Surgeon ges sued for CRNA overdose of patient

[PGY2]

Here is why surgeons shouldnt depend on CRNAs. Guess who got sued???

http://www.cnn.com/2006/LAW/10/26/rival.poisoned.ap/index.html

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[dogbone65]

This doesn't have a damn thing to do with clinical competency...just another wigged out chick. Maybe you should read it before you post it.

 

[Gimlet]

Man, that's some grudge, though!

I agree that it doesn't have anything to do with her competence as a CRNA, but it does still serve as a good reminder that anything that goes on in your office is ultimately your responsibility.

 

[badgas]

This doesn't have a damn thing to do with clinical competency...just another wigged out chick. Maybe you should read it before you post it.

I think you missed the point. The point was "guess who got sued?" With an anesthesiologist, the plastic surgeon doesn't get sued since they don't have to sign off on their chart. With a CRNA the surgeon becomes liable for anesthesia mistakes whether they are intentional or not. This is how I have always understood it but I am also no lawyer.

 

[dogbone65]

Nah man, didn't miss the point at all....just think it was poorly worded. I agree it is a shame that the surgeon got sued for something that wasn't his fault...never should happen, but it not your fault, my fault or the fault of anyone in healthcare, generally. It's the damn lawyers and our litigious society. Frankly, I think they oughta hang the biatch after she pays the surgeon back his money. To point a finger and say it's because she was a crna is childish, foolish and uninformed. I wonder...........think she's ever boiled a rabbit?

 

[badgas]

Nah man, didn't miss the point at all....just think it was poorly worded. I agree it is a shame that the surgeon got sued for something that wasn't his fault...never should happen, but it not your fault, my fault or the fault of anyone in healthcare, generally. It's the damn lawyers and our litigious society. Frankly, I think they oughta hang the biatch after she pays the surgeon back his money. To point a finger and say it's because she was a crna is childish, foolish and uninformed. I wonder...........think she's ever boiled a rabbit?

I agree with you 100%. The whole system is completely ass backwards due to the lawyers, insurance companies, government, etc. But the fact is that the plastic surgoen would not have been sued if it were an anesthesiologist who went off the deep end. That is our messed up system and it's up to the surgeons to figure out if they want to take that chance or not.

 

[dogbone65]

But the fact is that the plastic surgoen would not have been sued if it were an anesthesiologist who went off the deep end.

ahhhhhh..........wrong again

 

[The_Sensei]

ahhhhhh..........wrong again

How do you figure?

 

[dogbone65]

How do you figure?[/

QUOTE]

All licensed people are responsible and accountable for their actions, misactions, etc. The lawyers and insurance companies typically go after the MD cause they have deeper pockets. Since none of us know the particulars of the original case, then we can only speculate on why they went after the surgeon. If an anesthesiologist had been doing the case instead of a crna, then they might as well would have gone after him too, again, because of the $$. I would bet good money though that the surgeon would still be named in the lawsuit, however. Shakespeare was right................

 

[militarymd]

QUOTE]

All licensed people are responsible and accountable for their actions, misactions, etc. The lawyers and insurance companies typically go after the MD cause they have deeper pockets. Since none of us know the particulars of the original case, then we can only speculate on why they went after the surgeon. If an anesthesiologist had been doing the case instead of a crna, then they might as well would have gone after him too, again, because of the $$. I would bet good money though that the surgeon would still be named in the lawsuit, however. Shakespeare was right................

What did Shakespeare say?

 

[7by11thenout]

I know an anesthesiologist who got sued when the surgeon put the pectus bar through the heart when operating on a teenager for pectus excavatum. Now since this is a rare complication there was no cardiopulmonary bypass unit imediately available and a hole in the right ventricle with no CT surgeon around means the patient died and fast since keeping up with blood loss is nearly impossible - Was this the anesthesiologists fault? No did the anesthesiologist ram the rod through the heart? no Did she get sued? Yes along with the surgeon...

We all get named when something goes wrong. It is just if you are a surgeon pick your anesthesia team carefully and if you are an anesthesiologist pick which surgeons you work for carefully - certain people have more complications than others.

 

[dogbone65]

What did Shakespeare say?

"The first thing we do, let's kill all the lawyers. "

Shakespeare's Henry VI

Gotta love Billy.

 

[Bertelman]

We all get named when something goes wrong. It is just if you are a surgeon pick your anesthesia team carefully and if you are an anesthesiologist pick which surgeons you work for carefully - certain people have more complications than others.

Great, but ultimately what happened to this anesthesiologist? Sure, everyone gets mentioned initially because they cast a large net. Was the anesthesiologist ultimately deemed responsible? Did he/she owe any money?

I think one of the points here is that ultimately the surgeon is RESPONSIBLE for the CRNA. The anesthesiologist in your situation is NOT responsible for the surgeon. Named in the suit, yes, but I am sure ultimately was cleared. Not so sure about the surgeon in this case. Obviously this seems like a case of malicious intent, yet it is under supervision of the surgeon.

