Dallas Jury awards $21M for anoxic brain injury under anesthesia at BUMC

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GandalfTheWhite

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Apparently they didn't even tell the family that MD/DO was even an option....
Also why are all these things happening at Baylor facilities? (Dr. Death, the whole LAST string of deaths, and now this)

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I didn't realize it was malpractice to give someone a crna without informed consent.

Do we have to tell them that they are less trained and inferior?
 
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Tragic. Would be very interesting if the case did go before a jury and set a precedent that would alter day to day practice for us, at least at the state level.

USAP and Baylor probably did not want to be going to court to defend the ins/outs of the ACT model and damage the Baylor brand. Plantiffs lawyer probably would have a field day explaining the role of private equity companies in the ACT model to the jury and local media.
 
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I was wondering how long it would take before someone posted this.
 
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I thought Texas had tort reform with 500k cap? Or is this case about not being told options vs malpractice?

Regardless, reinforces my desire not to work for usap/pe and be forced to supervise nurses I have little say in hiring based on abilities
 
I always explain the ACT model to patients. I can count on my fingers those who have refused to have a CRNA in the room, or have asked me to spend as much time as possible in their room.

I'm sorry to say it like this, but patients get what they deserve. Except for emergency surgeries, they should be voting with their feet, like I do.

I took a 20% pay cut to work 90% solo, and it was one of the best decisions I have made.
 
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I always explain the ACT model to patients. I can count on my fingers those who have refused to have a CRNA in the room, or have asked me to spend as much time as possible in their room.

I'm sorry to say it like this, but patients get what they deserve. Except for emergency surgeries, they should be voting with their feet, like I do.
The article says they told them a nurse was going to be in the case. So you tell every patient you can have either a nurse do your case or doctor and they say ok with nurse?
 
The article says they told them a nurse was going to be in the case. So you tell every patient you can have either a nurse do your case or doctor and they say ok with nurse?
I tell them that the CRNA will be with them at all times, but I won't be in the room except for the most challenging parts and to help the CRNA. They don't care.

It's the same as in internal medicine. I have acquaintances who sing the praises of their APRNs until something goes wrong. People are relatively less educated in this country, and that includes understanding who does what in healthcare. The healthcare corporations and their governmental cronies have no interest to change that.
 
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Everyone always settles, the systemic ills get swept under the rug..

Tragic. Would be very interesting if the case did go before a jury and set a precedent that would alter day to day practice for us, at least at the state level.

USAP and Baylor probably did not want to be going to court to defend the ins/outs of the ACT model and damage the Baylor brand. Plantiffs lawyer probably would have a field day explaining the role of private equity companies in the ACT model to the jury and local media.
 
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Everyone always settles, the systemic ills get swept under the rug..
That's why punitive damages for big healthcare corporations should almost bankrupt them, so they never think about a patient as just an insurance premium expense.
 
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Crna documented perfect vitals while pushing phenylephrine and even calcium chloride. Patient had a rash. Never woke up. Sounds like anaphylaxis or emboli? (But urticarial rash) and did not call anesthesiologist about trouble til too late. Treating symptoms and not the problem......
 
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I thought Texas had tort reform with 500k cap? Or is this case about not being told options vs malpractice?

Regardless, reinforces my desire not to work for usap/pe and be forced to supervise nurses I have little say in hiring based on abilities

This is about economic damages and/or punitive damages. Only non-economic damages (I.e. Pain and suffering) are capped

Hard to say what this case is about. One claim says falsifying medical records (Don't know how you prove that because Epic wasn't used at BUMC until a couple years after the incident), another says not routinely using neuro monitoring (not sure what that means, BIS? Cerebral Oximetry? EEG?), yet another trashes the Care team model.
 
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I didn't realize it was malpractice to give someone a crna without informed consent.

