MD employs CRNA - MD gets in major trouble when the gas goes wrong...

[PikminOC]

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http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation
CRNA denies responsibility for esophageal intubation. Fights with paramedics.
Ophthalmologist gets in trouble as "captain" of the ship, including the anesthesia..

 

[FIREitUP]

http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation
CRNA denies responsibility for esophageal intubation. Fights with paramedics.
Ophthalmologist gets in trouble as "captain" of the ship, including the anesthesia..

Was the anesthetist employed by the ophthalmologist? It seems like with relationships such as these there exists a conflict of interest that undermines the ability of the anesthetist to advocate properly for the patient. Of course, had the CRNA been adequately trained, this gentleman likely would not have perished.

 

[Baller MD]

If a CRNA had been present, the patient wouldn't have died. After all, they are competent in all aspects of anesthesia care.





















Oh wait.

 

[PikminOC]

Was the anesthetist employed by the ophthalmologist? It seems like with relationships such as these there exists a conflict of interest that undermines the ability of the anesthetist to advocate properly for the patient. Of course, had the CRNA been adequately trained, this gentleman likely would not have perished.

What are you babbling about?

 

[PikminOC]

From article:

"When the paramedics arrived, they determined that the CO2 monitor had not changed color indicating the tube was in the esophagus rather than the trachea. This prompted the CRNA to get into a shoving match with one of the paramedics. The paramedic re-intubated the patient and O2 saturations began to go up. The patient was transferred to the hospital where he died eight days later.
Analysis
The plaintiff’s anesthesiology expert had many criticisms of the insured ophthalmologist. He testified that surgery should not have been performed since the plaintiff had low blood sugar and high blood pressure on the morning of surgery. It was this expert’s opinion that, given the patient’s medical condition, general anesthesia should have been used, but if local anesthesia was used, the surgery should have been performed in a hospital or facility where an MD anesthesiologist was available. Since this surgery center did not have an MD anesthesiologist, the expert pointed to the ophthalmologist as the “captain of the ship.” The expert testified that the CRNA did not intubate the patient properly and the insured did not diagnose improper esophageal intubation.
The defense expert disagreed with these opinions and the role of a surgeon in anesthesia care. He insisted that the anesthesia provider is responsible for monitoring the patient during surgery. He testified that the CRNA failed to monitor and communicate a low oxygen level to the insured prior to the patient’s arrest, thus leading to a delay in resuscitation. Unfortunately, the defense expert was not comfortable rendering an opinion on the standard of care related to the decision to perform surgery. The co-defendant CRNA testified at his deposition that he was responsible for providing anesthesia to the patient, but that the insured was the “captain of the ship.” The CRNA admitted that he had not performed an intubation in the five years preceding this case and that he never discussed the risks and complications of anesthesia with the patient because he did not want to scare him. However, he maintained that the intubation was properly done and that the paramedic dislodged the tube. It was defense counsel’s opinion that a jury would award the plaintiff $2.8 to $4 million and hold the OMIC insured 25% to 50% liable. The CRNA settled first for $975,000, and the OMIC insured settled later at mediation for $800,000."

 

[FIREitUP]

What are you babbling about?

I'm 'babbling' about the fact that there is an inherent conflict of interest between the anesthetist and the surgeon if the surgeon is employing the anesthetist. Therefore, the anesthetist would be more hesitant to go against the will of the surgeon, even if he/she felt that it wasn't safe. I'm not sure if that's what happened here, but it may have contributed if that power dynamic was in place. The Joan Rivers incident is an example of this.

 

[Baller MD]

I'm 'babbling' about the fact that there is an inherent conflict of interest between the anesthetist and the surgeon if the surgeon is employing the anesthetist. Therefore, the anesthetist would be more hesitant to go against the will of the surgeon, even if he/she felt that it wasn't safe. I'm not sure if that's what happened here, but it may have contributed if that power dynamic was in place. The Joan Rivers incident is an example of this.

How is that relevant to this case though? I don't see it. How is the CRNA's incompetence of being unable to intubate the surgeon's fault?

 

[PikminOC]

I'm 'babbling' about the fact that there is an inherent conflict of interest between the anesthetist and the surgeon if the surgeon is employing the anesthetist. Therefore, the anesthetist would be more hesitant to go against the will of the surgeon, even if he/she felt that it wasn't safe. I'm not sure if that's what happened here, but it may have contributed if that power dynamic was in place. The Joan Rivers incident is an example of this.

Citation please.
In what way in this case did the CRNA go against the physician ? The CRNA even pushed a paramedic.

 

[FIREitUP]

How is that relevant to this case though? I don't see it. How is the CRNA's incompetence of being unable to intubate the surgeon's fault?

