Taking Umbrage at the "If a CRNA had been there..." Idiocy

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BuzzPhreed

BuzzPhreed

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The fallout from a recent high profile celebrity case that ultimately resulted in a patient's death has created an opportunist moment for the vulture-like, high-schooler mentality of certain members of the nursing profession.

The AANA even generated a statement (please feel free to read it and determine your own level of personal disgust), which barely fell short of saying that if a nurse anesthetist had been there this wouldn't have happened:

http://www.aana.com/newsandjournal/...isory-CMS-Report-on-Death-of-Joan-Rivers.aspx

Many other CRNAs on other forums as well as in the comments section of online articles have echoed similar opinions, namely that if a CRNA had been there Ms. Rivers would still be alive.

Since individual anecdotes equal evidence of a systemic problem in their inadequately educated minds, let's look at another eerily similar anecdote.

http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation/

Some highlights of the case discussion:

"During the vitrectomy, a CRNA administered local anesthesia with IV sedation, and the (sic) [ophthalmologic surgeon] performed a retrobulbar block (sic) [in the right eye]."

"When the patient became agitated and complained of pain, the CRNA provided more sedation after which the patient turned pale and stopped breathing. The CRNA administered oxygen through an Ambubag but O2 saturation did not increase."

"Despite intubation, the patient’s O2 saturation did not improve."

"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."

You can read the rest of the case at the link.

The complete idiocy of the AANA's thinly veiled statement about the perceived superiority of their bedside care -- parasitically using this one celebrity example in an attempt to bolster that unsupported claim -- is part and parcel to the ongoing war against our profession. As the case I linked proved, after the **** does hit the fan then they want to claim respondeat superior to cover their own asses. The fact is when the **** hits the fan, they usually call us to pull them out of the fiery pit or at least diffuse their own level of responsibility in front of the judge.

Welcome to the ongoing dumbing-down of America.

TURN 'EM LOOSE!
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They want the money and glory without the risk and education.

To quote ronnie coleman from another field, "Everyone wants to be a bodybuilder but nobody wants to lift no heavy ass weights"
 
Listen, I don't care what any CRNA may think or ultimately do. I just don't want to be part of it. At all.

If they think that the world will accept them as independent practitioners, that they have equivalent outcomes, and that there is no difference in what we do in the OR, then so be it! Just go and work completely independently. Don't call me when there's a problem. Don't try to have the courts enjoin me into your lawsuit based on your mistakes. And don't expect me to train you, support you, and treat you with equivalent respect in the locker room or doctor's lounge.
 
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Reading our own thread on the matter, it's clear we all were hoping that an anesthesiologist wasn't involved and that we could use this as a teaching moment for the need for anesthesiologists in these practices. Everyone would have benefitted. Unfortunately it didn't work out that way, and if the Anesthesiologist was the GIs spouse, she's not going to pick up the banner of the problems being employed by another physician who owns the clinic.
2 missed opportunities.
I don't bother to read there nonsense bullet points comparing icu nurse work time to residency, nursing school equivalent to medical school, 18 months of clinical work on mostly healthy patients being the same as 36 months of residency, or the rest of it. It's the same old half truths.
 
And what does the ASA have to say about this?

😏
 
I've had nurses tell me they plan on doing "residency" (APN school) so that they can become a hospitalist. Part of the game they play is by using the same terminology as doctors and trying to blur the lines. MDA being a prime example.
 
nvm
 
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We can't allow them to manipulate the terminology in their favor. Calling us MDAs... They are "expert anesthesia provider's" along with "others". Confusing patients with their DNP BS degrees. Referring to their high school education as residency and their trip to the museum as the start of their clinical rotations.

Their PAC has had a much better PR campaign, and most people don't know the difference between us or don't care to know. I believe these are things our beloved ASA should emphasize ..

Don't allow them to dictate the language, restrict the terms they can use, and reinforce to the lay public the importance of an MD supervising at all times and being superior by all quality measures.

