NC Appeals Court Rules that CRNAs cannot be sued for malpractice

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msnbc2020

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Nearly a century ago, our Supreme Court rejected the notion that nurses can be liable for medical malpractice based on their diagnosis and treatment of patients. The Court reasoned that nurses “are not supposed to be experts in the technique of diagnosis or the mechanics of treatment.”
Soon after the anesthesia team administrated the sevoflurane, Amaya went into cardiac arrest. After about thirteen minutes, Amaya’s treatment team was able
to revive her, but the oxygen deprivation left her with permanent brain damage, cerebral palsy, and profound developmental delay.
Plaintiffs asserted a number of negligence based claims, including a claim that VanSoestbergen breached the applicable
standard of care by agreeing, during the anesthesia planning stage, to induce Amaya with sevoflurane using the mask induction procedure. Plaintiffs asserted that
certified registered nurse anesthetists are highly trained and have greater skills and treatment discretion than regular nurses. Moreover, they asserted, nurse
anesthetists often use those skills to operate outside the supervision of an anesthesiologist. Plaintiffs also argued that VanSoestbergen was even more
specialized than an ordinary nurse anesthetist because he belonged to the hospital’s “Baby Heart Team” that focused on care for young children.
The trial court refused to admit Plaintiffs’ evidence of this claim. The court determined that this theory of liability was precluded by Daniels v. Durham County
Hosp. Corp., 171 N.C. App. 535, 615 S.E.2d 60 (2005), a decision that analyzed and applied the Supreme Court’s holding in Byrd v. Marion Gen. Hosp., 202 N.C. 337, 162
S.E. 738 (1932).
 

marr65

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Is there a gofundme account to take it all the way to the Supreme Court? if not, here comes 1:16 supervision ratio!!!
 
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RadsWFA1900

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If they win on appeal: forget being an MD anesthesiologist.

Also, I was unaware being on the “Baby Heart Team” was a certification of ones skill in anything.

I’ve seen the “heart team” at my own shop which outside of the surgeon and nurses is just a rotating group of crnas who take orders from an MD.
 

msnbc2020

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North Carolina Nurses Not Liable for Medical Malpractice
June 16, 2020, 3:30 PM
Certified nurse anesthetist not required to defend claim
Appeals court must follow state supreme court precedent
Nurses in North Carolina can’t be held liable for medical malpractice based on their diagnosis or treatment of patients, a state appeals court said Tuesday, relying on an 88-year-old decision of the state’s supreme court.

The North Carolina Court of Appeals was bound by the 1932 decision that nurses aren’t liable for medical malpractice because they merely carry out a physician’s orders and aren’t experts in medical diagnosis or treatment, it said.

A lower court can’t reject supreme court precedent just because a decision didn’t “age well,” the court said.

 

dr doze

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If they win on appeal: forget being an MD anesthesiologist.

Also, I was unaware being on the “Baby Heart Team” was a certification of ones skill in anything.

I’ve seen the “heart team” at my own shop which outside of the surgeon and nurses is just a rotating group of crnas who take orders from an MD.

There are many ways to look at this. physicians who supervise CRNAs clearly are responsible for the CRNA’s actions. This decision is a blow against independent CRNA practice because the surgeons will own the CRNA behavior as a matter of law. No matter what the contracts or hospital bylaws say.
 
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IMGASMD

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There are many ways to look at this. physicians who supervise CRNAs clearly are responsible for the CRNA’s actions. This decision is a blow against independent CRNA practice because the surgeons will own the CRNA behavior as a matter of law. No matter what the contracts or hospital bylaws say.

True.


Also it’s a good time to stress that “nurse” part of their education/title. Even funnier push back for those with DNPs. At end of the day, still a nurse.
 
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dr doze

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There are many ways to look at this. physicians who supervise CRNAs clearly are responsible for the CRNA’s actions. This decision is a blow against independent CRNA practice because the surgeons will own the CRNA behavior as a matter of law. No matter what the contracts or hospital bylaws say.

It will be interesting to see how their state association will react to this. CRNAs who work in an ACT setting and have no aspirations to practice independently will be cheering this ruling. The independent practice types will be upset because even if state law allows Crna independent practice, this will be a obstacle. So will the state association ask for increased liability for the majority of their members to appease the minority who practice independently? Will they oppose any change of the status quo?
 
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IlDestriero

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Well, I won’t be practicing anesthesia in N.C. with CRNAs, that’s for sure. I think this will definitely hurt their push for independent practice and will make the surgeons/proceduralists think twice about solo CRNA practice.
 
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BLADEMDA

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The vast majority of time you will be held liable for the actions of your crnas. You are their supervisor. That means you are team leader and supposedly direct the care of the patient. Even if you try to throw the crna under the bus the trial lawyers will still blame you.

Yes, crnas have a duty to perform at a reasonable level to their training. That means not giving the wrong drugs or doing obviously stupid things like giving TXA into the subarachnoid space. But, ultimately any failure on the part of your crna is your failure as well. That’s what it means to be the leader of the care team model.
 
