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

[IMGASMD]

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

Not sure in this case what dentist would add to the equation. So essentially your life is in the hand of the crna, with or without supervision.

Is the dentist acls trained? Do they have to be? Don’t matter. It’s irresponsible all around. Surely dentist has to pay and should be told that someone is dead because s/he is too cheap to hire a real doctor.

Crna is responsible. Someone is dead because as an airway and emergency situation “provider” he didn’t recognize his own limitations and call for help, with or without direction from a dentist!

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[drmwvr]

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.

Thanks for the clarification...still...for a patient to accept that without disruptive gagging (and consequential misdirection of the laser beam) would seem to require some respectable 'sedation'...

 

[Sublimazing]

Thanks for the clarification...still...for a patient to accept that without disruptive gagging (and consequential misdirection of the laser beam) would seem to require some respectable 'sedation'...

We do it on every sedation in the oral surgery office every day. Otherwise you’re going to get a lot of water and surgical debris in that airway very very quickly.

 

[drmwvr]

We do it on every sedation in the oral surgery office every day. Otherwise you’re going to get a lot of water and surgical debris in that airway very very quickly.

right...got that part....

 

[coffeebythelake]

Colorado plastic surgeon faces manslaughter charges for death of 18-year old

A popular Colorado plastic surgeon and his nurse anesthetist are facing manslaughter charges in connection to a botched breast augmentation surgery that killed a teen patient.

nypost.com

 

[IMGASMD]

Wow. There it is.

 

[coffeebythelake]

Wow. There it is.

Meeker and Kim deserve the book thrown at them. This cannot be a slap on thr wrist. Prison time is needed.

 

[VA Hopeful Dr]

Just proves what I've always thought: never trust a doctor.who wears pinstriped suits

 

[gcc322]

If only the headline read “CRNA charged with manslaughter after failing to follow standards of care for anesthesia…”

 

[anbuitachi]

Surprised it was 1m each, crna and surgeon. Didn't even go over insurance limit.

 

[coffeebythelake]

Damn I just realized I posted this in the wrong thread. Sorry! Ive been super exhuasyed from work and home. Can an admin move these last few posts to the appropriate thread?

 

[GaseousClay]

doofus cant even double check his professional profile? "Certifiend"

 

[pgg]

View attachment 350664
doofus cant even double check his professional profile? "Certifiend"

Certifiend sounds like the title of a Pixar villain tax accountant.

 

[Airway]

View attachment 350664
doofus cant even double check his professional profile? "Certifiend"

Pretty sure it's intentional. Also has anyone ever found linked in actually useful for anything? Maybe I'm too old.

 

[thinkorswim]

Pretty sure it's intentional. Also has anyone ever found linked in actually useful for anything? Maybe I'm too old.

Sure, age could be a factor, but you’re also just in the wrong line of work. It’s much more useful outside the bubble of clinical medicine.

 

[Proudfather94]

Hey guys is there any substantial evidence that NPs and CRNAs are held to a lower standard of care besides these latest court cases?

 

[Volatile]

Hey guys is there any substantial evidence that NPs and CRNAs are held to a lower standard of care besides these latest court cases?

You could argue that learning blocks/epidurals on cadavers/mannequins which is often done in CRNA school is a “lower standard” as this would never be allowed for graduation of an anesthesiology resident.

 

[Proudfather94]

You could argue that learning blocks/epidurals on cadavers/mannequins which is often done in CRNA school is a “lower standard” as this would never be allowed for graduation of an anesthesiology resident.

True but I'm wondering if there has been any court cases or laws that show beyond a doubt that the standards of care are lower for them.

 

[Dr. Rude]

True but I'm wondering if there has been any court cases or laws that show beyond a doubt that the standards of care are lower for them.

There is supposed to be one standard of care. It is the same for MDs and NPs. Standard of care is not the same as cutting edge care. What the standard of care should be is established by expert witness opinion testimony.

 

[aimedicine]

This is criminal!

 

[Proudfather94]

There is supposed to be one standard of care. It is the same for MDs and NPs. Standard of care is not the same as cutting edge care. What the standard of care should be is established by expert witness opinion testimony.