We've tried to take the high road for the longest, but it's time we stoop to their level and engage in a PR campaign for the sake of our future livelihoods. The public is generally easily persuaded to pay a little more for higher quality products. However, if the pay is equivocal regardless, why wouldn't any sane being demand a superior product?

BTW, that's ludicrous that the Crna mentioned in this article had not intubated in 5 years. Cases like these should be more highly publicized to demonstrate their deficiencies, and how quickly they will turn on whatever surgeon MD is supervising them, and how they will ultimately be held liable for their incompetence.
 
jwk said:
What would you like them to say?
Click to expand...

In response to this AANA article specifically? Nothing.

As a whole? Go on the offensive rather than sit in their offices and do nothing.
 
k12balla said:
We can't allow them to manipulate the terminology in their favor. Calling us MDAs... They are "expert anesthesia provider's" along with "others". Confusing patients with their DNP BS degrees. Referring to their high school education as residency and their trip to the museum as the start of their clinical rotations.

Their PAC has had a much better PR campaign, and most people don't know the difference between us or don't care to know. I believe these are things our beloved ASA should emphasize ..

Don't allow them to dictate the language, restrict the terms they can use, and reinforce to the lay public the importance of an MD supervising at all times and being superior by all quality measures.

We've tried to take the high road for the longest, but it's time we stoop to their level and engage in a PR campaign for the sake of our future livelihoods. The public is generally easily persuaded to pay a little more for higher quality products. However, if the pay is equivocal regardless, why wouldn't any sane being demand a superior product?

BTW, that's ludicrous that the Crna mentioned in this article had not intubated in 5 years. Cases like these should be more highly publicized to demonstrate their deficiencies, and how quickly they will turn on whatever surgeon MD is supervising them, and how they will ultimately be held liable for their incompetence.
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I would like to nominate THIS for best post of 2015 (so far)
 
"CRNAs stay with their patients throughout their procedure, assessing their airway, monitoring their vital signs and making critical adjustments as needed in their anesthesia care. CRNAs are fully educated and prepared to handle any anesthesia-related emergency that may arise."

You guys don't. Ergo, you suck... 🙄

"CRNAs are advanced practice registered nurses who undergo 7-8 years of education and training related to their specialty, resulting in a master’s or doctoral degree. They are the only anesthesia specialists who obtain an average of 3+ years of critical care practice experience before entering an anesthesia educational program."

They are the only ones with critical care experience. Ergo, you suck. 🙄

"To ensure the safest anesthesia experience possible in an outpatient setting, a qualified anesthesia expert such as a Certified Registered Nurse Anesthetist (CRNA) should be involved in the patient’s care."

WHAT THE FUQ?!

This is an embarrasment. I am not an anesthesiologist but what is happening to your field is a disgrace and it's just the tip of the iceberg of what's to come to all specialties. We are ****ed.
 
"What are the physicians’ and other healthcare providers’ qualifications? Are they certified to practice?"

Laughable. If you went through medical school and a gas residency, yes you are certified to practice. Merely posing the question and knowing who's behind the question is insulting.
 
PlutoBoy said:
"CRNAs stay with their patients throughout their procedure, assessing their airway, monitoring their vital signs and making critical adjustments as needed in their anesthesia care. CRNAs are fully educated and prepared to handle any anesthesia-related emergency that may arise."

You guys don't. Ergo, you suck... 🙄

"CRNAs are advanced practice registered nurses who undergo 7-8 years of education and training related to their specialty, resulting in a master’s or doctoral degree. They are the only anesthesia specialists who obtain an average of 3+ years of critical care practice experience before entering an anesthesia educational program."

They are the only ones with critical care experience. Ergo, you suck. 🙄

"To ensure the safest anesthesia experience possible in an outpatient setting, a qualified anesthesia expert such as a Certified Registered Nurse Anesthetist (CRNA) should be involved in the patient’s care."