Do we have to tell them that they are less trained and inferior?
I would at least let the patient know who is going to be in the case and what their title is.
They then have the opportunity to decide if the want the more experienced person providing the anesthesia (and possible delay the case) or go with the lesser trained one with limited oversight by the physician.

Apparently the Texas jury agrees. Also its stated that its USAP's policy to make the patient aware of this fact and give the patient the option to choose their choice of provider: physician or CRNA. This was also not done.

I was wondering how long it would take before someone posted this.

Do you happen to know any intra-poperative details? It appears that the articles only state the outcome, but not the events leading up to the anoxic injury.
 
I would at least let the patient know who is going to be in the case and what their title is.
They then have the opportunity to decide if the want the more experienced person providing the anesthesia (and possible delay the case) or go with the lesser trained one with limited oversight by the physician.

There's actually a couple posters on here that work exclusively in Care team models and will not honor patient requests of MD/DO only. They have been very vocal about this

Apparently the Texas jury agrees. Also its stated that its USAP's policy to make the patient aware of this fact and give the patient the option to choose their choice of provider: physician or CRNA. This was also not done.
Jury awards are funny sometimes in that they can be heavily influenced by local demographics and politics. My wife is a lawyer in this area. She is under the opinion that if this happened in neighboring Tarrant, Colin, or Denton counties (as opposed to Dallas County), the jury verdict and/or award would have been different
 
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I thought Texas had tort reform with 500k cap? Or is this case about not being told options vs malpractice?

Regardless, reinforces my desire not to work for usap/pe and be forced to supervise nurses I have little say in hiring based on abilities
That reform is for noneconomic damages. Not economic as you can see clearly in this case. Ain’t no pain and suffering here. The patient is obviously never gonna work. I am sure it will be appealed though for a lesser amount.
Anyway, I thought you worked for a PE company already out in the dessert of TX.

Edit: Looks like they already settled with Baylor so they likely won’t be seeing a penny of this. Why do people settle if they plan on suing?

Let’s be honest, people who work in an ACT model push that model on patients. Sure it’s “informed consent” in letting the patients know about the CRNA. But if you are in that model you tell your patients what’s gonna happen. Not advise them of their options. And some places have no options for physician only.
 
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There's actually a couple posters on here that work exclusively in Care team models and will not honor patient requests of MD/DO only. They have been very vocal about this


Jury awards are funny sometimes in that they can be heavily influenced by local demographics and politics. My wife is a lawyer in this area. She is under the opinion that if this happened in neighboring Tarrant, Colin, or Denton counties (as opposed to Dallas County), the jury verdict and/or award would have been different
I'm sure you can find many more posters that will not touch CRNA/ACT practices on this forum just as easily as the ACT-only posters.
I just treat my patients the same way I would want my family treated, and thats how I conduct myself. And as I would never let one of my family members be taken care of by an anesthesia nurse, I would not do the same to my patients. Hence why I opted to work at a physician-only practice.

I dont think the award would have changed significantly. A big chunk of that is to provide life-long care of the patient, while another big chunk is for lost lifetime earnings.
That reform is for noneconomic damages. Not economic as you can see clearly in this case. Ain’t no pain and suffering here. The patient is obviously never gonna work. I am sure it will be appealed though for a lesser amount.
Anyway, I thought you worked for a PE company already out in the dessert of TX.

Edit: Looks like they already settled with Baylor so they likely won’t be seeing a penny of this. Why do people settle if they plan on suing?

Let’s be honest, people who work in an ACT model push that model on patients. Sure it’s “informed consent” in letting the patients know about the CRNA. But if you are in that model you tell your patients what’s gonna happen. Not advise them of their options. And some places have no options for physician only.

The plaintiffs settled with Baylor, but took the USAP anesthesiologist and CRNA to trial. They are allowed to settle with some parties while taking others to trial. Baylor was smart and probably paid a lower settlement than what the MD and CRNA's malpractice insurance will have to bear. I imagine USAPs malpractice premium is about to shoot up though.
 