 

[dogbone65]

We all get named when something goes wrong. It is just if you are a surgeon pick your anesthesia team carefully and if you are an anesthesiologist pick which surgeons you work for carefully - certain people have more complications than others.

yup

 

[UTSouthwestern]

How quickly we have forgotten about the anesthesiologist that was the only person found liable in the death of an orthopedic surgeon in the surgeon's own facility in the recovery area. Anesthesiologist was the only one found liable.

In any malpractice suit, the SOP is to blanket sue everyone. One by one, people get dropped from the suit when their role, or lack thereof, in the event is delineated.

I had a partner get sued when a nurse and subsequently a urologist traumatized a patient's urethra and tore created a tear. He had absolutely nothing to do with a foley placement, but he was named in the suit. He was dropped from the lawsuit without much effort on his part.

Having an anesthesiologist around does change the medicolegal environment of a case.

 

[Atropine]

This doesn't have a damn thing to do with clinical competency...just another wigged out chick. Maybe you should read it before you post it.

Actually, it has everything to do with clinical competency whether she "wigged out" as you say, or not. She gave too much fentanyl and subsequently didn't know how to revive the patient. The prosecution/police are only speculating she had malicious intent.

 

[MacGyver]

Absolutely outrageous case.

There's no way any doc should be named in this suit.

Trial lawyers strike again

 

[Gern Blansten]

This doesn't have a damn thing to do with clinical competency...just another wigged out chick. Maybe you should read it before you post it.

I would argue that it has everything to do with clinical competence. If there was an inability to recognize and treat respiratory failure due to narcotics, that demonstrates a lack of clinical competence(although details are not known). If the CRNA had malicious intent, that falls under the heading of professionalism, or lack of it to an extreme degree. Although CRNAs do not fall under the ACGME umbrella, the ACGME has determined that professionalism is a CORE competency that, if not achieved, constitutes failure as much as lack of sufficient knowledge or inadequate clinical skills would. Therefore, I would say that this does have a "damn (sic) thing" to do with competency. I suspect that the original poster did, in fact, read the article before they posted it.

Without regard for the lawsuit and assuming no malicious intent, would the presence of an anesthesiologist have made a difference in the rescue of this patient?

 

[racerx]

We just covered this in our medical legal/ethics course. This is referred to as vicarious liability. In the eyes of the law (read as trial lawyers, NOT the legislatures or courts), the surgeon is "captain of the ship" and thereby liable for her actions.

Whether this type of claim ever gets anywhere? I don't know, I just took the course.

Just looked it up: It is increasingly rare for the plaintiff to succeed in these cases. However, tort lawyers still try it, and can tie up a surgeon's life/money/practice/reputation for quite a while until the surg. is dropped from the case.

 

[dogbone65]

Actually, it has everything to do with clinical competency whether she "wigged out" as you say, or not. She gave too much fentanyl and subsequently didn't know how to revive the patient. The prosecution/police are only speculating she had malicious intent.

It didn't say she didn't "know how to revive the patient" She was trying to kill her......big difference...in fact not even in the ballpark there sparky.

 

[MacGyver]

We just covered this in our medical legal/ethics course. This is referred to as vicarious liability. In the eyes of the law, the surgeon is "captain of the ship" and thereby liable for her actions.

Whether this type of claim ever gets anywhere? I don't know, I just took the course.

Thats a load of BS. Nowhere in the law does it say the surgeon is the "captain of the ship" or responsible for everybody's actions.

What you are referring to is a trial lawyer trick. They make up the rules as they go, however it suits them.

WTF. Are you teling me that the surgeon is also responsible for the actions of the first assist, the surg tech, and the other people in the room? Nowhere in the law does it say that, because if it did there would be riots in the streets.

This is a lawyering maneuver, certainly its not established law. They can argue whatever the hell they want, regardless of whats actually written in the law.

 

[racerx]

Thats a load of BS. Nowhere in the law does it say the surgeon is the "captain of the ship" or responsible for everybody's actions.

What you are referring to is a trial lawyer trick. They make up the rules as they go, however it suits them.

WTF. Are you teling me that the surgeon is also responsible for the actions of the first assist, the surg tech, and the other people in the room? Nowhere in the law does it say that, because if it did there would be riots in the streets.

This is a lawyering maneuver, certainly its not established law. They can argue whatever the hell they want, regardless of whats actually written in the law.

While it may be a load of BS to you, it is an often used legal theory and attempted tactic by trial lawyers in malpractice cases under the principle of respondeat superior. It still costs the surgeon money, heartache, and time until the court finds that she/he is not liable (upwards to $15K). I never said it was a part of written law.

Also, I never said it wasn't a ****ty way of going about things, and wasn't trying to tell you anything (considering I don't argue with those that seem to simply enjoy arguing).

BTW, there is a difference between legislated laws and case law, especially when dealing with civil cases. The criminal component doesn't generally deal with vicarious liability.