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dr doze

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The vast majority of time you will be held liable for the actions of your crnas. You are their supervisor. That means you are team leader and supposedly direct the care of the patient. Even if you try to throw the crna under the bus the trial lawyers will still blame you.

Yes, crnas have a duty to perform at a reasonable level to their training. That means not giving the wrong drugs or doing obviously stupid things like giving TXA into the subarachnoid space. But, ultimately any failure on the part of your crna is your failure as well. That’s what it means to be the leader of the care team model.

There is a difference between having to own a piece of a bad decision made by a CRNA under your supervision, and having no choice but to own all of it. This decision seems to indicate the latter is the case in North Carolina under current law.
 
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BLADEMDA

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There is a difference between having to own a piece of a bad decision made by a CRNA under your supervision, and having no choice but to own all of it. This decision seems to indicate the latter is the case in North Carolina under current law.

This decision does not alter the care of patients in North Carolina. Like AAs, the midlevels in North Carolina are essentially restricted to supervisory practices. Any surgeon who supervises a crna now owns all their mistakes even those concerning just anesthesia. This means Gi centers and ASCs May rethink who they hire to do their anesthesia.

As for hospital based practices this decision should help Anesthesiologists in North Carolina assert more control over their crnas. Now, they can clearly show CRNAs are viewed as nurses by the Courts and the Supervising MD bears all the legal responsibility.
 
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coffeebythelake

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AANA loves to say how cRNas don't have to pay as much malpractice as anesthesiologists. Now we know why. Because they have no responsibility. Someone else takes responsibility for their mistakes.
 
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dannyboy1

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The vast majority of time you will be held liable for the actions of your crnas. You are their supervisor. That means you are team leader and supposedly direct the care of the patient. Even if you try to throw the crna under the bus the trial lawyers will still blame you.
The lawyers will try and blame you and the CRNA. More people in the lawsuit mean more people to collect from. It is strange that people think you would be not liable for a CRNA’s actions in an ACT practice. That is the exact reason that you are there in the first place.....
 

dr doze

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The lawyers will try and blame you and the CRNA. More people in the lawsuit mean more people to collect from. It is strange that people think you would be not liable for a CRNA’s actions in an ACT practice. That is the exact reason that you are there in the first place.....

Again there is a big difference between negotiating owning a piece of a bad decision by CRNA e.g., tube pulled too soon, oversedated MAC patient who got in trouble, fire on MAC case around face. Seen all of those resulting in settlements where the CRNA took 50-75% of the hit. Appropriate IMO.

As opposed to this law-where no choice but for the anesthesiologist to take 100% of the hit.
 
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jwk

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I'm sure this can just as easily be replaced with "nursing malpractice". They make a big deal out of "nurse anesthesia scope of practice" can be determined by nursing boards and not medical boards. If they can't be sued for "medical malpractice" then surely they can be sued for "nursing malpractice" under any number of negligence statutes.
 
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dr doze

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I'm sure this can just as easily be replaced with "nursing malpractice". They make a big deal out of "nurse anesthesia scope of practice" can be determined by nursing boards and not medical boards. If they can't be sued for "medical malpractice" then surely they can be sued for "nursing malpractice" under any number of negligence statutes.

Sounds like in this case there might be a claim for legal malpractice by the attorney for failing to include this as part of the complaint.
 
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sidefx

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North Carolina Nurses Not Liable for Medical Malpractice
June 16, 2020, 3:30 PM
Certified nurse anesthetist not required to defend claim
Appeals court must follow state supreme court precedent
Nurses in North Carolina can’t be held liable for medical malpractice based on their diagnosis or treatment of patients, a state appeals court said Tuesday, relying on an 88-year-old decision of the state’s supreme court.

The North Carolina Court of Appeals was bound by the 1932 decision that nurses aren’t liable for medical malpractice because they merely carry out a physician’s orders and aren’t experts in medical diagnosis or treatment, it said.

A lower court can’t reject supreme court precedent just because a decision didn’t “age well,” the court said.


It sounds like the court did not appreciate the contextual difference between an RN and a CRNA. RNs do not diagnose or make treatment decisions and therefore should not be held responsible for administering a therapy that is sub-optimal or incorrect (assuming it had been ordered by a physician and wasn't glaringly obviously wrong), which I agree with. They can't be expected to know what the correct diagnosis and management for everything is, otherwise... they'd be a doctor. However, a CRNA has a much broader scope of practice than this and they have much more autonomy and independence to diagnose and treat conditions even if under physician supervision. To say they then cannot be held accountable for the diagnoses they are making and the treatments they are rendering is absurd. It really seems like the court did not appreciate the difference between an RN and an NP/CRNA... like they just saw the word "nurse" in the title and were like "oh it's pretty much the same thing". When that decision was made in 1932, CRNAs did not even exist, therefore it cannot have possibly been a precedent meant to include CRNAs and other APPs that had not yet come into existence.
 