WHAT THE FUQ?!

This is an embarrasment. I am not an anesthesiologist but what is happening to your field is a disgrace and it's just the tip of the iceberg of what's to come to all specialties. We are ******.
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This is utter f*^*in garbage. Screw it. Let them practice on their own. Those idiots have no idea what they are talking about.
 
I've had it with all APNs and CRNAs and PAs Everyone wants to be a doctor without putting in the time. I've even heard it from DPTs. It's obscene.

When I was a medical student, I asked a CRNA what the dosing was of propofol on an adult to test the knowledge waters. She responds,"I don't know" and proceeds to give a whole stick of propofol. Came back 2 days later to tell me. I'm sure there are a few okay ones sprinkled in there but that's insane. If my attending asked me that and I didn't know. He/She would slap me in stage 4.

What gets me is who do these mid-levels bring their loved ones to? If their spouse has a known difficult airway do they call the CRNA to intubate? ASA4E Granny comes down from the unit on 3 pressors - quick get the CRNA. Babyboy CDH to the OR - hmmm I'll take the peds CRNA I think she did some hernia on an 14 year old the other day, that's the same. Sure. Aunt 50pack/yr has lung cancer - someone call the heme/onc PA to manage it. 9 year old Jimmy has a facial laceration - Call the EM PA to suture. Yeaaaaa riiiiight.

There is a reason why we are doctors and they are nurses/PAs. They're good at doing what we tell them to do.

I can't believe this even has to be done. But we need some marketing to accurately distinguish doctors from midlevels in all specialties. The ASA needs a leader who will grab specialty by the balls and make it what it was. Do you think an surgical APN would compare themselves to a surgeon? The surgeon would laugh, fire said APN, and then suture his/her ass to their face. I think we need to have that mentality.

Rant over.
 
BuzzPhreed said:
The fallout from a recent high profile celebrity case that ultimately resulted in a patient's death has created an opportunist moment for the vulture-like, high-schooler mentality of certain members of the nursing profession.

The AANA even generated a statement (please feel free to read it and determine your own level of personal disgust), which barely fell short of saying that if a nurse anesthetist had been there this wouldn't have happened:

http://www.aana.com/newsandjournal/...isory-CMS-Report-on-Death-of-Joan-Rivers.aspx

Many other CRNAs on other forums as well as in the comments section of online articles have echoed similar opinions, namely that if a CRNA had been there Ms. Rivers would still be alive.

Since individual anecdotes equal evidence of a systemic problem in their inadequately educated minds, let's look at another eerily similar anecdote.

http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation/

Some highlights of the case discussion:

"During the vitrectomy, a CRNA administered local anesthesia with IV sedation, and the (sic) [ophthalmologic surgeon] performed a retrobulbar block (sic) [in the right eye]."

"When the patient became agitated and complained of pain, the CRNA provided more sedation after which the patient turned pale and stopped breathing. The CRNA administered oxygen through an Ambubag but O2 saturation did not increase."

"Despite intubation, the patient’s O2 saturation did not improve."

"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."

You can read the rest of the case at the link.

The complete idiocy of the AANA's thinly veiled statement about the perceived superiority of their bedside care -- parasitically using this one celebrity example in an attempt to bolster that unsupported claim -- is part and parcel to the ongoing war against our profession. As the case I linked proved, after the **** does hit the fan then they want to claim respondeat superior to cover their own asses. The fact is when the **** hits the fan, they usually call us to pull them out of the fiery pit or at least diffuse their own level of responsibility in front of the judge.

Welcome to the ongoing dumbing-down of America.

TURN 'EM LOOSE!
Click to expand...
 
This is why we must supervise CRNAs, because we damn sure don't want them dropping the ball like this anesthesiologist did.
 