Courts have found time and time against VL, but schiesters still try it. The same ones that would sue their own grandmothers if it meant they got their 40%.

 

[Conflicted]

This is interesting

Has there been any of the attendings here named, as such, in a case?

 

[usnavdoc]

Here is why surgeons shouldnt depend on CRNAs. Guess who got sued???

http://www.cnn.com/2006/LAW/10/26/rival.poisoned.ap/index.html

Whats interesting here is the possible malicious intent that they are now re-investigating. I imagine the lawsuit was settled on the idea of medical negligence. The two are not compatible. If it were malicious intent(ie. Murder) the fentanyl might as well have been a handgun. Something the surgeon has no control over. I wonder if the lawsuit would have been succesful had the original charges against the CRNA had been more severe.

Even if she is found guilty at some later date I cant imagine what would happen to the original lawsuit since the details of the case are dramatically different.

 

[godfather]

it's hard to believe this happen. I will say this guys i have now worked with crna's as an attending for the past year, and believe me the bad ones are really bad. i have so many stories that i could write an encyclopedia on my experiences. i went in to practice with an open mind but now firmly believe medical supervision of crna's is absolutely necessary. and i don't mean this garbage of one attending covering 4 rooms, i believe maximum safety should be 2 rooms to 1. yes there are good crnas and bad ones, but i will say this, i would never let a crna deliver an anesthtic to me alone. i have just seen too much. and i gurantee you i speak for the vast majortity of anesthesiologists out there.

 

[Conflicted]

godfather

You dont speak for anyone but yourself. Your limited experience certainly does not represent the vast majority of our practices, just your tiny world.

 

[dogbone65]

i gurantee you i speak for the vast majortity of anesthesiologists out there.

you are so wrong

 

[Atropine]

It didn't say she didn't "know who to revive the patient" She was trying to kill her......big difference...in fact not even in the ballpark there sparky.

Bwahaha.... "know who to revive the patient"? Is that english? Dude, now you're using a baseball analogy to get your point across? Alright, I'll play along.... Are you even in the ballpark? Nope, you struck out mofo--did you consider who claimed "she was trying to kill her"? Yes, it didn't say she didn't know how to revive her. The police also didn't say she's a transexual with a 10 inch third leg, does that mean it's not possible either? Hmmm.. not sure why I used that analogy--I don't know, Mr. dog-boner, I think you remind me of one....

In about another 10 yrs, you might develop enough skills to read at a high school level, lover of dog-boning.

Hugs and kisses....

 

[Conflicted]

That added alot to the conversation, thanks for alerting me to your immaturity so that i could promptly add you to my ignore list.

Bwahaha.... "know who to revive the patient"? Is that english? Dude, now you're using a baseball analogy to get your point across? Alright, I'll play along.... Are you even in the ballpark? Nope, you struck out mofo--did you consider who claimed "she was trying to kill her"? Yes, it didn't say she didn't know how to revive her. The police also didn't say she's a transexual with a 10 inch third leg, does that mean it's not possible either? Hmmm.. not sure why I used that analogy--I don't know, Mr. dog-boner, I think you remind me of one....

In about another 10 yrs, you might develop enough skills to read at a high school level, lover of dog-boning.

Hugs and kisses....

 

[dogbone65]

[

QUOTE=Atropine;4329399]Bwahaha.... "know who to revive the patient"? Is that english? Dude, now you're using a baseball analogy to get your point across? Alright, I'll play along.... Are you even in the ballpark? Nope, you struck out mofo--did you consider who claimed "she was trying to kill her"? Yes, it didn't say she didn't know how to revive her. The police also didn't say she's a transexual with a 10 inch third leg, does that mean it's not possible either? Hmmm.. not sure why I used that analogy--I don't know, Mr. dog-boner, I think you remind me of one....

In about another 10 yrs, you might develop enough skills to read at a high school level, lover of dog-boning.

Hugs and kisses....

Thanks for catching my typo. I didn't use a baseball analogy, so that brings into question YOUR reading skills. Furthermore, young man or young lady, posts such as yours are not only insulting to physicians but to anyone claiming to be an adult.

 

[Atropine]

[

Thanks for catching my typo. I didn't use a baseball analogy, so that brings into question YOUR reading skills. Furthermore, young man or young lady, posts such as yours are not only insulting to physicians but to anyone claiming to be an adult.

Perfect--I'm under your skin, dogboner. I like the way you avoided answering the question by complimenting me. Yes, I like making fun of you and mine is bigger than yours.

 

[toughlife]

http://www.asahq.org/Newsletters/2006/11-06/stateBeat11_06.html

Alabama Supreme Court Addresses Liability Issues

Lisa Percy, J.D., Manager
State Legislative and Regulatory Affairs



The primary issue in the following lawsuit was whether an anesthesiologist was liable for the actions of a nurse anesthetist simply because he was the nurse’s employer. Employers can be held liable for the actions of an employee regardless of whether the employer is at fault. The employer’s liability is derived solely from the liability of the employee; however, the employee’s conduct must be performed within the course of the employee’s employment. This doctrine is called respondeat superior (“let the master answer”).

