Discussion of brain injury and carer issues
Medical Malpractice – Who is Treating You?
Do you know who is treating you? Patients are often unaware that the professional treating them is not a physician. By example, a patient goes into a routine outpatient procedure under which they are sedated with anesthesia. The anesthesiologist M.D. greets the patient briefly & asks some history & may perform a short examination. This takes place after another professional, likely a C.R.N.A. certified nurse anesthetist and/or a nurse has taken a history from the patient. The M.D. does not do a real thorough job taking the history or performing an examination because he assumes this has been done by the nurse and/or C.R.N.A.
He is present to sedate the patient & once sedated, leaves the operating room giving control & supervision over to the C.R.N.A. The patient has no idea
that this is taking place & that they are not being cared for by the M.D. If something goes wrong during the surgery with the anesthesia, the C.R.N.A. is allowed to use discretion to take care of the patient & may give more anesthesia without asking permission of the M.D. They do not have as much education & are not allowed by law to practice without the supervision of the M.D., but “supervision” is a loose term. What occasionally happens? The non-M.D. practitioner makes big mistakes which should not have been made & which injure the patient forever.
Another example are physician assistants who routinely treat patients in the E.R. The patient makes assumptions that the person giving the orders & treatment is a physician & does not know to inquire further. He is not aware that he is not being treated by a physician assistant & if he is, he is not aware of what that means. Specifically, he is not aware that the physician assistant is again loosely supervised by the physician in charge who may or may not look at the patient’s chart until after, & in some cases, well after, the patient has been discharged. Then, it may be too late as for example, in a hypothetical case in which the patient presents to the E.R. for back pain, gets examined, treated, & ultimately discharged by a physician assistant who diagnoses back strain.
Turns out, the back pain was a symptom of a heart attack & the patient goes home & dies of another massive heart attack. At deposition, the physician will testify that he did nothing wrong & it was no breach to allow the physician assistant to make the decisions he did & for the physician to sign off on the chart days later, having never been aware of the patient or the treatment prior to his death!
“BUYER” BEWARE!
Renee C. Walsh is a Michigan attorney who has been practicing law for six years, over three in medical malpractice defense, & over two in the general practice of law. She is presently focusing on two websites, http://www.walshlawpllc.com & http://www.lawrefs.com both of which aim to provide help-fulinformation & assistance to those in need. Renee’s aims are virtuous as she is one of those rare non-jerk, non-arrogant attorneys, who has since elementary school days, been helping those in need. If you have legal questions email Renee at lawref@lawrefs.com & she will provide the response in her blog.
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about 2 years ago
Ms Walsh
Respectfully, I have to say i absolutely disagree with what you have written here. Not only does it display a complete lack of understanding of what a CRNA does but also a lack of research on your part. I would have expected more from a lawyer.
CRNAs practice autonomously all over the country and often in places where there are NO anesthesiologists. CRNAs were, in fact, the 1st anesthesia providers in the country. The CRNA education prepares a Nurse Anesthetist to work independently in all aspects anesthesia. In short, Anesthesiologists are not needed (or used) to ensure the highest level of care for patients.
You might also spend a little more time looking into the law in regards to the difference between CRNAs and Anesthesiologists. There is very little.
I encourage you to look at the legal briefs prepared by the AANA lawyer. Case law clearly does not differentiate between CRNA only care, Anesthesiologist only care and Collaborative care (CRNA & Anesthesiologist).
The information can be found here:
http://www.aana.com/Resources.aspx?ucNavMenu_TSMenuTargetID=54&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=187
Thanks.
Mike MacKinnon CEN CCRN CFRN RN
Student Nurse Anesthetist
about 2 years ago
Unfortunately this information provided is incomplete and largely alarmist. In most instances the CRNA introduces themselves to the patient and advised them that the anesthetic will be performed by the CRNA. Most patients ignore this information however, excellent anesthesia is still administered. CRNAs are perfectly capable of performing a physical exam, taking a patients medical history and administering anesthesia.
CRNAs have been practicing for over 110 years in the USA. The safety associated with anesthesia administered by a CRNA vs an Anesthesiologist is equal to and in some cases better. In many facilities there are NO anesthesiologists and yet patients have excellent outcomes.
The CRNA is a Masters prepared RN who has studied at minimum 9 years vs the Anesthesiologists 11 years (the last 2 of which are spent in the administration of anesthesia or gaining experience). CRNAs are educated with emphasis on independent critical thinking and do not require an anesthesiologists to administer anesthesia. In fact 49 states do NOT require an Anesthesiologist be available to “supervise” the administration of anesthesia.
In the USA the majority, some approximations indicate 75% of the anesthesia to the rural population is administered by CRNAs who practice autonomously.
Feel free to communicate with me or the American Association of Nurse Anesthetists for more information regarding the practice of anesthesia or nurse anesthetists. http://www.aana.com
The practice of anesthesia is safer today than at any time in history. CRNAs continue to provide a good majority of the anesthesia provided daily in the USA. A little research would have been more appropriate before disparaging a very successful and honored profession.
Juan F. Quintana MHS, CRNA
Past President Texas Association of Nurse Anesthetists
about 2 years ago
As for “Who’s Treating You” (Sept 15):
Who wrote this inacurate story?
Supervision is NOT required by State Law in just over half of the US, and in 14 of these states the Medicare requirement for supervision is NOT required. In only ONE state (NJ) is the supervision required to be by an anesthesiologist – and that’s only outside the hospital when using more that moderate sedation. And if you compare the mortality and morbidity of NJ with one of the other states that have not had ANY requirement for supervision for years, there is not any difference. In other words, it’s political, not clinical.
Jump on the CRNA for something that ‘might’ happen, while you don’t jump on the anesthesiologist for charging big bucks for doing a brief and unthorough job???
Maybe the reason tens of millions of anesthetics are safely administered in this country each year is ‘because’ the CRNA is left to make the decisions???
When will the misinformation end?
Mark Adams CRNA
about 2 years ago
This statement has to be the biggest discredit to the public I have seen in a long time. Not only is it unethical to print something like this, but borders on liable. There has not been one validated study that proves CRNAs provide care that is not at least equal (or better by some accounts) to anesthiologists.
As far as mid-level providers (PAs & NPs) go I have never met one that tried to pass them self off as physicians. And, again trying to play on the public’s fear/ignorance is nothing short of criminal. Midlevel providers have been proven time and time again in several studies to just as safe as physicians.
about 2 years ago
“they [CRNA]…are not allowed by law to practice without the supervision of the M.D.”
you should check your facts before spreading untruths.
about 2 years ago
I picked this article up from Ezinearticles.com, and it is published all over the web, not just on this blog.
Comments are unlikely to be read by the author here; if anyone feels the article is seriously misleading, you should leave a comment on ezinearticles.com itself.
Depending on further feedback, I may take this post down: but the comments will disappear too…