The Michael Jackson and Joan Rivers' cases will make outpatient anesthesia safer. Gi doctors and CRNAs (not to mention certain segment of Anesthesiologists) will think twice before cutting corners of emergency drugs like Sux or allowing MDs without privileges to perform procedures there.

IMHO, whoever keeps the bulk of the anesthesia fee should also assume the bulk of the liability.
 
Ryan Bucsi, OMIC Senior Litigation Analyst

Digest, Summer 2012

Allegation

Negligent resuscitation resulting in death of 45-year-old father of three.

Disposition

Case settled for $1,775,000 of which CRNA contributed $975,000 and OMIC insured contributed $800,000.

Case Summary

Anon-OMIC-insured ophthalmologist performed cataract surgery on a patient who subsequently developed a hemorrhage OD. The patient was then seen by the insured, who had previously treated his proliferative diabetic retinopathy and bilateral retinal detachments. The insured recommended a vitrectomy under local anesthesia at a surgery center knowing that the patient had tolerated the cataract surgery under local anesthesia.
cs-test21-150x150.png
During the vitrectomy, a CRNA administered local anesthesia with IV sedation, and the insured performed a retrobulbar block OD. When the patient became agitated and complained of pain, the CRNA provided more sedation after which the patient turned pale and stopped breathing. The CRNA administered oxygen through an Ambubag but O2 saturation did not increase. The insured instructed the CRNA to intubate and 911 was called. Despite intubation, the patient’s O2 saturation did not improve. The CRNA confirmed that the tube was in the trachea but asked the surgeon to listen for breath sounds with him; both the surgeon and CRNA heard breath sounds. 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.
 
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For all the trolls out there who think the Surgeon isn't liable for your mishap think again. The Opthalmologist listed above got stuck paying $800,000 due to CRNA incompetence. If that same Opthalmologist had used a Board Certified, Independent Anesthesiologist he/she would have paid NOTHING. I can assure you an Opthalmologist doesn't make medical decisions or tell Anesthesiologists how to practice if that MD(A) is Independent; hence, the entire lawsuit would have been the fault of the Anesthesiologist.
 
Medical malpractice insurance rates for CRNAs are artificially low because the nurses do not bear primary responsibility for any negligent actions. When a CRNA injures a patient, the legal liability for that injury flows directly to the supervising physician--either the surgeon or the anesthesiologist. In some cases, the nurse is not even sued. In cases where the CRNA is not supervised by an anesthesiologist, the plaintiff's attorney focuses on the surgeon rather than the CRNA. The surgeon is a much less sympathetic target in front of a jury. As the licensed physician in charge, the surgeon is expected to know all aspects of anesthesiology practice. Plaintiffs' attorneys are able to make supervising surgeons appear negligent by forcing them to admit that they relied on the nurse's knowledge of anesthesia. This is ethically questionable and violates the medical practice act in most states because it is impossible to supervise care that one does not understand.
 
Plastic surgery, although a common elective surgery carries a risk for injury or death. It's important to understand that all surgeries carry a risk of injury or death. Simple surgical mistakes or anesthesia errors can result in great harm to a patient.

Plastic surgery medical malpractice is a frightening problem causing thousands of Americans to be seriously injured or die each year. Elective plastic surgery procedures including breast augmentation, lipo suction, face lifts, rhinoplasty, gastric bypass, stomach stapling, and other types of procedures are being done in doctor’s offices, hospitals, and surgical centers throughout the country. When these procedures are done in a hospital, generally there is a board certified anesthesiologist and a staff of nurses, critical care nurses, and others who deliver the anesthesia, monitor the patient during the surgery, make sure the patient recovers properly after the surgery, and avoids surgical complications.