The anesthesiologist claimed that he was not the nurse’s employer; they were co-employees of the same pain practice. As such, he argued that he was not liable for the nurse’s actions under the doctrine of respondeat superior.

The Alabama Supreme Court examined whether the anesthesiologist had the right to control the nurse anesthetist and whether the anesthesiologist voluntarily entered into the working relationship with the nurse anesthetist. If so, an employer/employee relationship existed between the two parties, and the anesthesiologist could be held liable under this doctrine.

The court concluded that the anesthesiologist had a right to control the nurse anesthetist but did not voluntarily enter into the relationship. Therefore the anesthesiologist was not held liable for the acts of the nurse anesthetist.


--------------------------------------------------------------------------------

illiam P. Ware, D.O., et al v. Johnnie Timmons involves the death of a 17-year-old patient (Brandi Timmons) who underwent elective surgery to correct an overbite. The nurse anesthetist (Lil Hayes) decided to remove the breathing tube approximately 15 minutes after the surgery was completed. An anesthesiologist (Dr. Ware) was summoned over the hospital speaker system to monitor the removal of the tube. The anesthesiologist arrived to watch the nurse anesthetist remove the patient’s breathing tube. The patient was disconnected from the equipment that monitored her vital signs and was moved to the postanesthesia care unit (PACU).

The patient went into cardiac arrest minutes after she was reconnected to the monitoring equipment in the PACU. Her brain had suffered irreversible damage caused by events that occurred during recovery from anesthesia. The patient died as a result of the brain damage.

Johnnie Timmons, on behalf of her daughter’s estate, sued the nurse anesthetist, anesthesiologist and Anesthesiology and Pain Medicine of Montgomery, P.C, employer of both the nurse anesthetist and anesthesiologist, alleging medical malpractice and wrongful death. The plaintiff argued that the treatment provided by the nurse anesthetist to the patient during the postoperative recovery fell below the applicable standard of care. Invoking the doctrine of respondeat superior, the plaintiff alleged that both the supervising anesthesiologist and employer, Anesthesiology and Pain Medicine, were vicariously liable for the nurse anesthetist’s conduct. The plaintiff did not claim or offer evidence that the anesthesiologist was negligent in supervising the nurse anesthetist.

At trial the defense objected to the plaintiff’s claim that the anesthesiologist could be held vicariously liable for the nurse anesthetist’s conduct. The defense argued that the nurse anesthetist was an employee of Anesthesiology and Pain Medicine, not of Dr. Ware individually. The trial court overruled the objection. The jury instructions included:

“I charge you — as it relates to agency and vicarious liability, I charge you the issue of agency in this case is not in dispute. Both the physician [Dr. Ware] and the CRNA [Nurse Hayes] were at all times working within the line and scope of their employment with Anesthesiology and Pain Medicine of Montgomery, P.C.
***

“The Court charges you further that the responsibility of Dr. Ware for the acts and omissions of Nurse Hayes is likewise not in dispute. Therefore, should you return a verdict in favor of the plaintiff and against [Nurse] Hayes, you must necessarily also return a verdict against Dr. Ware as well.”

The jury returned a verdict against the nurse anesthetist, anesthesiologist and employer and awarded the plaintiff $13.7 million in damages.

The issue on appeal was whether the trial court erred in instructing the jury as to the anesthesiologist’s vicarious liability for the acts of the nurse anesthetist. In a 5-4 decision, the Alabama Supreme Court reversed the trial court’s judgment in its entirety and remanded the case for a new trial.

Issues Before Alabama Supreme Court
1. Vicarious Liability Under Doctrine of Respondeat Superior: The trial court stated that based on the doctrine of respondeat superior, the anesthesiologist was liable for the nurse anesthetist’s tortious acts. To establish a claim based on respondeat superior, a plaintiff must establish the status of employer and employee. In Alabama proof of such relationship is established by analyzing whether an alleged employer 1) possesses a right of control over the alleged employee and 2) voluntarily entered into a relationship with the alleged employee. The court held that trial court’s instruction regarding Dr. Ware’s liability for the acts and omission of the nurse anesthetist would be correct only if the anesthesiologist and nurse anesthetist voluntarily entered into the relationship and that the anesthesiologist reserved a right of control.

In analyzing the first element, the court concluded that the anesthesiologist reserved a right of control over the nurse anesthetist. Dr. Ware conceded that as the supervising anesthesiologist, he had the right to control the nurse anesthetist’s actions. The nurse anesthetist also testified that she operated under “the supervision and direction of the anesthesiologist.” Moreover the hospital’s procedure manual required that “all anesthesia care… be directed by a qualified physician anesthesiologist.” Finally, Alabama law requires a nurse anesthetist to “function under the direction of a physician … who is immediately available.”