I agree that the CRNA appears to lack competence. I was just speculating if there was a power dynamic that was in place that prevented the patient from having the best possible advocate behind the curtain. The CRNA may have felt 'pushed' into doing a block when general anesthesia was more indicated as per the article.

I'm not trying to argue, just wondering and trying to spark discussion.

 

[PikminOC]

I agree that the CRNA appears to lack competence. I was just speculating if there was a power dynamic that was in place that prevented the patient from having the best possible advocate behind the curtain. The CRNA may have felt 'pushed' into doing a block when general anesthesia was more indicated as per the article.

I'm not trying to argue, just wondering and trying to spark discussion.

So, um..the esophageal intubation was bc the doc wanted it there and the CRNA was afraid to put it in the trachea?

 

[FIREitUP]

So, um..the esophageal intubation was bc the doc wanted it there and the CRNA was afraid to put it in the trachea?

Everyone on this allopathic sub-forum wants to do a circle jerk around incompetent CRNA's, I get it. I was just wondering if there was something else going on as well since there is so much to the story that we cannot surmise from the article.

 

[PikminOC]

he never discussed the risks and complications of anesthesia with the patient because he did not want to scare him. However, he maintained that the intubation was properly done and that the paramedic dislodged the tube.
==
Explain the power difference here as well

 

[PikminOC]

Everyone on this allopathic sub-forum wants to do a circle jerk around incompetent CRNA's, I get it. I was just wondering if there was something else going on as well since there is so much to the story that we cannot surmise from the article.

Im not trying to circle jerk the CRNA.
Im trying to show that as a PHYSICIAN, you are considered the CAPTAIN of the ship no matter what happens.
In ANY setting.
So BE CAREFUL.
You will hopefully be an attending someday.
It is important to know these cases as they set precedence.
This isn't a NEWS story.
This is the legal info.

 

[FIREitUP]

Im not trying to circle jerk the CRNA.
Im trying to show that as a PHYSICIAN, you are considered the CAPTAIN of the ship no matter what happens.
In ANY setting.
So BE CAREFUL.
You will hopefully be an attending someday.
It is important to know these cases as they set precedence.

The lack of competence is clear. I agree that this is an important issue.

But I wonder if part of the reason that the physician was held liable was because the CRNA was employed by the doc. It just doesn't make sense to me that the doc would be held liable otherwise (unless this court case is setting some sort of precedence). I also think that as an anesthetist you are supposed to be an advocate for the patient. I wonder if one of the reasons the advocacy was not there was because the power dynamic I mentioned earlier.

Of course, it all could have been incompetence on the part of the CRNA.

 

[FIREitUP]

Im not trying to circle jerk the CRNA.
Im trying to show that as a PHYSICIAN, you are considered the CAPTAIN of the ship no matter what happens.
In ANY setting.
So BE CAREFUL.
You will hopefully be an attending someday.
It is important to know these cases as they set precedence.
This isn't a NEWS story.
This is the legal info.

interesting thread regarding the joan rivers story. there was an original one that i believe was deleted. she also died at an outpatient surgery center.

http://forums.studentdoctor.net/threads/anesthesiologist-identified-in-joan-rivers-gi-death.1114645/

 

[PikminOC]

Please go study.

 

[FIREitUP]

Please go study.

Is this an attempt to undermine my credibility because "I'm just a student"? Surely you could have posted something a little less inflammatory and abrasive.

There are many parallels between this story and the Joan Rivers story. I think it's interesting to consider the possibility that there is more to the story than what was posted on this ophthalmology liability company's website.

 

[PikminOC]

No, its not undermine you. You aren't catching what I'm saying. I can't help you anymore. You will understand later. You notice I did not do this to anyone else.

 

[FIREitUP]

No, its not undermine you. You aren't catching what I'm saying. I can't help you anymore. You will understand later.

I understand what you're saying completely. This issue is emblematic of the current problem in which doctors are found liable when they should not have been. I get it, the anesthesiologist/CRNA is in control of the patient and is responsible when the **** hits the fan, that's not in the surgeon's realm of responsibility. But, I think there's more to the story than what this website posts, which by the way may not be the most objective source of information.

 

[PikminOC]

I understand what you're saying completely. This issue is emblematic of the current problem in which doctors are found liable when they should not have been. I get it, the anesthesiologist/CRNA is in control of the patient and is responsible when the **** hits the fan, that's not in the surgeon's realm of responsibility. But, I think there's more to the story than what this website posts, which by the way may not be the most objective source of information.

No No No.
It is the physician's responsibility.
The nurses need to decide if they are really independent or if they want to hide behind our legs.
One side or another. They need to choose ONE.
And in this case, the nurse still has not successfully intubated a patient in over five years.