When plastic surgeries are performed in doctor’s offices or a surgical center, anesthesia may be given by nurse anesthetists who may not have extensive experience working with anesthesia. With the growing number of plastic surgery procedures occurring in the United States, there is an increase in demand for surgeons and medical personnel. Under current law, a certified nurse anesthetist (CRNA) may provide anesthesia under supervision by a surgeon, who often has less knowledge about anesthesia than the CRNA. If a problem occurs with anesthesia or post-anesthesia recovery, the surgeon may not be able to properly handle the situation. This is where many medical malpractice lawsuits involving plastic surgery arise. In many cases, the surgery may go successfully but the patient is severely injured or dies from anesthesia injuries. It is therefore important for patients to understand the risks with elective surgeries. In surgical centers and doctor’s offices, if a major emergency occurs, the patient may be kept waiting an inordinate amount of time until an ambulance can arrive and transport the patient to the hospital. During this time, the patient’s medical condition may steadily worsen, even resulting in death.

Anesthesia errors that can happen during plastic surgery:

* Mistakes in communications between medical personnel
* Untrained or inexperienced personnel
* Failure of the medical personnel to adequately study the medical records regarding the patient’s medical condition as well as allergies and medication sensitivities

Because the patient is usually unconscious during an operation, he or she is generally the last person to find out if medical malpractice occurred. Most often, medical mistakes can be corrected so that there are no permanent effects, however, sometimes medical negligence, including post operation anesthesia errors do result in severe medical injuries or death.
Although a patient in a hospital setting is usually safer than in a doctor’s office or surgical center because of the full hospital staff and resources available during an emergency, medical malpractice may still happen.

ABOUT THE AUTHOR: Dr. Bruce Fagel
Dr. Fagel is an attorney and physician who represents plaintiffs in medical malpractice cases against doctors and hospitals exclusively on behalf of injured patients. His practice focuses on complex medical malpractice cases resulting in catastrophic injuries caused by doctor or hospital negligence, such as birth or brain damage, induced hypertension, wrongful death, cerebral palsy, Erb's palsy, nursing home negligence, misdiagnosis of cancer and paraplegia cases.

Dr. Fagel graduated from the University Of Illinois Medical College Of Medicine, M.D., 1972. He earned his law degree at Whittier College School of Law, Los Angeles, CA, J.D., 1982.
 
Sirach38 said:
This is utter f*^*in garbage. Screw it. Let them practice on their own. Those idiots have no idea what they are talking about.
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Expect then the responsibility goes to the surgeon. Crnas say they will be liable , then bad stuff happens and they say ooooo no that's the physician's responsibility!
 
This stuff is terrible. With the rise of mid-level practitioners, it's disgusting how the physicians/surgeons bear the brunt of malpractice when the mid-levels mess up, all because they are assumed to be supervising these mid-levels. If the increase in mid-level practitioners is going to be a financial burden on the physicians (less employment prospects, lower pay, etc.) in the future, then these mid-levels must be held accountable to the same extent as physicians. That is, they must also bear exorbitant malpractice insurance fees and be hit with extreme sanctions when anything goes wrong. Give credit (and any possible consequences) where it's due.
 
$1 Million Dollar Settlement (Confidential) – MEDICAL MALPRACTICE – WRONGFUL DEATH – Anesthesia Accident.
This medical malpractice action arose out of negligent care rendered by a nurse anesthetist, which resulted in the tragic death of the plaintiff. The Defendant’s key responsibility as a nurse anesthetist was, after intubating plaintiff, to monitor her carbon dioxide levels to ensure that she was receiving oxygen from the anesthesia machine while she was anesthetized. Defendant failed to do so, resulting in prolonged pre-operative oxygen deprivation, extensive brain damage, and the death of Plaintiff. The defendant Anesthesiologist’s responsibility was the overall supervision of the anesthesia team, including the defendant nurse anesthetist.

Plaintiff was admitted to the hospital for an elective back surgery. On the morning of the scheduled operation, plaintiff was intubated and administered general anesthesia by defendant nurse anesthetist whom was being supervised at the time by defendant anesthesiologist. Shortly after the induction of general anesthesia, before the operation began, plaintiff’s oxygen supply was cut off from the anesthesia machine. Nurse Anesthetist failed to recognize and correct the insufficient of the oxygen supply and plaintiff went into cardiac arrest as a result.