With respect to the second element, however, the court concluded that the anesthesiologist did not choose the nurse anesthetist. The right of selection resided in employer Anesthesiology and Pain Medicine. During Dr. Ware’s testimony as to the nature of the relationship between him and the nurse anesthetist, he stated they “would both be assigned to a case.” The plaintiff did not rebut his statement. Both parties testified that their involvement in the operation was within the course and scope of their employment with Anesthesiology and Pain Medicine. Even the plaintiff’s proposed jury instruction stated that both parties were at all times within the line and scope of their employment with Anesthesiology and Pain Medicine. The court held that the rules of agency reject the idea that co-employees are vicariously liable for the torts of another. Because co-employees do not individually agree to act on another’s behalf, the relationship is not consensual. Therefore the court concluded that “the doctrine of respondeat superior does not hold supervisors, as co-employees, vicariously liable for the torts of their subordinates. Supervisors lack the ability to willingly choose to enter the relationship with their subordinates; likewise subordinates do not have the ability to choose to enter into a relationship with their supervisors.” Because the plaintiff failed to introduce evidence that Dr. Ware, as the supervising anesthesiologist, had a right of selection, the court ruled that Dr. Ware did not choose the nurse anesthetist to assist him.

2. Vicarious Liability Based on Alternate Theories: In addition to analyzing whether the anesthesiologist is vicariously liable based on his supervisory status, the court analyzed whether Dr. Ware is vicariously liable based on his status as 1) a professional practicing in a professional corporation and 2) primary shareholder in Anesthesiology and Pain Medicine.

First, Alabama law provides that every individual who renders professional services as an employee of a professional corporation “shall be liable for any negligent or wrongful act or omission which he personally participates to the same extent as if he rendered such services as a sole practitioner” §10-4-390(a) Ala. Code. The plaintiff argued that the statute imposes vicarious liability on supervisors who are practicing in a professional corporation for the conduct of their subordinates. The court, however, rejected their argument and held that the statute imposed direct liability on Dr. Ware only for his negligence, wrongful acts or omissions. The language “in which he personally participates” prevented the court from holding Dr. Ware liable based merely on his status as a physician practicing in a professional corporation.

Second, the plaintiff argued that Dr. Ware is vicariously liable for the nurse anesthetist’s conduct based on his status as a shareholder of a professional corporation. In the Ala. Code, §10-4-390(b) provides that the personal liability of a shareholder of a professional corporation shall be no greater than that of a shareholder of a corporation organized under the Alabama Business Corporation Act. Because the doctrine of respondeat superior governs vicarious liability of corporations under such act, the court, for the same reason as set forth above, rejected the argument.

Implications
The ruling in Ware v. Timmons is narrow in its applicability. To begin, it is limited to vicarious liability in the state of Alabama. Furthermore the decision is based on the involuntary nature of the relationship between the anesthesiologist and the nurse anesthetist. Had the plaintiff introduced evidence that Dr. Ware requested to supervise the nurse anesthetist on this case or chose to enter into a working relationship with the nurse anesthetist, the court may have found the anesthesiologist liable under the doctrine of respondeat superior.

The ruling in Timmons hinged on its statement that supervisors lack the ability to willingly choose to enter the relationship with their subordinates and vice versa. Although the court seems to make a blanket statement in this regard, the plaintiff could easily introduce evidence to the contarary. Evidence that an anesthesiologist hired or recruited a nurse anesthetist or indicated in some manner that he or she preferred to work or only worked with a particular nurse anesthetist could support an argument that the relationship was voluntary. The court appears to leave this open because it also acknowledges that plaintiff’s failure to introduce evidence that the supervising anesthesiologist had a right of selection prevented the court from concluding that he chose the nurse anesthetist to assist him. Therefore, under different facts and circumstances, it is possible that an anesthesiologist could still be held liable under the doctrine of respondeat superior in Alabama.

 

[dogbone65]

Interesting case there Toughie. Implications for us all.

 

[Morpheous]

year 2000, penn.

Mr toogood got a nerve block for recurring jaw pain from a dental pain clinic, and the dentist requested an ANESTHESIOLOGIST to administer the block. The pt suffered a collapsed lung and sued the anesthesiologist, the dentist and the clinic. The anesthesiologist died and he directed his suit just towards the dentist....

Mr Toogood had brought suit against the anesthesiologist, The Pain Center that employed the anesthesiologist, and the dentist, who was the owner of The Pain Center. When the anesthesiologist died, the court had no choice but to dismiss the claim against the anesthesiologist. Under the Pennsylvania dead man's statute, the plaintiff was prohibited from testifying against the deceased anesthesiologist and there would not be any testimony to establish the anesthesiologist's liability. However, the dead man's statute did not apply in the plaintiff's suit against The Pain Center or the dentist. For those who know surgeons who are afraid to work with nurse anesthetists for fear that the negligence of the nurse anesthetists could be imputed to the surgeon, the Toogood case is just another case where an injured plaintiff is suing someone (in the Toogood case it happens to be a dentist, but it could just as easily have been a plastic surgeon or other physician) because of the negligence of an anesthesiologist. The trial court awarded $465,000 in favor of the patient against dentist

In all the recent flurry of activity over supervision, the policy makers often seem unaware that anesthesiologists make mistakes, too. How can anesthesiologists suggest supervision of nurse anesthetists as a cure-all when anesthesiologists make the same mistakes? If they promote the anesthesia care team as preferable to nurse anesthetists working directly with surgeons, why aren't they promoting it over Anesthesiologists working directly with surgeons?

