in this case I think the ophthalmologist should have picked a better team.
Did he know that the CRNA hasn't intubated someone in 5 years?
did he have exp in urgent care?
what was his resume like? etc etc
maybe hire someone who knows ACLS and intubation?
Unquestionably correct, and I previously acknowledged that fact. It still doesn't change the overriding issues whereby those in mid-level practice are seeking, in reality, equivalence with physicians, without the same length and quality of training and vetting, in general. It doesn't change the fact that the ophthalmologist was pulled into the legal pit. And as I have stated from the outset, that is unlikely to change so long as physicians either choose or are forced to work under the mid-level, independence model--b/c OVERALL, council will pull anyone with, again, big enough pockets into the suit.
Its a false belief to pretend that when the crap hits the fan during a procedure or whatever, the midlevel, with her/his licensure as an independent practitioner, will take full responsibility or be given the expectation of full accountability-even as it was where the physician performing the procedure was included in the "hit." He ways sued even thouh he is not certified in anesthesiology--but he is a licensed physician--doctor of medicine and the other provider is not.
I am somehow failing to make it clear that the physician working directly with a
midlevel provider (I'm not changing that term, b/c it is what it is, sorry if that bothers someone.) will still be held to a higher standard of practice, b/c of her/his education, licensure, etc--the expectation of leadership and control in application of medicine is higher for a physician than a midlevel or less. So, it's a no win deal. When something goes wrong outside of the less tightly controlled, non-hospital setting, who will be ultimately accountable or at least be included in the accountability? It's kind of a minefield then for physicians to work with mid-levels away from a controlled hospital setting and w/o BC anesthesiology or appropriate specialty- physician support and back-up.
For Pete's sake, the patient and staff are already at a disadvantage, being away from the back-up and support of a hospital setting--where there are more people and experts to help when the crap hits the fan.
We are so spoiled in this country with the abundance of "routine" procedures, that we forget how quickly it is that patients can start swirling the bowl. People don't really get that whether it is scientifically derived or not, Murphy's Law happens.
The following article was excerpted from
The Desert Wings
March 3, 1978
[Murphy's Law ("If anything can go wrong, it will") was born at Edwards Air Force Base in 1949 at North Base.
It was named after Capt. Edward A. Murphy, an engineer working on Air Force Project MX981, (a project) designed to see how much sudden deceleration a person can stand in a crash.
One day, after finding that a transducer was wired wrong, he cursed the technician responsible and said, "If there is any way to do it wrong, he'll find it."
The contractor's project manager kept a list of "laws" and added this one, which he called Murphy's Law.
Actually, what he did was take an old law that had been around for years in a more basic form and give it a name.
Shortly afterwards, the Air Force doctor (Dr. John Paul Stapp) who rode a sled on the deceleration track to a stop, pulling 40 Gs, gave a press conference. He said that their
good safety record on the project was due to a firm belief in Murphy's Law and in the necessity to try and circumvent it.
Aerospace manufacturers picked it up and used it widely in their ads during the next few months, and soon it was being quoted in many news and magazine articles. Murphy's Law was born.
The Northrop project manager, George E. Nichols, had a few laws of his own. Nichols' Fourth Law says, "
Avoid any action with an unacceptable outcome."
The doctor, well-known Col. John P. Stapp, had a paradox: Stapp's Ironical Paradox, which says,
"The universal aptitude for ineptitude makes any human accomplishment an incredible miracle."
Nichols is still around. At NASA's Jet Propulsion Lab in Pasadena, he's the quality control manager for the Viking project to send an unmanned spacecraft to Mars. ]
http://www.murphys-laws.com/murphy/murphy-true.html