The carbon dioxide readings, which the nurse anesthetist was supposed to be recording, were not on the anesthesiology record for several consecutive time intervals during the critical time period. If he had been properly monitoring and recording the carbon dioxide levels, defendant nurse anesthetist would have noticed that they were significantly elevated and he would have corrected plaintiff’s oxygen deficiency. Unrecognized by either defendant, the oxygen deficiency continued and plaintiff’s brain was starved of oxygen long enough to cause her blood pressure to drop. The low blood pressure was recognized when it occurred, however, by that time, it was too late because she had been deprived of oxygen for too long.

Resuscitation attempts were performed and the crash team was able to get plaintiff’s blood pressure stabilized, however, because of prolonged lack of oxygen to the brain caused by the unrecognized and uncorrected oxygen insufficiency, plaintiff was severely and irreversibly brain damaged. Due to extensive brain damage caused by the oxygen deprivation, plaintiff was only able to remain alive through artificial means, and four days later, she died when her family agreed to discontinue life support.

This informational piece was prepared by Silverman & Fodera. If you would like more information on this topic, call us at (800) 220-LAW1, or use the “Do I Have A Case?” link on this web site.
 
Take a look at this fact:

$1 million malpractice policy for Anesthesiologist= $20,000
$1 million Malpractice Policy for a SOLO, Independent CRNA= $5,000

Clearly, the difference in the cost of these policies is due to the fact that the CRNA is FOUR TIMES safer than the Anesthesiologist. If you aren't sure that fact is true just ask the AANA.
 
Medical Malpractice: Anesthesia Error


Countless surgical patients find it distressing to learn that the anesthesiologist, the Medical Doctor who specializes in anesthesia, doesn't stay in the operating room once the patient is unconscious. It is common practice for the anesthesiologist to leave the patient in the hands of an frequently overworked nurse anesthetist. This can lead to medical malpractice.



The nurse anesthetist, is responsible for observing the patient with regard to anesthesia during surgery. In the majority of cases, this procedure works well. However, when complications arise and a medical decision must be made fast, there often isn't time to find the anesthesiologist to make the critical decision. Just a few seconds wasted finding the doctor and getting the doctor back on the case can be fatal.



An anesthesia error can result in a wrongful death or permanent brain damage.

https://www.odaylawfirm.com/anesthesia-error.html
 
While the AANA pretends there is no increased liability to the surgeon when they utilize SOLO CRNA providers the fact remains plaintiff attorneys will use that against them in a lawsuit making a settlement offer a more likely scenario.

Hence, the main reason a Solo CRNA pays 1/4 the amount of an Anesthesiologist when doing his/her own cases is the fact that the plaintiff's lawyer prefers to sue the DOCTOR involved with the procedure/case.
 
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If it ever comes to completely unsupervised solo CRNA practices, lawyers may end up becoming our best friends in the fight against CRNAs. Unfortunately many patients may suffer before people start to wake up.
 
That's the problem, with solo CRNAs practicing with no supervision, patient are likely to never wake up, from surgery...
 
Sirach38 said:
If it ever comes to completely unsupervised solo CRNA practices, lawyers may end up becoming our best friends in the fight against CRNAs. Unfortunately many patients may suffer before people start to wake up.
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This may sound rather cruel and/or heartless, but I say let 'em loose!

It may take years and several unnecessary patient deaths, but it may also mean that those in charge (hospital admins, law makers, and to a lesser extent lawyers and surgeons) will realize who they really want managing anesthesia.
 
PlutoBoy said:
"What are the physicians’ and other healthcare providers’ qualifications? Are they certified to practice?"