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I didn't realize it was malpractice to give someone a crna without informed consent.

Do we have to tell them that they are less trained and inferior?
Haha. You think if an anesthesiologist in an ACT model explained things that way patients wouldn’t have a problem? The ones who aren’t pro nurse everything that is. Or he/she wouldn’t get in trouble with the group? Remember that when working in an ACT model one of the main things one has to do is keep the nurses happy. And calling them less trained and inferior is going to get their panties in a bunch and will surely lead to complaints about the doc.
As for me, I prefer to do my own cases.
 
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Tragic. Would be very interesting if the case did go before a jury and set a precedent that would alter day to day practice for us, at least at the state level.

USAP and Baylor probably did not want to be going to court to defend the ins/outs of the ACT model and damage the Baylor brand. Plantiffs lawyer probably would have a field day explaining the role of private equity companies in the ACT model to the jury and local media.
This case DID go before a jury.

To answer Gandalf’s question to why this happens at Baylor facilities the answer is this. It’s Texas, not Baylor specifically, and Baylor has a huge footprint here. Baylor does seem to lack a good PR department. There was a huge award out of utsw (IR case - radiology tech left a syringe of contrast on the anesthesia cart. Anesthesiologist thought it was propofol and pushed it on induction. Patient died. Somehow this wasn’t reported in the news).
In a state like Texas anyone can open a hospital or a surgery center (vs a state like indiana where you need to obtain a certificate of need). This creates incredible competition amongst hospitals and surgery centers for people like surgeons who “bring the patients in” to the lucrative ORs. Good, right? That’s capitalism and the American way! Competition!
However what ends up happening is admin bends to surgeons - quickie temp privileges for dr death, allowing a terrible person like Ray ortiz to practice (because surgeons don’t care who’s doing the case as long as they can operate when they want), and pressuring groups (like mine) to run more rooms to accompany the always demanding never satisfied surgeons…. Who if they don’t get the block time they want or put their addons on will just hop down the road to the next hospital that will cater to them. I see it all the time- our own surgeons jump hospitals from time to time.
Many in my group, probably most, would prefer to go md only but there’s no way we can hire that many drs… it’s not about money it’s about the pressure to cover the rooms the hospital wants covered. At this point act is not a money saver… it’s just a get the job done thing. Until there’s some reform of the system here by the government it will probably go on the same…
I know the facts of this case but am not at liberty to share as the appeals are in place already.
This part is gossip so idk the truth - Baylor didn’t want to settle but changed their mind after the surgicare thing. The decision to settle or not in this case belonged to tmlt the malpractice provider - not USAP or the providers. What USAP or the providers wanted is not relevant as it ultimately was not their decision
 
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The verdict is puzzling. Even if the patient wasn't informed of the option of MD vs CRNA, why is that worth 21MM? If he was in a practice that didn't have an option of MD only would the verdict have gone the other way?

Seems like a lot of details are missing. Really unfortunate case, but patients should start to realize that 4:1 coverage is not a viable system.
 
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Supervising four CRNAs concurrently is the sound bite and an ancillary argument designed to appeal to emotion rather than reason. A fit looking, presumably healthy 27 year old walked in to the hospital for a routine procedure and suffered a catastrophic complication. More likely than not something indefensible happened. The supervisory ratio is not it,
 
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The verdict is puzzling. Even if the patient wasn't informed of the option of MD vs CRNA, why is that worth 21MM? If he was in a practice that didn't have an option of MD only would the verdict have gone the other way?

Seems like a lot of details are missing. Really unfortunate case, but patients should start to realize that 4:1 coverage is not a viable system.


This is a young patient who is permanently disabled and will need expensive care for the remainder of what could still be a very long life. How much are good nursing homes nowadays? How much will it cost to provide 24/7 nursing care for 30-50yrs? How much will his medical bills be? And mom has relocated to take care of her son. What did she do for a living? What did the patient do before his injury? Economic damages can be huge.