And I am posting this in the DOC forum to let DOC's know and beware.
More specific circumstances do not matter.
You are looking at the trees, not the forest.

 

[giantswing]

Can we focus on the fact that we're starting to ask optho/ortho/plastics to also do anesthesia now? Because crnas want all the autonomy without the liability?

FUTURE SURGEONS: problemz. We haz them.

 

[calvnandhobbs68]

"The CRNA admitted that he had not performed an intubation in the five years preceding this case and that he never discussed the risks and complications of anesthesia with the patient because he did not want to scare him. "

lol wut

 

[FIREitUP]

No No No.
It is the physician's responsibility.
The nurses need to decide if they are really independent or if they want to hide behind our legs.
One side or another. They need to choose ONE.
And in this case, the nurse still has not successfully intubated a patient in over five years.

And I am posting this in the DOC forum to let DOC's know and beware.
More specific circumstances do not matter.
You are looking at the trees, not the forest.

Good point. I had missed that the argument was that since there was no MD that the ophtho MD was held liable. Was the decision made because no MD anesthesiologist was available? I wonder what the verdict would have been if it had been an incompetent anesthesiologist?

 

[jl lin]

Major incompetence. Sad and embarrassing. I'm wondering what he was doing there working in that setting in that role if he hadn't been up-to-date on his skills; but really, on multiple levels, the dude was deficient. Not discussing risks--part of informed consent. Not noting the ETCO2. Not assessing more quickly and carefully to see the need to re-intubate. Not owning the fact that he failed to effectively evaluate and respond correctly--ETT in esophagus and f/u up properly. And what is the deal with fighting the paramedic?

As far as I have seen or heard in surgical areas, it's the surgeon that runs the room and the ship; but he/she is counting on competent anesthesia practitioners--and if there is a problem, he or she wants the anesthesiologist. Well, that's less of a possibility with some of these outpatient arrangements it seems. But defense seemed to have used that here to stretch things in order to soften the blow(?) for the CRNA. Be interesting to see how the CRNA nursing board will deal with this person.

 

[jl lin]

No No No.
It is the physician's responsibility.
The nurses need to decide if they are really independent or if they want to hide behind our legs.
One side or another. They need to choose ONE.
And in this case, the nurse still has not successfully intubated a patient in over five years.

Correct, but when they can float between that nether world of independence and dependence, and still collect the nice salaries, what makes you think they will? I say this fully acknowledging that this does not represent all CRNAs for sure. At the same time, I want a reputable, BC anesthesiologist very nearby for my procedures, thank you.

The defense's argument that the operating physician is still a physician and it's his/her surgery, etc. He/she, therefore, should be able to intervene or direct when the patient is in jeopardy. But I don't think I have ever seen a surgeon in the OR leave the open patient and push the anesthesiologist aside to revive a patient. (Of course the optha was right there at the head, so. . .) Mind you, I'm not an OR nurse but a SICU/OH recovery nurse. But I have had time in the OR, and you hear a lot of what happens in there if you are in the right circles.

What's the alternative? Physicians choosing not to work with CRNAs. Sounds good, but how is that going to work in the hospital? They aren't gong to pay an anesthesiologist to be in full attendance of each surgery or procedure throughout the ORs.

The answer is that physicians have to stand strong together and say, "We will not perform w/o appropriate anesthesiology back-up."

But to be honest, if this CRNA doesn't get board sanctions, I'd be surprised and also livid. There are incompetent providers on ALL LEVELS.

Surgeons in the hospital have a lot of pull--especially those that are the big bread winners for the institution. They know with which CRNAs and anesthesiologists they feel confident working and those that they do not. In the outpatient setting, there's a more loosey-goosey set-up it seems--at least often enough to hear about these situations.

 

[Imnotfromjersey]

It sucks that this situation has happened.

 

[jl lin]

You are all clearly missing the big picture. We need to give CRNA 100% practice rights and independence. That way they'd be responsible for their own mistakes.

No. I'm not. I'm saying it's better to prevent that from happening for the sake of patients. Plus this nimrod defied the sense a good ICU RN would have used. Also, it's a lot of fluff looking for independence, b/c they will always be able to snag a physician that is directly involved in there. Why? B/c s/he does have more education and the expectation of supremacy in care would go to that. In every OR I know of, the surgeon in ultimately in charge. How is that going to change if you allow then 100% practice rights and independence? They will still be providing the anesthesia care BUT THEY WILL STILL NOT BE MEDICALLY LICENSED PHYSICIANS. There is a higher expectation of care and accountability for the physician no matter what they seek to pass in terms of independence of practice. The law will use that expectation and play it to the fullest. Do you see what I am trying to say? The attorneys will pull in whomever they can in order to up the outcome for their clients/plaintiffs and themselves. I am not knocking attorneys, but this is how it works, in general. So, they will get the CRNA. They will get the lead physician performing the procedure. They will get the hospital or facility. Full rights won't mean so much when it comes to full liability, b/c they will go after anyone in the circle of the event that has deep enough pockets.