Laughable. If you went through medical school and a gas residency, yes you are certified to practice. Merely posing the question and knowing who's behind the question is insulting.
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Well, personally, I have induced, intubated, managed, and recovered a couple dozen pigs for experimental procedures.

I guess that means I can handle the 83-yo granny with hypertension, COPD, and renal failure who is here for her emergency hip replacement.

I mean, passing gas is passing gas, right? It's not like unpredictable sh1t happens, right? An ASA1 swine and an ASA4 granny are pretty much the same thing, right?





(that was sarcasm, fyi)
 
njorl said:
This is why we must supervise CRNAs, because we damn sure don't want them dropping the ball like this anesthesiologist did.
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Nobody is perfect. The Anesthesiologist did drop the proverbial ball here. FYI, I do believe CRNAs can be qualified to administer sedation to many patients in a Gi center. However, the AANA doesn't have a system for making sure the CRNA has the additional qualifications and experience necessary to do the task alone. Fortunately, most CRNAs do the right thing and wait until they have enough experience to venture out solo.

At the ASCs where CRNAs administer GAs solo the bar for the crna should be set higher than the those working in the ACT model. But, the ASC and owners want to keep the anesthesia dollars for themselves. This means greed can surpass safety at times. There is no savings here to the medical system as the ASC pockets the anesthesia revenue and distributes it to the owners.
 
Are CRNAs and anesthesiologists equals?
No, they are not. Anesthesiologists are doctors, and their training of four years of medical school followed by a minimum of four years of anesthesia residency makes them specialists in all aspects of surgical medicine.

The American Society of Anesthesiologists’ STATEMENT ON THE ANESTHESIA CARE TEAM states “Anesthesiology is the practice of medicine including, but not limited to, preoperative patient evaluation, anesthetic planning, intraoperative and postoperative care and the management of systems and personnel that support these activities. In addition, anesthesiology includes perioperative consultation, the management of coexisting disease, the prevention and management of untoward perioperative patient conditions, the treatment of acute and chronic pain, and the practice of critical care medicine. This care is personally provided by or directed by the anesthesiologist.” (Approved by the ASA House of Delegates on October 26, 1982, and last amended on October 16, 2013)

Doctor J H Silber’s landmark study from the University of Pennsylvania (Anesthesiologist direction and patient outcomes, Anesthesiology. 2000 Jul;93(1):152-63) documented that both 30-day mortality and failure-to-rescue rates were lower when anesthesia care was supervised by anesthesiologists, as opposed to anesthesia care by unsupervised nurse anesthetists. This study has been widely discussed. The CRNA community dismissed the conclusions, citing that the Silber study was a retrospective study. In a Letter to the Editor published in Anesthesiology, Dr. Bruce Kleinman wrote regarding the Silber data, “this study could not and does not address the key issue: can CRNAs practice independently?” (Anesthesiology: April 2001 – Volume 94 – Issue 4 – p 713)

I’m not a fan of CRNAs working alone without physician supervision. In both my expert witness practice and in the expert witness practice of my anesthesia colleagues, we find multiple adverse outcomes related to acute anesthetic care carried out by non-anesthesiologists.

CRNAs will play a significant role in American healthcare in the future. That significant role will be best played with an MD anesthesiologist at their right hand.

Rick Novak, MD

http://theanesthesiaconsultant.com/...actor-in-anesthesia-care-in-the-21st-century/
 
What’s In It for the Anesthesiologist?

Which begs the question: What’s in it for anesthesia providers to take part in any of these models?

“The average CRNA in this country earns more than the average pediatrician or family care practitioner,” Mr. Schuster said. “In the company model, the in-house group model and the group practice model, the CRNA makes about the same. It’s the fee-for-service model where the CRNA can make considerably more if they’re very productive. CRNAs are paid very well.”

Mr. Schuster added that CRNAs cost considerably less than alternatives, but have skill sets and professional abilities substantially similar to anesthesiologists.

