code § 4-11-1301, see flags on bad law, and search Casetext’s comprehensive legal database

casetext.com

Work with a nurse who demands to be called "doctor", you get what's coming to you.

 

[jwk]

Work with a nurse who demands to be called "doctor", you get what's coming to you.

We don't allow that in our shop. And when I interview potential hires, I make it clear we never use Dr. for nurses.

 

[nimbus]

Dr Richmond, DNP, fake doctor.. is f’ed. Maybe don’t pretend to be something you’re not?

Doubt it. Nursing board says he’s good to go.

 

[coffeebythelake]

Doubt it. Nursing board says he’s good to go.

It's a matter of nursing board being rotten to the core. Tragic incidents like these don't faze them because nurses are held to a nursing standard of care, not a medical standard of care.

You would think that a legitimate board investigating this would have some competent and experienced people. Nurse Angela Fountain, the CRNA who praised that joker Nurse Troy has barely a few years of clinical practice under her belt. What a farce. They commiserate under their own lofty made-up titles and their inadequate training. Who knew lasers and lots of oxygen can cause a fire? Apparently this is surprising to them and not something that could be foreseen.



Per the Arizona State Board of Nursing Website:

Angela Fountain, DNP, CRNA​

"Dr." Fountain received her Doctorate of Nursing Practice in 2019 from Arizona State University, Master of Science in Nurse Anesthesia in 2013 from Wolford College, and Master of Science in Nursing in 2010 from Grand Canyon University. She is a member of American Association of Nurse Anesthetists and Arizona Association of Nurse Anesthetists. Her areas of expertise or clinical interest include Anesthesia, Critical Care, and Workplace Incivility.

“In regards to the case with the laser, job well done as far as I’m concerned,”
“I’m sorry for the outcome. But job well done."

- Angela Fountain, a nurse who took a couple online courses


Yes, great job starting that patients mouth on fire. Job well done!

Troy and Angela, medicine is hard. I'm sorry you are just figuring that out now.

 

[coffeebythelake]

"This has been an issue from the start. They are held to a lesser standard when it comes to licensure and malpractice. They want equal scope but aren’t willing to accept equal consequences or liability that comes with that scope. Ultimately, the patients suffer from this. They literally have no recourse to outright malpractice. His license will remain intact, and he will continue to put patients lives at risk for practicing outside of his scope because his professional organization lobbied hard enough to allow that to happen."

 

[wholeheartedly]

Lifeguard Anesthesia

Team — Lifeguard Anesthesia

www.lifeguardanesthesia.surgery

Nurse anesthesiologist

Someone should sue for false advertising. Does the state anesthesiology group know they’re calling themselves that.

 

[coffeebythelake]

Someone should sue for false advertising. Does the state anesthesiology group know they’re calling themselves that.

Public: "CRNAs are not anesthesiologists"
Doctors: "CRNAs are not anesthesiologists"
The Fukking Dictionary: "CRNAs are not anesthesiologists"
AANA: "Waaaah, But we really wanna be called anesthesiologists"

The AANA gave them a pass. This will be litigated in the courts. New Hampshire has said it is illegal for CRNAs to call themselves anesthesiologists. I'm sure other states will follow suit.

 

[vector2]

This is one of the situations where lawyers may be the savior. When lawsuits start to fly for this behavior things will change. In the remote past patients would fall out of bed with regularity and break hips, etc. Lawyers started to sue and all of a sudden guardrails were utilized and the occurrence of this type of injury became a rarity. Monetary penalties change behavior more than logic or truth.

I'm curious as to what the insurance companies think about stories like these. When nurses like operate these physician-less practices in opt out states, what kind of malpractice premiums are they paying?

 

[wholeheartedly]

Need to find out how someone gets on this board of nursing and if there are mechanisms to remove them and put tremendous public pressure on them to remove the board or for them to resign for not having the publics best interest at heart.

It would also be a good case to highlight that members of nursing are held to a different and lower standard of care than physicians.

 

[caligas]

I suspect most of us would be shocked to see how dental sedation is commonly handled in these offices; unprotected bloody airways with throat packs, inadequate ventilation “overcome” with high oxygen flows, poor monitoring, and poorer equipment and planning for resuscitation.

