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Looking for some perspective on all the hate?
Started by RapidResponseNurse
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deleted171991
Exactly.
And the result of this is what happens in a code, in the hospital: nurses rush in, trainees rush in, wise attendings walk away. Hence the patients get trainee-level care in the best case. Truly in the public interest.
I have long said that this is beyond shameful. Not for the doctors, but for those who wrote the law. Any doctor should be treated as a good samaritan when helping somebody else's patient in an emergency, when they have nothing to gain personally. (And no, being employed by the same hospital or group does not mean that there is anything to gain there personally.)
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No guarantees in court, of course, but as a general rule you're not liable for malpractice committed prior to your arrival, provided you had no previous duty to the patient.
Consider the code blue team for a hospital. If the hospitalist prescribes a fentanyl patch, Dilaudid PCA, oxycontin, and PRN Demerol to an inpatient with severe OSA ... and that patient has a respiratory arrest ... the EM physician who runs upstairs isn't liable for the hospitalist's malpractice that led to the code. But if the EM physician commits some malpractice of his own that causes injury (say he breaks some teeth intubating the patient) ...
Once you're involved, you have to practice within the standard of care. This is wholly unlike the Good Samaritan layperson who tries to help an injured person on the street but ends up harming the person via enthusiastic ignorance.
Consider the code blue team for a hospital. If the hospitalist prescribes a fentanyl patch, Dilaudid PCA, oxycontin, and PRN Demerol to an inpatient with severe OSA ... and that patient has a respiratory arrest ... the EM physician who runs upstairs isn't liable for the hospitalist's malpractice that led to the code. But if the EM physician commits some malpractice of his own that causes injury (say he breaks some teeth intubating the patient) ...
Once you're involved, you have to practice within the standard of care. This is wholly unlike the Good Samaritan layperson who tries to help an injured person on the street but ends up harming the person via enthusiastic ignorance.
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If you have no responsibility and/or physician patient relationship, going to help a colleague in an emergency/code should not end with your being named in a lawsuit. You may be named initially along with every other physician that interacted with the patient in any way, but unless you committed malpractice while there, you will be dropped.
The problem in the above situation is that there isn't a responsible anesthesia physician for the independently practicing CRNA. The surgeon will say it wasn't him, and the CRNA will say it can't be them, they're just a nurse. That leaves the responding Anesthesiologist in an unusual situation. There isn't enough case law about this yet. But there will be, and if the captain of the ship is the surgeon, we may be pulled back in to those facilities, though they will probably only want a litigation shield, covering as many CRNAs as humanly possible managing preop, post op and disasters. No thanks, I'd rather go to Business school and join the enemy.
I didn't like the role of the scheduler/floor runner in the Navy as they had to sign off on the plan of any "independent" CRNA that had an ASA 3+ patient in their room. I don't want anything to do with that case and approving the plan puts me on the hook for CRNA mismanagement. That is bullshït. I can't tell you how many CRNAs were relieved at 4 by the call team because they were doing a case they had no business doing, and doing it poorly. I'm sure PGG sees this, though perhaps they are so awesome now, they don't even have to sign off anymore. This is a real problem, and will get worse.
The problem in the above situation is that there isn't a responsible anesthesia physician for the independently practicing CRNA. The surgeon will say it wasn't him, and the CRNA will say it can't be them, they're just a nurse. That leaves the responding Anesthesiologist in an unusual situation. There isn't enough case law about this yet. But there will be, and if the captain of the ship is the surgeon, we may be pulled back in to those facilities, though they will probably only want a litigation shield, covering as many CRNAs as humanly possible managing preop, post op and disasters. No thanks, I'd rather go to Business school and join the enemy.
I didn't like the role of the scheduler/floor runner in the Navy as they had to sign off on the plan of any "independent" CRNA that had an ASA 3+ patient in their room. I don't want anything to do with that case and approving the plan puts me on the hook for CRNA mismanagement. That is bullshït. I can't tell you how many CRNAs were relieved at 4 by the call team because they were doing a case they had no business doing, and doing it poorly. I'm sure PGG sees this, though perhaps they are so awesome now, they don't even have to sign off anymore. This is a real problem, and will get worse.
If you respond to an emergency and it results in litigation because of a bad outcome, you can be 100% certain that you will be named in the lawsuit.
The lawyer will do everything possible to get as many insured providers as possible included, because this will increase the chances of a bigger settlement or bigger jury award.
Every name on that chart is a potential defendant.
The lawyer will do everything possible to get as many insured providers as possible included, because this will increase the chances of a bigger settlement or bigger jury award.
Every name on that chart is a potential defendant.
It's much easier for the lawyers to name everyone and then remove names over time. It's my understanding that they can't ADD names to a suit after a certain period of time has gone by. I guess they don't want to miss the boat on naming someone who might turn out being liable.
They're still required to consult us for ASA 3+ patients. We don't sign the chart. I'm sure some of them document "discussed plan with Dr PGG" but to be honest I don't think that's much of a liability. Even though Feres Doctrine doesn't apply to most of our patients (who are dependents and retirees, not active duty) we still have an extremely malpractice friendly environment to work in.
CRNA or no CRNA, supervision or no supervision, direction or no direction, our lawyers are the US Govt, on salary, with endless time and resources, and the US Govt will defend everything tooth and nail, even stuff that shouldn't (can't) be defended. Another nice detail is that military physicians can't be sued directly. The patient has to sue the government, and one of the downstream results (for better or worse) is that our names don't go to the national provider data bank after a payout unless a government inquiry (conducted by other military doctors) thinks we should. Unfortunately this means some military doctors who should be on that naughty list aren't, but it really cuts down on garbage "I was frivolously named; my carrier settled because it was cheaper than defending; now my name's on the list" incidents.
The government now has a much lower threshold than in the past to settle cases, and if they settle they will report your name to the data bank, and since you are their employee they might not even inform you of their intent to report you until it's already done, which means your input might not be included.
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