So how can we use this opinion of testimony to hold them to the same standard as physicians? Maybe we need some kind of database to draw from when people die from malpractice that has the offenders name, title, and cause of patients death. That would settle the matter once and for all because there would be data to prove CRNAs are not as safe.

 

[chessknt]

There is supposed to be one standard of care. It is the same for MDs and NPs. Standard of care is not the same as cutting edge care. What the standard of care should be is established by expert witness opinion testimony.

Expert witnesses seem to frequently be hacks for hire based on the medmal stuff I have read. The fact that they are paid by one side or the other really erases all hope of neutrality. A more ideal solution would be an independent pool of experts for each specialty and subspecialty on a state to state basis that were drawn from randomly to review the case and render a committee/consensus opinion but that makes too much sense because then it would be like a peer review instead of a circus. I think some states have something like this as a bar that needs to be passed to even file a medmal suit.

 

[coffeebythelake]

There is supposed to be one standard of care. It is the same for MDs and NPs. Standard of care is not the same as cutting edge care. What the standard of care should be is established by expert witness opinion testimony.

If this is remotely true with Med Mal cases these midlevels would be eviscerated.

 

[jwk]

Expert witnesses seem to frequently be hacks for hire based on the medmal stuff I have read. The fact that they are paid by one side or the other really erases all hope of neutrality. A more ideal solution would be an independent pool of experts for each specialty and subspecialty on a state to state basis that were drawn from randomly to review the case and render a committee/consensus opinion but that makes too much sense because then it would be like a peer review instead of a circus. I think some states have something like this as a bar that needs to be passed to even file a medmal suit.

I don't think of myself as a hack and I do a little expert witness work. Whether from the plaintiff or defendant side, someone with similar credentials has to offer an opinion on meeting the standard of care. That means I can testify with regard to the standard of care rendered by a CAA, but not for a physician or CRNA.

That being said, the peer review concept isn't a bad idea (isn't that used in some states) but no doubt some attorney will claim their client's rights are violated in some way.

 

[chessknt]

I don't think of myself as a hack and I do a little expert witness work. Whether from the plaintiff or defendant side, someone with similar credentials has to offer an opinion on meeting the standard of care. That means I can testify with regard to the standard of care rendered by a CAA, but not for a physician or CRNA.

That being said, the peer review concept isn't a bad idea (isn't that used in some states) but no doubt some attorney will claim their client's rights are violated in some way.

So if the party that hires you is in the wrong according to your opinion what happens? Do you get paid less? Do you still testify? Do you find ways they are right even if overall they are wrong?

 

[nimbus]

So if the party that hires you is in the wrong according to your opinion what happens? Do you get paid less? Do you still testify? Do you find ways they are right even if overall they are wrong?

I don’t do expert witness work but I know people who do. They charge an hourly rate to review a case. And a higher hourly rate to testify in court. If you think the case has no merit, you don’t have to testify in court and still get paid for the case review. If you refuse to testify a lot, the lawyer may be less likely to hire you as an expert witness in the future.

 

[Volatile]

Expert witnesses seem to frequently be hacks for hire based on the medmal stuff I have read. The fact that they are paid by one side or the other really erases all hope of neutrality. A more ideal solution would be an independent pool of experts for each specialty and subspecialty on a state to state basis that were drawn from randomly to review the case and render a committee/consensus opinion but that makes too much sense because then it would be like a peer review instead of a circus. I think some states have something like this as a bar that needs to be passed to even file a medmal suit.

This is pretty much what the military does

 

[jwk]

So if the party that hires you is in the wrong according to your opinion what happens? Do you get paid less? Do you still testify? Do you find ways they are right even if overall they are wrong?

I establish my rate up front before I do any actual review. They’re paying me for my honest opinion, which is the only one I’ll give. They can agree or disagree with my findings - not my problem. They’ll have an honest assessment of the merits of their case.

 

[Dr. Rude]

….A more ideal solution would be an independent pool of experts for each specialty and subspecialty on a state to state basis that were drawn from randomly to review the case and render a committee/consensus opinion but that makes too much sense because then it would be like a peer review instead of a circus…..