Usually they get away with it.

 

[woopedazz]

nurse-cum

 

[epidural man]

Lawsuits filed against Arizona nurse anesthetist after two dental deaths, fire in mouth

An Arizona nurse anesthetist is facing multiple lawsuits after two of his patients died in separate dental procedures within a year.

www.abc15.com

- First patient died while under anesthesia due to hypoxic brain injury during elective teeth extraction to facilitate dentures
- Second patient died after inhalational burn injury caused by airway fire during laser procedure in which an unsafe FiO2 was administered.
- In at least one of these cases CRNA failed to perform a pre-anesthesia assessment and no anesthesia consent form was signed
- Dental office was not equipped for procedures under anesthesia, and the dentist did not hold certification to perform dental procedures under sedation
- Dental office paid a "mobile anesthesia" CRNA group to come in and sedate patients regardless of lack of adequate equipment or certification of facility
- Arizona Board of Nursing reviews cases and clears CRNA of any wrong doing, and refers to him as a "doctor" because he has a doctorate of nursing...
- Nursing Board member expresses sympathy for CRNA saying "I have to tell you, I am sorry. You have been through hell to say the least" due to the stress of having his professional conduct reviewed, while expressing no sympathy for family of patients who died.
- Nursing Board recommends against disciplinary action but rather for the CRNA to simply "review the Nursing Practice Act" with regards to reminding him of the mandatory performance of pre-op assessments.

... WTF?

And you guys want to supervise these adults and all their choices?

Greed is a strange strange thing.

 

[chessknt]

I'm curious as to what the insurance companies think about stories like these. When nurses like operate these physician-less practices in opt out states, what kind of malpractice premiums are they paying?

My take on it was that they operated on a cash only basis. I doubt health insurance would pay for anesthesia during a dental procedure.

 

[vector2]

My take on it was that they operated on a cash only basis. I doubt health insurance would pay for anesthesia during a dental procedure.

I was referring just to the malpractice insurers. There is a mispricing occurring in that market because if anything the nurses should be paying double what I do if the surgeon or proceduralist they're working with isn't liable for them.

 

[deleted126335]

I was referring just to the malpractice insurers. There is a mispricing occurring in that market because if anything the nurses should be paying double what I do if the surgeon or proceduralist they're working with isn't liable for them.

Not usually the case. Most of Independent CRNA practice is rural areas. Which tend to be small town, not plaintiff friendly areas where local juries are disinclined to put a bullet in what is often the town’s biggest employer- the hospital. Not to mention finding against someone who has a decent chance of taking care of you or your loved one. Non rural stuff tends to be be relatively low risk- cataracts, cosmetic surgery, healthy screening endos, etc. so the actuarial data is probably not that bad for solo CRNAs. But it is not an apples to apples comparison. Of course that doesn’t stop the AANA from saying that premiums are not significantly different. Also AANA runs their own malpractice company. Don’t know what percent of solo CRNAs they insure.

 

[coffeebythelake]

The problem is most if not all these cases are so f’ed up that they all settle, sweeping the whole thing under the rug. No good institutional change or public awareness comes to light.

Dr Richmond, DNP, fake doctor.. is f’ed. Maybe don’t pretend to be something you’re not?

It's almost like we ought to compile all these cases and have them easily accessible. Along with a basic explanation of what happened and what should have been done.

 

[secretasianman]

It's almost like we ought to compile all these cases and have them easily accessible. Along with a basic explanation of what happened and what should have been done.

The Rex meeker files.

 

[pgg]

Somebody wake me up when the ASA rents a couple billboards or publishes a op-ed to expose just how common these assassinations are. I might even renew my ASA membership and start donating to ASAPAC again. I regret every dollar I ever gave those clowns.

Of course we all know they'll be silent lest anyone's feelings or business model gets hurt.

I can't walk 12 feet through our radiology department without passing a glossy 2x3 poster extolling the training radiologists get, and asking patients to demand that their films get read by a board certified (if not fellowship trained) radiologist. But apparently everyone at the ASA is locked up in the AANA basement trying on different size ball gags.

 

[pgg]

The plaintiffs' attorneys are likely to open a can of whup ass on the dentist and their corporation

One can only hope.