 

[Imnotfromjersey]

No. I'm not. I'm saying it's better to prevent that from happening for the sake of patients. Plus this nimrob defied the sense a good ICU RN would have used. Also, it's a lot of fluff looking for independence, b/c they will always be able to snag a physician that is directly involved in there. Why? B/c s/he does have more education and the expectation of supremacy in care would go to that. In every OR I know of, the surgeon in ultimately in charge. How is that going to change if you allow then 100% practice rights and independence? They will still be providing the anesthesia care BUT THEY WILL STILL NOT BE MEDICALLY LICENSED PHYSICIANS. There is a higher expectation of care and accountability for the physician no matter what they seek to pass in terms of independence of practice. The law will use that expectation and play it to the fullest. Do you see what I am trying to say? The attorneys will pull in whomever they can in order to up the outcome for their clients/plaintiffs and themselves. I am not knocking attorneys, but this is how it works, in general. So, they will get the CRNA. They will get the lead physician performing the procedure. They will get the hospital or facility. Full rights won't mean so much when it comes to full liability, b/c they will go after anyone in the circle of the event that has deep enough pockets.

I dont agree with that.

 

[jl lin]

^perfect example of nurses wanting to play doctor but tucking their tail when ish hits the fan. Nursing lobbies have made it clear that nurses are equivalent to or better than doctors. Accept the risks that come with it too, please? 🙂

OK, but you are now missing the point. Anyone within spitting distance can be pulled into the suit. The law will use a higher expectation in care and practice, in many instances, b/c they were there and they have gone through the rigors of medical school, all the needed processes that go along with that, Steps, etc, residency, board certification. It's like the old adage, "To much is given, much is expected." Of course in this example "given" means worked your butt off and invested a lot of time and money.

It is for this and many other reasons that it is unwise for physicians to allow this so called "independence" in practice.
I mean, I am cool with say an NP not having to call a doc over whether or not a patient needs a social services follow-up or referral for homecare. They have enough education and experience, in general, to make that determination without bugging a doc to get a sign-off on it. Funny thing is that a number of insurance companies don't care if there is such a referral from an independent NP, they still want a LMN from a physician. LOL.

This is something that really needs good political backing and relentless support from physicians. You have to demonstrate that this is about something more than turf wars. Until a CRNA can demonstrate the knowledge, training, full experiences and fitness for Board Certification as an anesthesiologist that has/does--or even a physician that has gone through medical school, the rigors of residency/fellow, licensure to BC--allowing them independence in practice will do nothing to stop the legal, financial, and "reputational" impact on the physician/s in attendance; b/c the expectation of the standard of practice will always be higher with a physician. Are anesthesiologists going to be cool with someone waving a wand and making CRNAs of full equivalence in this regard? Even if they could, ultimately they will not be so, b/c the processes are more rigorous and better measured for physicians. You really don't think attorneys use this and will continue to do so, as leverage?

 

[W19]

Im not trying to circle jerk the CRNA.
Im trying to show that as a PHYSICIAN, you are considered the CAPTAIN of the ship no matter what happens.
In ANY setting.
So BE CAREFUL.
You will hopefully be an attending someday.
It is important to know these cases as they set precedence.
This isn't a NEWS story.
This is the legal info.

Many physicians shortchange the profession for a buck... For instance, my PCP has 3 offices. Never saw her. It's always the PA/NP. Last time I saw her was in 2010.

 

[Psai]

There are no studies that show that CERTIFIED REGISTERED nurse anesthetists are inferior providers and we are just as good, if not better than MDAs. There is NO difference in outcomes in SCIENTIFIC peer review studies which is research based on FACTS. We have been practicing independently and safely for over one hundred and fifty years. We are a cost effective alternative to those MDAs who just sit there and stare at the board as they do their crosswords.

Warm regards, Dr. Psai, BSN MSN RN CNOR CRNA DNP ARNP MBA AORN

 

[Sirach38]

There are no studies that show that CERTIFIED REGISTERED nurse anesthetists are inferior providers and we are just as good, if not better than MDAs. There is NO difference in outcomes in SCIENTIFIC peer review studies which is research based on FACTS. We have been practicing independently and safely for over one hundred and fifty years. We are a cost effective alternative to those MDAs who just sit there and stare at the board as they do their crosswords.