You mean you would trust doctors to police themselves? Who do you think you are? Lawyers?

 

[chessknt]

I establish my rate up front before I do any actual review. They’re paying me for my honest opinion, which is the only one I’ll give. They can agree or disagree with my findings - not my problem. They’ll have an honest assessment of the merits of their case.

And do you think your opinion will get presented if it disagrees with them? Im guessing it doesn't and they fish expert opinions until they find one they like and neglect to mention the differing opinions which makes the entire concept pointless.

 

[ambiturner]

I’ve done some limited med mal. Most cases don’t even go to trial, so your review is most often helping the prosecution or defense establish its case, in the best interest of their client. Thus if you tell the defense their doc is a butcher, that helps inform them that they need to settle and have little leverage. Or you can say they’re not so bad, and this can help them avoid a trial or a big payout. In these cases an honest evaluation is more valuable than that of a hack who wants to play nice. Neither side wants to go to trial, it’s too risky and expensive so it’s all about posturing (like, for example, trying to use diplomacy to determine the fate of an Eastern European nation instead of a hot war). Yes they might shop around for a favorable opinion but that starts to get costly and irritates clients (med mal insurers).

There are definitely some unscrupulous expert witnesses out there but they probably tend to work for the prosecution. Another red flag is if they do only med mal for a living.

 

[jwk]

And do you think your opinion will get presented if it disagrees with them? Im guessing it doesn't and they fish expert opinions until they find one they like and neglect to mention the differing opinions which makes the entire concept pointless.

I have no idea if they do that or not. But - if an expert gives them an expert opinion, especially if there is more than one (which there usually is), then the attorney should think hard about how to proceed. For me as an expert witness, the facts are the facts, and my opinion is based on those. And although I generally have an idea at the start, the attorney's, particularly plaintiff's attorneys, don't actually tell me which side they're on up front. They just ask me my qualifications and ask me to review the case and give me their opinion.

 

[Chrish]

You bas!ards are making me scared to have my wisdom tooth removal..

 

[coffeebythelake]

You bas!ards are making me scared to have my wisdom tooth removal..

Nah dont be scared. Bottom line most dental surgeries do not require much anesthesia. Some local and pop a xanax if you are nervous going in. The biggest danger comes from deep sedation with unprotected airways. patient should either get light/moderate sedation or if appropriate general anesthesia with an ETT.

 

[Chrish]

Nah dont be scared. Bottom line most dental surgeries do not require much anesthesia. Some local and pop a xanax if you are nervous going in. The biggest danger comes from deep sedation with unprotected airways. patient should either get light/moderate sedation or if appropriate general anesthesia with an ETT.

Yeah but the thing is as a patient, I don’t know how much anesthesia I would need for my procedure. I would expect dentist to do the right thing. Judging from all the response, I guess that’s not always the case.

Also, do you even have a choice in this matter? Even if you want anesthesiologist instead of CRNA for the procedure, I highly doubt dentist would comply with the request. They probably would tell you to go elsewhere.

 

[coffeebythelake]

Yeah but the thing is as a patient, I don’t know how much anesthesia I would need for my procedure. I would expect dentist to do the right thing. Judging from all the response, I guess that’s not always the case.

Patient knowledge is power. Most dental deaths occur due to airway mishaps and respiratory issues. Most dental procedures can also be done with moderate to no sedation. Yes you will feel the local anesthetic being injected. Yes you may feel pressure and tugging when a tooth is pulled.

Also, do you even have a choice in this matter? Even if you want anesthesiologist instead of CRNA for the procedure, I highly doubt dentist would comply with the request. They probably would tell you to go elsewhere.

Many dental clinics that offer sedation don't have any qualified anesthesia providers present. No anesthesiologist. No CRNA. It is the dentist doing the procedure and ordering his dental assistant to give sedation and monitoring. I do not think that is safe, and the alarming statistics of dental deaths is in-line with my stance. There are perverse incentives for dentists to offer sedation like this because it can be very lucrative. They will claim a death rate of 1 in a million which is utterly false.

If you require deep sedation or general anesthesia, best to do it in a place with qualified and experienced anesthesia providers and ideally not performed in an office environment.