dr doze

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It sounds like the court did not appreciate the contextual difference between an RN and a CRNA. RNs do not diagnose or make treatment decisions and therefore should not be held responsible for administering a therapy that is sub-optimal or incorrect (assuming it had been ordered by a physician and wasn't glaringly obviously wrong), which I agree with. They can't be expected to know what the correct diagnosis and management for everything is, otherwise... they'd be a doctor. However, a CRNA has a much broader scope of practice than this and they have much more autonomy and independence to diagnose and treat conditions even if under physician supervision. To say they then cannot be held accountable for the diagnoses they are making and the treatments they are rendering is absurd. It really seems like the court did not appreciate the difference between an RN and an NP/CRNA... like they just saw the word "nurse" in the title and were like "oh it's pretty much the same thing". When that decision was made in 1932, CRNAs did not even exist, therefore it cannot have possibly been a precedent meant to include CRNAs and other APPs that had not yet come into existence.

Or maybe it was a procedural error by the plaintiff attorney- the complaint was filed solely as a medical malpractice action instead of a medical and nursing malpractice action. In addition to Anesthesia being a practice of Medicine, it is a practice of nursing governed by the board of nursing.
 
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fadedrebel

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There are many ways to look at this. physicians who supervise CRNAs clearly are responsible for the CRNA’s actions. This decision is a blow against independent CRNA practice because the surgeons will own the CRNA behavior as a matter of law. No matter what the contracts or hospital bylaws say.


That is how I read and interpreted it as well. The Court basically said since they were being supervised and following orders they are not liable for the decision-making process. It would be interesting to see what would the court rule if this were an independent practicing CRNA... would they then be liable or would the liability fall onto the surgeon?
 

IMGASMD

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Or maybe it was a procedural error by the plaintiff attorney- the complaint was filed solely as a medical malpractice action instead of a medical and nursing malpractice action. In addition to Anesthesia being a practice of Medicine, it is a practice of nursing governed by the board of nursing.

Even if that’s the case. Now there’s a judgement against the physician/surgeon (presumably higher pay out). Why would a lawyer bring a lawsuit against crna?

A test case would be one independent crna with one independent anesthesiologist. crna’s case goes to sh!t, anesthesiologist came to help. Who do you sue, who ultimately gets bitch slapped?
cRNa, Anesthesiologist, Surgeon?
 
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Man o War

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Even if that’s the case. Now there’s a judgement against the physician/surgeon (presumably higher pay out). Why would a lawyer bring a lawsuit against crna?

A test case would be one independent crna with one independent anesthesiologist. crna’s case goes to sh!t, anesthesiologist came to help. Who do you sue, who’s ultimately get bitch slapped?
cRNa, Anesthesiologist, Surgeon?
[/QUOTE
I would like to say in this scenario it would be no different than me coming in to assist one of my MD colleagues; I have been deposed for this very situation and dismissed when they found out I was there to assist. My partner whose case it was remained on the suit.
However, there’s 2 things that make me think otherwise. 1) Competency level. I have no faith that when I show up in that independent CRNA room, that things will have been done the way a well trained doctor would’ve done them because their training is inadequate and abbreviated, especially when they’re in a situation when things go wrong. It would likely be a salvage job and I’m going to actually assume control of the case at that point. Nurse is a deer in headlights, seen it plenty.
2)as these “collaberative” models become a thing, I’m convinced we will start to see case law implicating the “collaborating” anesthesiologist. A jury will see a nurse and a doctor. CRNA will chart that Dr Man O War said to do this that and the other, or Dr Man O War showed up in the room when the CRNA got in over their heads. I would not collaborate with a nurse for this reason- I don’t want my name in that chart when I have zero control over that case.
 
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SXMMD

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Even if that’s the case. Now there’s a judgement against the physician/surgeon (presumably higher pay out). Why would a lawyer bring a lawsuit against crna?

A test case would be one independent crna with one independent anesthesiologist. crna’s case goes to sh!t, anesthesiologist came to help. Who do you sue, who ultimately gets bitch slapped?
cRNa, Anesthesiologist, Surgeon?

I asked a similar question in the ER forums regarding independent midlevel in ED who got in over their head and "called for help" in the E.R. Can ER doc refuse? Would they hold any liability for a bad outcome?

For comparison, we can ask if you have 2 independent anesthesiologists and one asks for help with a case gone bad, how would that play out?

Edit: looks like Man o War beat me to it
 
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BLADEMDA

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Lawyers like to sue doctors not nurses or assistants. This means the lawyer will always try to blame the physician or physicians involved with the case. Like it or not that is just how the game is played in the USA. The goal isn’t justice but rather money. You have the deep pocket and are less sympathetic to a jury than a poor nurse or assistant. If they can somehow blame or implicate you they will do so. Most of the time the nurse or assistant gets dropped from the case while the physician takes the blame/hit.
 

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