Warm regards, Dr. Psai, BSN MSN RN CNOR CRNA DNP ARNP MBA AORN

Lol...love it.

I can't wait until CRNAs practice completely independently from MDs.

Surgeons need to wake up and realize that with the current legal climate, if **** hits the anesthesia fan and they are the only MD in the room, they WILL be held liable for whatever happens. CRNAs love to proclaim independence, that is, until things go bad. At that point, they are just some poor, defenseless, little nurses who didn't know any better. It's now the big bad greedy MD who killed the patient because he should have known better than to employ a poor defenseless little nurse who didn't know any better. 🙄

 

[Sirach38]

Correct, but when they can float between that nether world of independence and dependence, and still collect the nice salaries, what makes you think they will? I say this fully acknowledging that this does not represent all CRNAs for sure. At the same time, I want a reputable, BC anesthesiologist very nearby for my procedures, thank you.

The defense's argument that the operating physician is still a physician and it's his/her surgery, etc. He/she, therefore, should be able to intervene or direct when the patient is in jeopardy. But I don't think I have ever seen a surgeon in the OR leave the open patient and push the anesthesiologist aside to revive a patient. (Of course the optha was right there at the head, so. . .) Mind you, I'm not an OR nurse but a SICU/OH recovery nurse. But I have had time in the OR, and you hear a lot of what happens in there if you are in the right circles.

What's the alternative? Physicians choosing not to work with CRNAs. Sounds good, but how is that going to work in the hospital? They aren't gong to pay an anesthesiologist to be in full attendance of each surgery or procedure throughout the ORs.

The answer is that physicians have to stand strong together and say, "We will not perform w/o appropriate anesthesiology back-up."

But to be honest, if this CRNA doesn't get board sanctions, I'd be surprised and also livid. There are incompetent providers on ALL LEVELS.

Surgeons in the hospital have a lot of pull--especially those that are the big bread winners for the institution. They know with which CRNAs and anesthesiologists they feel confident working and those that they do not. In the outpatient setting, there's a more loosey-goosey set-up it seems--at least often enough to hear about these situations.

Surgeons intervening and directing anesthesia?!?!?! Are you insane?!?! Surgeons don't know or care to know squat about anesthesia. I had a cardiac surgeon in the room once who was having trouble turning on an O2 tank. Come on!

 

[PikminOC]

Major incompetence. Sad and embarrassing. I'm wondering what he was doing there working in that setting in that role if he hadn't been up-to-date on his skills; but really, on multiple levels, the dude was deficient. Not discussing risks--part of informed consent. Not noting the ETCO2. Not assessing more quickly and carefully to see the need to re-intubate. Not owning the fact that he failed to effectively evaluate and respond correctly--ETT in esophagus and f/u up properly. And what is the deal with fighting the paramedic?

As far as I have seen or heard in surgical areas, it's the surgeon that runs the room and the ship; but he/she is counting on competent anesthesia practitioners--and if there is a problem, he or she wants the anesthesiologist. Well, that's less of a possibility with some of these outpatient arrangements it seems. But defense seemed to have used that here to stretch things in order to soften the blow(?) for the CRNA. Be interesting to see how the CRNA nursing board will deal with this person.

DEFENSE trying to soften the the blow my tukus.
" The co-defendant CRNA testified at his deposition that he was responsible for providing anesthesia to the patient, but that the insured was the “captain of the ship"

 

[jl lin]

There are no studies that show that CERTIFIED REGISTERED nurse anesthetists are inferior providers and we are just as good, if not better than MDAs. There is NO difference in outcomes in SCIENTIFIC peer review studies which is research based on FACTS. We have been practicing independently and safely for over one hundred and fifty years. We are a cost effective alternative to those MDAs who just sit there and stare at the board as they do their crosswords.

Warm regards, Dr. Psai, BSN MSN RN CNOR CRNA DNP ARNP MBA AORN

😉

Yes, but 150 years you haven't been practicing independently. You were trained, originally, by physicians and in reality still are to some degree. All is moot until you complete the same quality and quantity of preparation and have the same required benchmarks as physicians.

And don't cherry pick the research. And do more of your own original research. How about that? 😉

 

[jl lin]

soften the blow my tukus.
" The co-defendant CRNA testified at his deposition that he was responsible for providing anesthesia to the patient, but that the insured was the “captain of the ship"

Yes, and at the end of the day, there is no getting around the fact that the ultimate standard of care would come from a physician b/c he/she went to medical school and jumped through all those hoops, etc. For the physician in the case, dodging this bullet will be tough, and it won't matter if the CRNA is "independent." It's a no win until you get medicine to take a stronger position on the issue of overstep and physicians quality and quantity of education, training, etc. as superior, which lawyers will say it is. So, yes. CRNAs and other midlevel providers shouldn't have it both ways, but in a lawsuit, those with deep insurance pockets who are somehow associated with the event will get pulled into it.