Tort reform states have caps on noneconomic damages (like pain and suffering) but there are no limits on economic damages. California is a tort reform state with a cap of $250k for noneconomic damages. However, there have been 8 figure settlements and jury awards when a child or young professional becomes permanently disabled by malpractice. When a patient dies, the settlements tend to be smaller. But when they survive and need lifetime care, the amounts can be very high.

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In rereading the article, it says $8mil of the award was for medical care. Of the remaining $13mil, I’m sure some of it was for lost income, some for pain and suffering, and some to send a message.
 
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Wasn't there a study from U of M a few years ago about morbidity and mortality risk at different ATC staffing ratios? Safer with 1:2 and riskier with 1:4? And lots of these PE AMCs run 1:4 default
 
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This case DID go before a jury.

To answer Gandalf’s question to why this happens at Baylor facilities the answer is this. It’s Texas, not Baylor specifically, and Baylor has a huge footprint here. Baylor does seem to lack a good PR department. There was a huge award out of utsw (IR case - radiology tech left a syringe of contrast on the anesthesia cart. Anesthesiologist thought it was propofol and pushed it on induction. Patient died. Somehow this wasn’t reported in the news).
In a state like Texas anyone can open a hospital or a surgery center (vs a state like indiana where you need to obtain a certificate of need). This creates incredible competition amongst hospitals and surgery centers for people like surgeons who “bring the patients in” to the lucrative ORs. Good, right? That’s capitalism and the American way! Competition!
However what ends up happening is admin bends to surgeons - quickie temp privileges for dr death, allowing a terrible person like Ray ortiz to practice (because surgeons don’t care who’s doing the case as long as they can operate when they want), and pressuring groups (like mine) to run more rooms to accompany the always demanding never satisfied surgeons…. Who if they don’t get the block time they want or put their addons on will just hop down the road to the next hospital that will cater to them. I see it all the time- our own surgeons jump hospitals from time to time.
Many in my group, probably most, would prefer to go md only but there’s no way we can hire that many drs… it’s not about money it’s about the pressure to cover the rooms the hospital wants covered. At this point act is not a money saver… it’s just a get the job done thing. Until there’s some reform of the system here by the government it will probably go on the same…
I know the facts of this case but am not at liberty to share as the appeals are in place already.
This part is gossip so idk the truth - Baylor didn’t want to settle but changed their mind after the surgicare thing. The decision to settle or not in this case belonged to tmlt the malpractice provider - not USAP or the providers. What USAP or the providers wanted is not relevant as it ultimately was not their decision


This is the time to break the news that anesthesia is not an endless resource because that is the truth. Hospitals and surgicenters need to learn that we can no longer cater to their every whim.
 
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Supervising four CRNAs concurrently is the sound bite and an ancillary argument designed to appeal to emotion rather than reason. A fit looking, presumably healthy 27 year old walked in to the hospital for a routine procedure and suffered a catastrophic complication. More likely than not something indefensible happened. The supervisory ratio is not it,
What if the CRNA didn’t call for help in a timely fashion and discouraged others in the room from calling for help? Becuase that happened to me and I just happened to be doing my rounds when I found the patient saturating in the 80s and vomit all over his face with an LMA. Sometimes the surgeons and circulators are of no help or too busy not paying any attention to what’s happening behind the drapes that bad things happen.
 
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What if the CRNA didn’t call for help in a timely fashion and discouraged others in the room from calling for help? Becuase that happened to me and I just happened to be doing my rounds when I doing the patient saturating in the 80s and vomit all over his face with an LMA. Sometimes the surgeons and circulators are of no help or too busy not paying any attention to what’s happening behind the drapes that bad things happen.
Legally, if you're medically directing, the CRNA is a physician extender, i.e. everything they do it's in your name and you're as liable as if working solo. Even if they don't call you. Why? Because it's your "failure to supervise". You should be reading the CRNA's mind at all times, watching their every move like a hawk, from your other rooms, while taking care of other patients.