Cue the Board of Teeth and Gums, or whatever body governs these guys, to join the nursing board in expressing sympathy for the poor, poor dentist who was only cutting corners a little bit to squeeze an extra $600 cash payment out of his patients.

 

[coffeebythelake]

The Rex meeker files.

I was thinking more like www.CRNAssassin.com

 

[GassYous]

It's almost like we ought to compile all these cases and have them easily accessible. Along with a basic explanation of what happened and what should have been done.

RM CRNA - killed patient. Don't intubate esophagus.

 

[deleted126335]

I was thinking more like www.CRNAssassin.com

I am sure that there are plenty of dramatic, indefensible clean kills by anesthesiologists as well. Remember the saying about glass houses.

 

[MirrorTodd]

I am sure that there are plenty of dramatic, indefensible clean kills by anesthesiologists as well. Remember the saying about glass houses.

Something about sinking ships.

 

[greatnt249]

I am sure that there are plenty of dramatic, indefensible clean kills by anesthesiologists as well. Remember the saying about glass houses.

Ostensibly the difference is that we're capable of policing ourselves as physicians. When the board of nursing is saying "job well done" for what was essentially a never-event, how exactly are you supposed to not cast judgment?

 

[chessknt]

Ostensibly the difference is that we're capable of policing ourselves as physicians. When the board of nursing is saying "job well done" for what was essentially a never-event, how exactly are you supposed to not cast judgment?

Medical boards aren’t run by doctors though. Most of the policing comes at the privilege level.

 

[secretasianman]

The bar is set so low, where patient death is just another day at work for them. The guy died but “good job anyways”? That’s a line waiting to become an ad. If a physician did this you bet there would have been a real investigation; the medical board is quick to protect the public and punish the doc.

Why no one is calling these guys out for subpar level care while calling themselves “doctor” is beyond me.

 

[deleted126335]

Somebody wake me up when the ASA rents a couple billboards or publishes a op-ed to expose just how common these assassinations are. I might even renew my ASA membership and start donating to ASAPAC again. I regret every dollar I ever gave those clowns.

Of course we all know they'll be silent lest anyone's feelings or business model gets hurt.

I can't walk 12 feet through our radiology department without passing a glossy 2x3 poster extolling the training radiologists get, and asking patients to demand that their films get read by a board certified (if not fellowship trained) radiologist. But apparently everyone at the ASA is locked up in the AANA basement trying on different size ball gags.

 

[VA Hopeful Dr]

Medical boards aren’t run by doctors though. Most of the policing comes at the privilege level.

They're not?

 

[coffeebythelake]

ASA might not. But PPP might.

 

[chessknt]

They're not?

Ah you are right--I have always interfaced with MSW-level employees but it appears the majority of the board (and 4 other states I looked in) are physicians. Makes sense which is why I guess I thought it would not be the case.

 

[Planktonmd]

Ok, so CRNAs kill people, but also Anesthesiologists do! It's sad but it's a fact of life.
The essential issue here is not who kills more people, but it's why we even got there? Why did we get to the point where the only way we can prove our merit as physicians is to prove that we kill less people?
Think about it and review the history of the ASA.
The ASA long time ago declared that they are OK with CRNA's working under the supervision of a "physician" not necessarily an anesthesiologist, just a physician, even a podiatrist would do!
That was when the ASA sold us out, and no matter what they do or say now, it's too late.
They basically admitted publicly that we are just another physician, and now they are trying to back paddle... but it's too late.

 

[Airway]

Think about it and review the history of the ASA.
The ASA long time ago declared that they are OK with CRNA's working under the supervision of a "physician" not necessarily an anesthesiologist, just a physician, even a podiatrist would do!

I admit I'm not familiar with this. Can you reference the white paper or similar?

 

[dhb]

I admit I'm not familiar with this. Can you reference the white paper or similar?

"White paper not available; code brown called a long time ago."

 

[coffeebythelake]

Ok, so CRNAs kill people, but also Anesthesiologists do! It's sad but it's a fact of life.

This can be easily re-framed.

While anesthesia has made great strides in terms of safety over the last few decades, it remains a field where rapid changes and potentially lethal mistakes can occur. When everything goes well, these nurses can pretend to be like doctors. When **** hits the fan, do you want a nurse or a doctor taking care of you?