IMHO, the only way to stop this is to become as tough and almost militant about resisting independence in practice as they are about having it.

That is, unless you think they will be out there setting up shop with PAs and NPs performing procedures w/ CRNAs--all sole providers of the medical care. Now if they could house themselves together in this, that would be different, b/c ultimately a trend of substandard practice or getting out of their element would present itself to the general public--but then it would be ALL on them.
But as long as physicians choose or are forced to work with their "independence" model, and then something goes wrong, physicians will continue to be fair game in a lawsuit. . .unfortunately.

 

[jl lin]

Many physicians shortchange the profession for a buck... For instance, my PCP has 3 offices. Never saw her. It's always the PA/NP. Last time I saw her was in 2010.

See, that is screwy. And do you know how long I would continue to go to this practice?

 

[calvnandhobbs68]

😉

Yes, but 150 years you haven't been practicing independently. You were trained, originally, by physicians and in reality still are to some degree. All is moot until you complete the same quality and quantity of preparation and have the same required benchmarks as physicians.

And don't cherry pick the research. And do more of your own original research. How about that? 😉

 

[cincincyreds]

Lol...love it.

I can't wait until CRNAs practice completely independently from MDs.

Surgeons need to wake up and realize that with the current legal climate, if **** hits the anesthesia fan and they are the only MD in the room, they WILL be held liable for whatever happens. CRNAs love to proclaim independence, that is, until things go bad. At that point, they are just some poor, defenseless, little nurses who didn't know any better. It's now the big bad greedy MD who killed the patient because he should have known better than to employ a poor defenseless little nurse who didn't know any better. 🙄

cRNAs are the probably the laziest scum of human beings on this planet. They want all the money and glory and don't want to be responsible for anything. If a cRNA wants to practice independently, I say fine, but they have to get a 30 or above on the MCAT, pass Steps 1,2,3 of the USMLE, and pass the Anesthesia Board certification process. Trust me, I doubt even one of them could actually do this.

cRNAs are dangerous to patients and I would never let one of them touch me or any family members of mine.

 

[giantswing]

Surgeons intervening and directing anesthesia?!?!?! Are you insane?!?! Surgeons don't know or care to know squat about anesthesia. I had a cardiac surgeon in the room once who was having trouble turning on an O2 tank. Come on!

This. You'd never ask an anesthesiologist to do a lap chole. Don't ask acsurgeon to do anesthesia, which includes the pre op screening and post op. Especially if they are ortho. 😛

 

[jl lin]

cRNAs are the probably the laziest scum of human beings on this planet. They want all the money and glory and don't want to be responsible for anything. If a cRNA wants to practice independently, I say fine, but they have to get a 30 or above on the MCAT, pass Steps 1,2,3 of the USMLE, and pass the Anesthesia Board certification process. Trust me, I doubt even one of them could actually do this.

cRNAs are dangerous to patients and I would never let one of them touch me or any family members of mine.

Yes, hold them to the same standards. If not, they can't practice as independents. But politically, their ball has picked up a lot of momentum. I'm not totally clear on why there doesn't seem to be the same amount of momentum on the other side.

If they want to practice independently, then they have to put that model in with those on a similar level. They sit for other midlevel procedures, not physicians' procedures. Let them house their own within it. Then see how far they get. But as long as physicians are forced or choose to work with them under this model, there will continue to be problems.

Personally, if I were a CRNA, I'd be totally cool with working under a anesthesiologist--so long as she or he was not incompetent or a terrorist, lol. 🙂 When the patient runs into trouble, first, you need support, and how could it be wrong to have a BC anesthesiologist there directing?

IDK, I just don't understand why people can't shut up and do their jobs, work with others, and call it a day. Life is already stressful enough.

How come you don't see this issue w/ RNFA's? Do you see first assistants taking on surgeons as equals--or working completely independent? How did it ever get this far?

 

[Sirach38]

Yes, hold them to the same standards. If not, they can't practice as independents. But politically, their ball has picked up a lot of momentum. I'm not totally clear on why there doesn't seem to be the same amount of momentum on the other side.

If they want to practice independently, then they have to put that model in with those on a similar level. They sit for other midlevel procedures, not physicians' procedures. Let them house their own within it. Then see how far they get. But as long as physicians are forced or choose to work with them under this model, there will continue to be problems.