Just some thoughts...what is best for the patient? Does title make a good anesthetist alone. NO. It is skill and education...whether a CRNA or an MDA puts my children to sleep does not matter to me one bit. HOWEVER, what does matter to me is who that MDA or CRNA is. I want an excellent provider of anesthesia to put my child to sleep and bring them back with no adverse affects.
If you had to pick a provider for your child. Would it be guided by titles, name calling, or political bashing? Or would you choose based on their ability to provide the best care for your child? Would you want a fresh out of school cocky, who thinks he/she knows it all.....or the seasoned skills of a veteran to the art and science of anesthesia...which provider for your child would you pick...without regards to titles and BS.

Morpheous

 

[7by11thenout]

year 2000, penn.

Mr toogood got a nerve block for recurring jaw pain from a dental pain clinic, and the dentist requested an ANESTHESIOLOGIST to administer the block. The pt suffered a collapsed lung and sued the anesthesiologist, the dentist and the clinic. The anesthesiologist died and he directed his suit just towards the dentist....

Mr Toogood had brought suit against the anesthesiologist, The Pain Center that employed the anesthesiologist, and the dentist, who was the owner of The Pain Center. When the anesthesiologist died, the court had no choice but to dismiss the claim against the anesthesiologist. Under the Pennsylvania dead man's statute, the plaintiff was prohibited from testifying against the deceased anesthesiologist and there would not be any testimony to establish the anesthesiologist's liability. However, the dead man's statute did not apply in the plaintiff's suit against The Pain Center or the dentist. For those who know surgeons who are afraid to work with nurse anesthetists for fear that the negligence of the nurse anesthetists could be imputed to the surgeon, the Toogood case is just another case where an injured plaintiff is suing someone (in the Toogood case it happens to be a dentist, but it could just as easily have been a plastic surgeon or other physician) because of the negligence of an anesthesiologist. The trial court awarded $465,000 in favor of the patient against dentist

In all the recent flurry of activity over supervision, the policy makers often seem unaware that anesthesiologists make mistakes, too. How can anesthesiologists suggest supervision of nurse anesthetists as a cure-all when anesthesiologists make the same mistakes? If they promote the anesthesia care team as preferable to nurse anesthetists working directly with surgeons, why aren't they promoting it over Anesthesiologists working directly with surgeons?

Just some thoughts...what is best for the patient? Does title make a good anesthetist alone. NO. It is skill and education...whether a CRNA or an MDA puts my children to sleep does not matter to me one bit. HOWEVER, what does matter to me is who that MDA or CRNA is. I want an excellent provider of anesthesia to put my child to sleep and bring them back with no adverse affects.
If you had to pick a provider for your child. Would it be guided by titles, name calling, or political bashing? Or would you choose based on their ability to provide the best care for your child? Would you want a fresh out of school cocky, who thinks he/she knows it all.....or the seasoned skills of a veteran to the art and science of anesthesia...which provider for your child would you pick...without regards to titles and BS.

Morpheous

Skill matters but Md's have 6 YEARS MORE TRAINING THAN CRNA's.... You can not overcome that kind of studying especially once the MD gets out and also gains clinical experience.

Your post is almost silly. Why do ANESTHESIOLOGISTS get sued for surgeons mistakes? that is the reverse of the arguement. WE ALL GET SUED BECAUSE WE ARE a team and they can get more money if they sue us all not just one of us - Out

 

[Morpheous]

You must have read the article wrong...the surgeon (in this case the dentist) got sued and had to pay damages because of the anesthesiologist's mistake...just another case to PROVE that just because you work with an anesthesiologist does not release any responsibility....which was the argument a few posts ago. It is unfortunate that greed fuels most of the ASA's attacks and not patient safety. Very unfortunate. And to illustrate my point I have a question...What model of anesthesia care works best? ACT or independent provider?

And I am very interested in knowing how you came up with 6 more years training? From my view point it looks like this, MDAs 4 yrs pre-med (most people agree that you get no MEDICAL(especially anesthesia) traing in pre-med, so scratch that, 4 yrs med school, some pt experience, + 3-5 yrs residency (more for CC etc), just dealing anesthesia, so that equals 9 on the high end.... Now for me BSN 4 yrs, all pt related, 1-2 or more ICU exp. (i had three), 2-3 yrs crna school, so that (on the high end) equals 9yrs plus....so where is the 6 yrs more training.
Just one man's opinion

Morpheous

 

[toughlife]

You must have read the article wrong...the surgeon (in this case the dentist) got sued and had to pay damages because of the anesthesiologist's mistake...just another case to PROVE that just because you work with an anesthesiologist does not release any responsibility....which was the argument a few posts ago. It is unfortunate that greed fuels most of the ASA's attacks and not patient safety. Very unfortunate. And to illustrate my point I have a question...What model of anesthesia care works best? ACT or independent provider?