Don't you just love American malpractice law?
 
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Who pays in this situation?
Certainly doc/and CRNA don’t have that $$. Malpractice insurance has a cap (usually 1 million).
We have no details about what went on in the case but I’m assuming lost airway. Pretty hard to fu(k up a 27 year old without involvement of the airway, and a lost airway is pretty much indefensible these days….
 
This is the time to break the news that anesthesia is not an endless resource because that is the truth. Hospitals and surgicenters need to learn that we can no longer cater to their every whim.
Visiting from EM to agree and add, unlimited healthcare in general has ended. It is real scary. I couldn’t find an open PICU bed in my state despite living in a decent sized state with 8-10 PICUs.. so I got to be a peds intensivist for a very sick 2 year old a few days ago, despite working at the decidedly non peds hospital in my city. A few weeks ago a colleague couldn’t place an aortic dissection anywhere in our state, he died waiting for the heli to take him two states over. I’m spending 80% of my shifts trying to practice medicine in the waiting room. The malpractice laws are going to need to be modified to accommodate the new standard of care, or there will be no insurable ER doctors in my state in 10 years.
I feel for you guys esp those who work in ACT model. There’s probably no going back, right? Could even 80% of the current caseload be covered by anesthesiologists solo?
 
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What if the CRNA didn’t call for help in a timely fashion and discouraged others in the room from calling for help? Becuase that happened to me and I just happened to be doing my rounds when I found the patient saturating in the 80s and vomit all over his face with an LMA. Sometimes the surgeons and circulators are of no help or too busy not paying any attention to what’s happening behind the drapes that bad things happen.
Good luck convincing a jury. These lawsuits happen years after the event. On deposition everyone claims to have done the correct thing. Bottom line, if your name is on the chart, you are liable.
 
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Legally, if you're medically directing, the CRNA is a physician extender, i.e. everything they do it's in your name and you're as liable as if working solo. Even if they don't call you. Why? Because it's your "failure to supervise". You should be reading the CRNA's mind at all times, watching their every move like a hawk, from your other rooms.

Don't you just love American malpractice law?
Agree. Was just trying to say that the supervisory ratio for sure can play a role because when supervising 4 rooms plus pre and post op you many not have much time to make frequent rounds and catch bad **** happening in a timely fashion.
I’m my example the circulator wanted to call for help but was told no by CRNA and the surgeon thought the CRNA would let him know if something was seriously wrong. Sats sitting in the 80s for a while and CRNA fumbling at the HOB was not serious enough for him. Lol
 
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This is the time to break the news that anesthesia is not an endless resource because that is the truth. Hospitals and surgicenters need to learn that we can no longer cater to their every whim.
Anybody who is writing anesthesia payroll checks has gotten the message.
 
This article says the CRNA administered a bunch of pressors while charting perfect VS, but also left the room for 12 min.

What? Left patient unattended for 12 minutes? And the surgeon was ok with this? Let me read this. If surgeon was aware then he or she needs to be liable too. WTAF?

Edit: That article sucks. It talks about low brain oxygen being clued in by the BP alone and no mention of sats. And the monitoring of Brain activity as if BIS tells us about the Oxygen in the brain and is not an ASA requirement. Also talks about the nurse leaving the room for 12 minutes but we don’t know if anyone was covering for them like the doc or another CRNA.
 
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Anybody who is writing anesthesia payroll checks has gotten the message.
They don't, until they are made criminally liable PERSONALLY, like the nurse who gave vecuronium instead of versed. Suddenly, a lot of nurses stopped playing doctor in my neck of woods.

The $21M is not out of the pockets of those responsible in the healthcare system.
 