Personally, if I were a CRNA, I'd be totally cool with working under a anesthesiologist--so long as she or he was not incompetent or a terrorist, lol. 🙂 When the patient runs into trouble, first, you need support, and how could it be wrong to have a BC anesthesiologist there directing?

IDK, I just don't understand why people can't shut up and do their jobs, work with others, and call it a day. Life is already stressful enough.

How come you don't see this issue w/ RNFA's? Do you see first assistants taking on surgeons as equals--or working completely independent? How did it ever get this far?

It got this far because of market forces and the huge need for anesthesia providers plus greed. First, there wouldn't be enough anesthesiologists to cover every OR in the country so we need CRNAs to fill in the void. Second, it is much more profitable to staff four rooms with 4 CRNAs and one MD overseeing them than to hire 4 MDs to cover these rooms. Initially this model of using CRNAs was very profitable to private practice groups. Now that many private groups have been taken over by AMCs, this profit is going to administrators. Furthermore, a small minority of CRNAs have become extremely militant and arrogant and have pushed for legislature that increases independence. All of these factor combined have created the current climate. Much of the blame can be placed on old timer anesthesiologists who got rich off of CRNAs all while showing up just to sign charts.

So esentially those going into gas have inherited this mess and will be working through the consequences.

 

[Jabbed]

The lack of competence is clear. I agree that this is an important issue.

But I wonder if part of the reason that the physician was held liable was because the CRNA was employed by the doc. It just doesn't make sense to me that the doc would be held liable otherwise (unless this court case is setting some sort of precedence). I also think that as an anesthetist you are supposed to be an advocate for the patient. I wonder if one of the reasons the advocacy was not there was because the power dynamic I mentioned earlier.

Of course, it all could have been incompetence on the part of the CRNA.

That has almost nothing to do with it. They both could have been sub-contracted under the same group together and the doctor still would've been sued. The only possible exception is if this was a state in which CRNAs are not allowed to practice independently, in which case the "supervising" anesthesiologist would have been sued instead.

I was almost surprised that the CRNA was able to practice after not displaying competence in ET intubation in 5 years. Almost.

 

[Ost3oclast]

Oh this is surprising.......

 

[Rendar5]

I wouldn't trust either an anaesthesiologist OR a CRNA who hadn't intubated anyone in 5 years to perform anaesthesia. You lose skills fast. It is still both of their faults. CRNA for ****ing up, and The ophthalmologist is at fault for having an inexperienced anaesthesia provider on hand. He's not responsible for the intubation itself going wrong.

I'm not a big fan of procedures taking place outside of hospitals or AMC's. I've been on the ED end of these things gone wrong (similar case, vascular surgery had someone oversedated, I think the surgeon himself did an esophageal intubation, paramedics came in and save the guy by placing a King Airway and I had to properly intubate once they got to the ED). I intubate regularly and even I won't work in a place without anaesthesia backup if I can help it. You never know when you'll get an airway emergency.
CRNA's really shouldn't be operating without the direct availability of anaesthesiologists

 

[W19]

See, that is screwy. And do you know how long I would continue to go to this practice?

It's very convenient... yearly checkup. closer to home.

 

[bc65]

The problem in this case is not the CRNA per se, it's that this CRNA was incompetent, and that there was no anesthesiologist backup. Both of those deficiencies are the fault of the Surgery Center, which hires the anesthesiologists. The lesson from this case is to makes sure that there are competent CRNAs and competent anesthesiologist backup.

Why all the worry about CRNAs? If you don't want to work with them, just work in an OR that will provide you with only anesthesiologists.

The hospital that I work in has CRNAs working under the supervision of anesthesiologists. Honestly, I would let any of them do my anesthesia with no reservations whatsoever, while there have been anesthesiologists that I have known that I wouldn't let near my patients, let alone near me. It all depends on the individual and their competence. They also need to be working within their comfort zone.

Overall, there seems to be too much energy devoted on these forums to worrying about ancillary providers. They are not going to be your problem in practice. When you get into practice, you will succeed based on your own skills and abilities. The nurse practitioners, midwives, PAs, homeopaths, naturopaths, chiropracters, and faith healers will not be your real competition. Don't worry about them. You don't want patients who will go to them anyway.

Also, in most cases, it's DOCTORS who hire the lower paid ancillary providers, to increase their own income, and not have to share it with a partner.

 

[jl lin]

The problem in this case is not the CRNA per se, it's that this CRNA was incompetent, and that there was no anesthesiologist backup. Both of those deficiencies are the fault of the Surgery Center, which hires the anesthesiologists. The lesson from this case is to makes sure that there are competent CRNAs and competent anesthesiologist backup.

Why all the worry about CRNAs? If you don't want to work with them, just work in an OR that will provide you with only anesthesiologists.