And I am very interested in knowing how you came up with 6 more years training? From my view point it looks like this, MDAs 4 yrs pre-med (most people agree that you get no MEDICAL(especially anesthesia) traing in pre-med, so scratch that, 4 yrs med school, some pt experience, + 3-5 yrs residency (more for CC etc), just dealing anesthesia, so that equals 9 on the high end.... Now for me BSN 4 yrs, all pt related, 1-2 or more ICU exp. (i had three), 2-3 yrs crna school, so that (on the high end) equals 9yrs plus....so where is the 6 yrs more training.
Just one man's opinion

Morpheous

You are ridiculous. Get a life and stop imagining your BSN and ICU experience bathing patients, changing diapers, giving meds, hanging fluid, taking verbal orders from a resident, starting drips when you were told to , were equivalent to four years of med school and two years of residency. If you were in charge of patient care rather than taking orders from a resident, you'd have more credibility but we all know that is not the case.

BSN degrees are so easy to earn all you need is a pencil to fill out the application form. Now go get a degree in chem E, chemistry or EE and come back and tell me how easy it was compared to BSN. You are a darn fool and the sad part is you don't even recognize it.

 

[Morpheous]

WOW, got under your skin rather easily....must feel real insecure about your position in the food chain. In many ICU's,(usually larger one's with a teaching school) have residents that realize when they come out to the real world..that they know very little about pt's and their care....many, at least 10-12 residents and attendings have told me that residents do not know how to care for patients when they get out. So....what did those years of medical school and did you say 2yrs of residency?? You seem real ballsy about what ICU nurses do and don't do...here in a forum behind a mask of anonymity...lets see you walk up to a nurse ICU PACU and tell her all they are good for are baths and diapers. You woudl be killed, and if you think that is what happens...hmmmm...your education has served you a grave disjustice...to much time sniffing fumes in chemistry class maybe......but on a serious note...if CRNA's were not as competent as MDA's to administer anesthesia, then why do the studies not substantiate the claim...and they don't, because they are equal in quality of administration. Now CC fellowships, advanced pain fellowships, that is not my league. But that does not change my competence to provide anesthesia to surgical patients. You never answered my question about which model of care is best for the patient? ACT or solo practice?

I know that huge arguments get started all the time....but the simple fact is that both professions are here to stay....both are proven equally effective ( i can list the studies and court cases) and what should be the focus of everyones intent should be on the lawyers(for making malpractice awards a game), and politicians for making people not acountable for their healthcare needs. Good luck with your career.

 

[fakin' the funk]

You woudl be killed, and if you think that is what happens...your education has served you a grave disjustice...to much time sniffing fumes in chemistry class maybe...if CRNA's were not as competent as MDA's to administer anesthesia, then why do the studies not substantiate the claim

Hey buddy, you're new here.

Which means you missed the mods' rules a few months back, which I will paraphrase here: This forum is for docs and med students, if you're neither (check), and you're stirring up trouble (check), shape up or buzz off.

 

[Conflicted]

Odd

Ive been reading this forum for over 3 years and I can tell you, there has never been a time when anyone has said this forum was ONLY for medical students and Physicians. In fact, there is a private passworded forum for that.

If this was the case, why isnt the whole site moderated for medical students and attendings only? It isnt.

 

[VolatileAgent]

hey morpheus. how did the anesthesiologist drop a lung doing a block for a toothache?

i think your full of the brown stuff. otherwise, post a link.

 

[badgas]

Maybe if someone started a studentNURSE.com then this garbage would stop? I know that if there were a studentNURSE.com, I would not visit it because I am not a nurse. I suppose I would only visit it and start trouble if I wished I was a nurse....

 

[johnnywad]

You are ridiculous. Get a life and stop imagining your BSN and ICU experience bathing patients, changing diapers, giving meds, hanging fluid, taking verbal orders from a resident, starting drips when you were told to , were equivalent to four years of med school and two years of residency. If you were in charge of patient care rather than taking orders from a resident, you'd have more credibility but we all know that is not the case.

BSN degrees are so easy to earn all you need is a pencil to fill out the application form. Now go get a degree in chem E, chemistry or EE and come back and tell me how easy it was compared to BSN. You are a darn fool and the sad part is you don't even recognize it.

Thanks, toughie! As long as you and these other sophomoric, egomanical fools continue to act this way, crna's and amc's have a bright future. Thanks for adding to my security!

 

[fakin' the funk]

hey morpheus. how did the anesthesiologist drop a lung doing a block for a toothache?

i think your full of the brown stuff. otherwise, post a link.