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Visiting from EM to agree and add, unlimited healthcare in general has ended. It is real scary. I couldn’t find an open PICU bed in my state despite living in a decent sized state with 8-10 PICUs.. so I got to be a peds intensivist for a very sick 2 year old a few days ago, despite working at the decidedly non peds hospital in my city. A few weeks ago a colleague couldn’t place an aortic dissection anywhere in our state, he died waiting for the heli to take him two states over. I’m spending 80% of my shifts trying to practice medicine in the waiting room. The malpractice laws are going to need to be modified to accommodate the new standard of care, or there will be no insurable ER doctors in my state in 10 years.
I feel for you guys esp those who work in ACT model. There’s probably no going back, right? Could even 80% of the current caseload be covered by anesthesiologists solo?


It depends which region of the country you are talking about. Some parts of the country have always been solo MD and are currently >90% solo MD. In other regions it is rare to have solo MD.


We recently had a RSV/flu outbreak in our community. Last weekend, the ER at our regional children’s hospital had over 100 patients leave without ever being seen because the wait was so long. So I feel for ER doctors and nurses too.
 
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CRNA charts perfect vitals while administering pressors. Imaging in PACU shows global hypoxic injury.
 
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CRNA charts perfect vitals while administering pressors. Imaging in PACU shows global hypoxic injury.
This is very strange. Mild hypotension in a 27 year old causing anoxic encephalopathy? No way…
 
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This is very strange. Mild hypotension in a 27 year old causing anoxic encephalopathy? No way…
Agreed. I read it as there was probably prolonged hypotension or hypoxia that wasn't charted and the anesthesiologist wasn't notified. Only way to explain a global ischemic event like that.
 
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This is very strange. Mild hypotension in a 27 year old causing anoxic encephalopathy? No way…


Reminds me of those beach chair shoulder cases. They don’t happen often but they have happened.


Anybody routinely use cerebral oximetry?
 
Does anybody know the details of the jury verdict? I.e., what percent of the blame was assigned to the CRNA vs. the doc, vs. USAP?
 
Reminds me of those beach chair shoulder cases. They don’t happen often but they have happened.


Anybody routinely use cerebral oximetry?

Agree. There is something incredibly strange in this case. Is he an undiagnosed severe hypertensive? Extremely narrowed carotids? Clots? Heart failure/severe myocardial depression? Or did he an anaphylactic reaction (the requirement for neo in a 27 year old is telling). It really doesn’t make much sense.
 
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Wasn't there a study from U of M a few years ago about morbidity and mortality risk at different ATC staffing ratios? Safer with 1:2 and riskier with 1:4? And lots of these PE AMCs run 1:4 default

It's not just AMCs that run high supervisory rates in private practice. I know it's en vogue on SDN to trash USAP (and other AMCS), but I actually work for them and I've been exclusively 100% MD/DO only for almost a decade now (both before and after the merger) and will stay that way for the foreseeable future
 
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Who pays in this situation?
Certainly doc/and CRNA don’t have that $$. Malpractice insurance has a cap (usually 1 million).
We have no details about what went on in the case but I’m assuming lost airway. Pretty hard to fu(k up a 27 year old without involvement of the airway, and a lost airway is pretty much indefensible these days….

The insurance company, especially if the Anesthesiologist wanted to settle out of court but the malpractice company wanted to fight it.

I'm sure the award is going to be appealed, but awards like this contribute to higher malpractice rates for everyone, not just the involved party. I saw this happen pretty severely when I was a medical student in PA. A lot of the OBs and Neurosurgeons closed up shop and moved their practice to NJ because Philly had become too expensive (malpractice wise) to stay there
 
The insurance company, especially if the Anesthesiologist wanted to settle out of court but the malpractice company wanted to fight it.

I'm sure the award is going to be appealed, but awards like this contribute to higher malpractice rates for everyone, not just the involved party. I saw this happen pretty severely when I was a medical student in PA. A lot of the OBs and Neurosurgeons closed up shop and moved their practice to NJ because Philly had become too expensive (malpractice wise) to stay there
Insurance company has a policy cap (usually 1M). Why would they pay over the limit?
 