The hospital that I work in has CRNAs working under the supervision of anesthesiologists. Honestly, I would let any of them do my anesthesia with no reservations whatsoever, while there have been anesthesiologists that I have known that I wouldn't let near my patients, let alone near me. It all depends on the individual and their competence. They also need to be working within their comfort zone.

Overall, there seems to be too much energy devoted on these forums to worrying about ancillary providers. They are not going to be your problem in practice. When you get into practice, you will succeed based on your own skills and abilities. (true) The nurse practitioners, midwives, PAs, homeopaths, naturopaths, chiropracters, and faith healers will not be your real competition. Don't worry about them. You don't want patients who will go to them anyway. (That's kind of extreme and unrelated. I mean you are entitled to your opinion, but, well, it is kind of extreme in my view, but whatever.)

Also, in most cases, it's DOCTORS who hire the lower paid ancillary providers, to increase their own income, and not have to share it with a partner.

(And healthcare service providers as well as these physicians continue to be part of the problem when they don't recognize the limitations and shortsightedness of this mentality--and everyone ends up paying for it.)

Yes I agree it is the competence of the individual provider. (I would still like to know if the board will put any disciplinary actions upon this CRNA. Hmm.)

Personally, I have little issues with most reputable NPs, midwives, PAs, or naturopaths, so long as they stay within their scope of practice and are competent. In fact for wellness purposes, I have followed some of the nutritional and exercise guidelines of a reputable RN/doctor of NM. She knows her limits. She is simply about nutrition and wellness and stress reduction. All good things.

Where I do have a problem is with a group of professionals, which have less than the top standards and thus cannot use or claim the same scope of practice, due to limited education, training and vetting, whom are in charge of something as precarious and dangerous as anesthesia. Sure the CRNA in this example was just plain incompetent. But to demand the full rights of independence without being practiced and primed and vetted in the same way as physicians, well, it's illogical--especially since any other physicians practicing with them will be viewed with expectations of higher standards and a more comprehensive/expansive scope of practice from a legal perspective. This is what will be argued in legal suits over and over.

Everyone needs to stay within their scope of practices for whatever they do. The full scope of a CRNA is not nearly the same for an anesthesiologist or a physician. Whether of or not the physician is subpar in her/his practice is not the main issue here. Yes, individual competences and strengths are important; but to say such providers can practice with full independence is to try to suggest that their scope and the expectation of practice overall are the same. If indeed they are the same, let them demonstrate it in the same manner in which physicians in general must, and then as those that specialize in anesthesiology must. The whole thing is just too hairy for patients, healthcare, and for the separate professions. These advanced nurse-models were never established to be that of full, independent, medical practitioners, regardless of how good the individual APN or PA is at what s/he does.[/QUOTE]

 

[Microshaft]

Case settled for $1,775,000
CRNA contributed $975,000
Surgeon (insured) contributed $800,000.

morale of the story: don't hire idiots to be on your team

 

[Sirach38]

The problem in this case is not the CRNA per se, it's that this CRNA was incompetent, and that there was no anesthesiologist backup. Both of those deficiencies are the fault of the Surgery Center, which hires the anesthesiologists. The lesson from this case is to makes sure that there are competent CRNAs and competent anesthesiologist backup.

Why all the worry about CRNAs? If you don't want to work with them, just work in an OR that will provide you with only anesthesiologists.

The hospital that I work in has CRNAs working under the supervision of anesthesiologists. Honestly, I would let any of them do my anesthesia with no reservations whatsoever, while there have been anesthesiologists that I have known that I wouldn't let near my patients, let alone near me. It all depends on the individual and their competence. They also need to be working within their comfort zone.

Overall, there seems to be too much energy devoted on these forums to worrying about ancillary providers. They are not going to be your problem in practice. When you get into practice, you will succeed based on your own skills and abilities. The nurse practitioners, midwives, PAs, homeopaths, naturopaths, chiropracters, and faith healers will not be your real competition. Don't worry about them. You don't want patients who will go to them anyway.

Also, in most cases, it's DOCTORS who hire the lower paid ancillary providers, to increase their own income, and not have to share it with a partner.

While there may be some very competent CRNAs, they are not physicians and should not be treated as such. If one wants to be a physician, no problem, go to med school.

While there are competent CRNAs who are very good at their job, as a patient, there is no way to know which ones they are. CRNAs don't take the MCAT, go to med school, take step 1, step 2, step 3, go to resdiency etc. So there is no way to know what you are getting. This is your life that you are playing russian rullet with.

Personally, I don't want an independent CRNA anywhere near my family or I during any surgery. I want an anesthesiologist who has not cut corners to provide anesthesia. When asked, most of America feels the way that I do.