Dude, didn't you know that any information that is typed in italics is unchallengably true?

And what, YOU'VE never slipped on an alveolar nerve block and given the pt a PTX?

 

[Conflicted]

Fakin

I LOVE this:

Dude, didn't you know that any information that is typed in italics is unchallengably true?

Thats going in the comeback bank. Well Done *insert clapping here*

 

[toughlife]

WOW, got under your skin rather easily....must feel real insecure about your position in the food chain. In many ICU's,(usually larger one's with a teaching school) have residents that realize when they come out to the real world..that they know very little about pt's and their care....many, at least 10-12 residents and attendings have told me that residents do not know how to care for patients when they get out. So....what did those years of medical school and did you say 2yrs of residency?? You seem real ballsy about what ICU nurses do and don't do...here in a forum behind a mask of anonymity...lets see you walk up to a nurse ICU PACU and tell her all they are good for are baths and diapers. You woudl be killed, and if you think that is what happens...hmmmm...your education has served you a grave disjustice...to much time sniffing fumes in chemistry class maybe......but on a serious note...if CRNA's were not as competent as MDA's to administer anesthesia, then why do the studies not substantiate the claim...and they don't, because they are equal in quality of administration. Now CC fellowships, advanced pain fellowships, that is not my league. But that does not change my competence to provide anesthesia to surgical patients. You never answered my question about which model of care is best for the patient? ACT or solo practice?

I know that huge arguments get started all the time....but the simple fact is that both professions are here to stay....both are proven equally effective ( i can list the studies and court cases) and what should be the focus of everyones intent should be on the lawyers(for making malpractice awards a game), and politicians for making people not acountable for their healthcare needs. Good luck with your career.

Well unless I am blind, here's what I have noticed about ICU nurses' work.

1) record vitals q30 min to 1hr (done by nurse's aide)
2) Watch/record output from foley, CTs, NGTs, SA drains and rectal tubes on chart and total values at end of day.
3) Give patient their scheduled/prn meds
4) Read and implement orders written in pt's chart..such as draw this lab (requires memorization of which colored tube you need), send that blood cx , HOB at 30degrees, titrate propofol 1-10cc/hr to MAAS 2-3, etc.
5) Write in chart "Chart checked at such and such time"
6) Call doc when vitals/labs are abnormal ("pt tachycardic at 101 but was normal 5 minutes ago at 99")
7) Examine the patient to do their 'nursing assessment' (i.e, patient c/o 4/10 pain at surgical incision site
Nursing A/P: pain/treat pain)
8)Note on chart the time they called the doc with an abnormal lab/vital sign.
9) Help set up the equipment needed when doc wants to do a line
10) Bathe the patient/change their dirty undergarments
11) Clamp the NGT (if on suction) when po meds are given for at least 1 hr.
12) take report on the patient from the nurse taking care of patient the prior shift.

If I took a two-month training course, I think I could learn to do the above very easily. I don't see anything complicated about that work. Who knows maybe you found it challenging.

I don't think I was the one arguing about outcomes. Maybe you are confusing me with someone else. My point was that you want to believe your education is equal to others'. If it was, you would hold the same degree. Be realistic and people will respect you more.

 

[VolatileAgent]

And what, YOU'VE never slipped on an alveolar nerve block and given the pt a PTX?

i wouldn't know. i don't do alveolar nerve blocks. dentists do. which makes me wonder why this anesthesiologist, who mysteriously died, was involved in this patient's care at all. now, if you want me to block V2 or V3, i promise you i won't be anywhere near a lung.

methinks morpheus is very confused (and/or full of "it").

 

[rn29306]

Who in the hell goes from a MAAS of 5-6 to a 2-3 with 1-10 mls of propofol an hour?

Pansies.

 

[VolatileAgent]

Thanks, toughie! As long as you and these other sophomoric, egomanical fools continue to act this way, crna's and amc's have a bright future. Thanks for adding to my security!

it's funny how many junior cc nurses don't think they need the doctor around until the stuff really hits the fan. it's a whole different ballgame when you are the one taking the primary responsibility for that patient's outcome. and, we're not talking managing one to two patients at a time, but sometimes 25-30. a lot of you young whipper-snapper nurses think you could do our job, but you're just kidding yourselves. most of the truly smart nurses know this beyond all doubt, and appreciate us being there to make the definitive call - and take the heat of that decision if/when it comes. the concept is teamwork, and yes nurses are the front lines. but, it becomes really dangerous when you start to think you can do our job. trust me, i've seen it... and i've seen nurses fired. including one crna with 20+ years of experience for gross insubordination and failure to follow the chain of command. lucky he didn't lose his nursing license. remember that.

 

[toughlife]

Regardless of the scoring method, who in the hell gets sedated or even comfortable with 1-10 mls of propofol an hour?

it runs along a fent drip at 2cc/hr. Pt is arousable. Never said it was designed to render patient unconscious.