What if the CRNA didn’t call for help in a timely fashion and discouraged others in the room from calling for help? Becuase that happened to me and I just happened to be doing my rounds when I found the patient saturating in the 80s and vomit all over his face with an LMA. Sometimes the surgeons and circulators are of no help or too busy not paying any attention to what’s happening behind the drapes that bad things happen.
From previous posts, y'all know we're pretty much 99%+ medically directed ACT. Not here to debate the pros and cons.

What I don't get is CRNAs that don't call for help. I've never understood this attitude. We drum this into all of our anesthetists, CRNA and CAA, from day one, or even earlier if they've rotated through our hospitals as students. Got a problem? Call for help. You can't call? Tell your circulator, loudly and clearly, to call for you, or hit the emergency button in the OR if there is one. Absolutely nobody in my department is going to criticize anyone that calls for help for anything, whether it's something minor or something catastrophic, because we don't want anyone to think they're being wimpy or a poor anesthetist or doc just because they call for help. Rather, calling for help is a sign of a professional that puts the patient's wellbeing before ego.

Don't call for help? You'll have a private conversation later with the attending doc or chairman. It will be very blunt and one-sided.
 
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Agree. There is something incredibly strange in this case. Is he an undiagnosed severe hypertensive? Extremely narrowed carotids? Clots? Heart failure/severe myocardial depression? Or did he an anaphylactic reaction (the requirement for neo in a 27 year old is telling). It really doesn’t make much sense.
Maybe the patients gown was tight around the neck for a prolonged time impeding carotid/jugular? Has to be something. It’s certainly not MAPs in the 50-60’s in an otherwise healthy patient.
 
From previous posts, y'all know we're pretty much 99%+ medically directed ACT. Not here to debate the pros and cons.

What I don't get is CRNAs that don't call for help. I've never understood this attitude. We drum this into all of our anesthetists, CRNA and CAA, from day one, or even earlier if they've rotated through our hospitals as students. Got a problem? Call for help. You can't call? Tell your circulator, loudly and clearly, to call for you, or hit the emergency button in the OR if there is one. Absolutely nobody in my department is going to criticize anyone that calls for help for anything, whether it's something minor or something catastrophic, because we don't want anyone to think they're being wimpy or a poor anesthetist or doc just because they call for help. Rather, calling for help is a sign of a professional that puts the patient's wellbeing before ego.

Don't call for help? You'll have a private conversation later with the attending doc or chairman. It will be very blunt and one-sided.
Well you may be one of the good practices. Maybe it’s because you guys are not just CRNA centered but CAA centered as well. CAAs are trained and think differentials for the most part and many CRNAs consider y’all our puppets created to provide them competition. Ego is a serious problem in many CRNAs. I think they are taught that in CRNA school. That they are just as good if not better and need no help or supervision.
 
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I thought Texas had tort reform with 500k cap? Or is this case about not being told options vs malpractice?

Regardless, reinforces my desire not to work for usap/pe and be forced to supervise nurses I have little say in hiring based on abilities
It limits noneconomic damages due to pain and suffering. Loss of an entire lifetime of earning potential and funds for required care for an entire lifetime are economic damages and not limited by tort reform.
 
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Well you may be one of the good practices. Maybe it’s because you guys are not just CRNA centered but CAA centered as well. CAAs are trained and think differentials for the most part and many CRNAs consider y’all our puppets created to provide them competition. Ego is a serious problem in many CRNAs. I think they are taught that in CRNA school. That they are just as good if not better and need no help or supervision.
They are taught that in NURSING school nowadays. There are certain militant undergraduate nursing schools I would never hire from.

Even in the ICU, where one is not just "anesthesia", there is a totally different level of respect from the Baby Boomer and Gen X nurses than from the Me-lennial and the "Z = Me squared" generations. A CRNA or DNP degree just piles more on the top of that Dunning-Kruger effect.
 
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