 

[pastafan]

This can be easily re-framed.

While anesthesia has made great strides in terms of safety over the last few decades, it remains a field where rapid changes and potentially lethal mistakes can occur. When everything goes well, these nurses can pretend to be like doctors. When **** hits the fan, do you want a nurse or a doctor taking care of you?

Another argument that hits home. You pay the same for the services of a doctor or a nurse. Which would you prefer?

 

[ambiturner]

Another argument that hits home. You pay the same for the services of a doctor or a nurse. Which would you prefer?

You may be depressed by the responses

 

[secretasianman]

Can you imagine if this conversation was posed in the icu? ICU doc vs icu np, which do you want? 50/50 you gonna die anyway!

 

[Airway]

Can you imagine if this conversation was posed in the icu? ICU doc vs icu np, which do you want? 50/50 you gonna die anyway!

Sure but one is by negligence/dunning Kruger. The other is after flogging the patient then allowing a natural death.

 

[IMGASMD]

Sure but one is by negligence/dunning Kruger. The other is after flogging the patient then allowing a natural death.

I want someone to talk to me and practice healthcare on me. None of you doctors who spend most your time learning how to save patients and practice medicine on me!

 

[dozitgetchahi]

The problem is most if not all these cases are so f’ed up that they all settle, sweeping the whole thing under the rug. No good institutional change or public awareness comes to light.

Dr Richmond, DNP, fake doctor.. is f’ed. Maybe don’t pretend to be something you’re not?

I am of the opinion that the details of all settlements in this country should be made public. If you want to settle a suit, that’s fine - but that should not buy you secrecy.

 

[deleted126335]

I am of the opinion that the details of all settlements in this country should be made public. If you want to settle a suit, that’s fine - but that should not buy you secrecy.

Uhm, no. That would greatly decrease the incentive to settle. The system would grind to a halt with the massive increase in the number of trials that would result. The NPDB was the compromise between complete confidentiality and what you are proposing.

 

[DazedWanderer]

Lifeguard Anesthesia: Someone should sue for false advertising. Does the state anesthesiology group know they’re calling themselves that.

More like Grim Reaper Anesthesia.

 

[coffeebythelake]

Another argument that hits home. You pay the same for the services of a doctor or a nurse. Which would you prefer?

You pay the same for the services of a doctor supervising said nurse.

 

[Sublimazing]

19. CRNA Richmond was the nurse anesthetist who was responsible for administering and monitoring the IV sedation and supplemental oxygen given to Ralph Chapman during the Laser Surgery. 20. Prior to the Laser Surgery, gauze throat packs and a bite-block were placed in Ralph Chapman intraorally on orders of Dr. Houser. 21. Throughout the Laser Surgery, CRNA Richmond administered supplemental oxygen to Ralph Chapman by nasal cannula at 6 liters, per minute.

Just from a technical point of view....throat packs? Without an ETT? Laser or no.... A complete novelty to me....lacking any more information, seems the surgeon is the co-assassin here....

23. Ralph Chapman was not properly advised of the risks of the use of a laser in this type of Laser Surgery.

Whatever 'risks' of 'this type of surgery' there were, they paled in comparison to the *way* in which this surgery/anesthetic was conducted.

How do you consent for bat s**t crazy?

They’re more like throat screens. It’s just 4x4 gauze we wet and put in the oropharynx. Doing these procedures under sedation WITHOUT one is malpractice.

Not knowing that 6L/m by nasal cannula and then firing their laser would cause this is criminal.

And the dentists absolutely deserve to be part of the lawsuit. General Dentists and Periodontists shouldn’t be allowed to supervise a CRNA. No exceptions.

 

[deleted126335]

General Dentists and Periodontists shouldn’t be allowed to supervise a CRNA. No exceptions.

If the only other choice is no supervision requirement for CRNAs, what would you choose?

 

[Sublimazing]

If the only other choice is no supervision requirement for CRNAs, what would you choose?

If dentists want patients sedated in their offices they should be required to get an anesthesiologist or a dental anesthesiologist. Otherwise, go get privileges at the hospital.