Money, of course, is rarely the only consideration for any professional.


http://www.gastroendonews.com/ViewA...&d_id=187&i=November+2010&i_id=684&a_id=16282
 
Blade, shall I post ALL THE CASES I have collected where Surgeons have also been named and paid when working with an MDA? I worked with 2 who have settled out of court after nerve injury due to blocks gone wrong WITH MDA only doing the block and cases. I have a file of over 100 cases nationally from when i commissioned a review of case law on risks of working with an solo CRNA vs working with solo MDA. The result, there is no increased liability risk.

So dont pretend like these cases would have worked out different with an MDA. They would not have and that is born out over and over in case law. EVERYONE is sued in these cases and when a settlement occurs it is NOT a dictation of liability or wrong doing. You should be well aware of that.

Additionally, Surgeons working with solo CRNAs do NOT have an increased liability insurance cost and they are not even required to disclose it. They dont pay anymore working WITH CRNAs only than ACT or MDA only. Actuaries come to these numbers by pure data and the fact is they will tell you (as they have told me) surgeons are no more likely to be sued when working with an MDA only than with a CRNA only. That is a fact.

You might also want to read your own ASA newsletter dec 2000 volume 64 issue #12 entitled "
Surgeon Liability for Nurse Anesthetists: Fact or Fiction?" written by the ASA legal counsel. I uploaded it here for you.

Let me just paste the conclusions:

"
A more outdated theory of liability known as captain of the ship
once was a basis for finding the surgeon responsible for every
person working in the operating room, without regard to whether
the surgeon did or did not try to exert control or even knew what
the other personnel were doing. That theory has fallen into
disfavor as courts recognize that today's operating rooms are
more complicated facilities with more specialized personnel,
some of whom are skilled in areas in which the surgeon has little
training."

"
The controlling factor in determining whether a
surgeon is to be held accountable for a nurse
anesthetist's actions is whether, based on the
facts of the case, the surgeon actually
exercised control or had the right to exercise
control over the nurse anesthetist during the
surgical procedure."

"Conclusion:
The controlling factor in determining whether a surgeon is to be
held accountable for a nurse anesthetist's actions is whether,
based on the facts of the case, the surgeon actually exercised
control or had the right to exercise control over the nurse
anesthetist during the surgical procedure. If not, the surgeon is
likely not to be held accountable for the actions of the nurse
anesthetist or adverse patient outcomes resulting from the
administration of anesthesia. Under this control or right to
control test, the scope of practice of the nurse anesthetist
under state law is less important. Whatever state law provides,
if a hospital requires some level of physician oversight of
anesthesia services, or if the surgeon intervenes in the
administration of anesthesia, the surgeon may be found liable
for a nurse anesthetist's actions."
 

Attachments

Last edited:
Hey, troll, that quote is valid for the ACT model only. If an anesthesiologist is supervising/directing the CRNA, even if not in the room, then (and only then) the surgeon is not liable.

If the CRNA is independent, or supervised by the surgeon, guess who's the captain of the ship, where the buck stops, in most of the cases? See Blade's examples.
 
Last edited by a moderator:
You might want to actually read the newsletter bub. It talks about surgeon liability with CRNAs in general and RARELY mentions MDAs. Regardless, the case law does not lie and neither do actuaries.

Not that I expect people with tunnel vision and a chip on their shoulders to change their opinion in the face of evidence, that would be a Christmas miracle. However, those reading who post or not, are MDAs or not can see the hypocrisy and reality here. So with that ive done all i needed to do.

FFP said:
Hey, troll, that quote is valid for the ACT model only. If an anesthesiologist is supervising/directing the CRNA, even if not in the room, then (and only then) the surgeon is not liable.

If the CRNA is independent, or supervised by the surgeon, guess who's the captain of the ship, where the buck stops, in most of the cases? See Blade's examples.
Click to expand...
 
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