Six tips to protect yourself before surgery
Speak up while in the hospital and help avoid doctor, surgeon, and anesthesia mistakes in the operating room
As a Houston medical malpractice lawyer, I have handled hundreds of cases where surgeons or anesthesiologists botch a surgery or procedure and cause a serious injury or death. Recently, though, I got to see things from a different vantage point, when a loved one was suddenly hospitalized and we faced the surprise of an urgent surgery.
Everything happened so quickly, starting with my loved one experiencing sudden, extremely-intense pain in the abdominal area. It was so bad and so unexpected that we went to the emergency room at once. It was not long until an ultrasound revealed problems with some gall stones.
The emergency room doctor said that my loved one would be admitted to the hospital and would probably need surgery to remove the gallbladder. The gallbladder is a small organ on the right side of the abdomen that helps digest fats. The doctor said that the surgery, called cholecystectomy, would most likely be laparoscopic and was a minor procedure.
While I am sure that this type of surgery is routine to the surgeons and medical staff, when it is you or your loved on going into the operating room, there is nothing minor about it at all.
And from my experience in handling surgical and anesthesia error cases, I know that medical mistakes in a so-called minor procedure can be just as deadly as those in a major operation.
If a surgeon or anesthesiologist has injured or hurt you or someone you care for, call the Texas medical malpractice attorneys at Painter Law Firm for a free consultation, at 281-580-8800.
The Importance of Consent Forms
The next afternoon, when it was time for my loved one’s surgery, a transport tech came to take us to the operating room area. Once there, a few nurses began their pre-surgery preparations, one of which was filling out the consent paperwork.
Under Texas law, a patient must consent to any surgical procedure. Without obtaining proper consent, if a surgeon operated on a patient, it could be considered battery. While hospitals provide pre-printed forms that discuss the risks of all kinds of operations, it is the doctor’s duty to obtain informed consent from the patient. In fact, the Texas Medical Board rules are clear that this is a duty that the doctor cannot delegate to anyone else.
Most commonly, though, the surgeon will have a brief discussion with the patient, addressing the risks versus benefits of the procedure.
This is your last chance to ask questions. When you are taken to the operating room, you are in the most vulnerable place in your life—you are put to sleep and have no idea what is going on around you. Before going to surgery, make sure that you understand, in plain English, what the doctors are proposing. Ask whether the surgery is absolutely necessary—in other words, what would be the risk of doing nothing. And be sure to mention any other medical conditions that you have, including any heart problems, past complications in receiving anesthesia, and things of that sort.
In my loved one’s situation, the surgeon spoke with us up in the room for a few minutes, and we never saw him again before the surgery.
Once were in the holding area of the operating room, a surgical team nurse went through the informed consent paperwork with us. Most of the forms covered things we had previously discussed with the surgeon. But then we came to the part about anesthesia.
The pre-printed hospital consent form stated that the patient consented to the use of non-anesthesiologist certified registered nurse anesthetists (CRNA) to provide anesthesia care. This was the only option on the form and made no reference to the fact that the patient could request that anesthesia care be provided by a physician anesthesiologist.
A CRNA is a registered nurse who has an additional year or two of anesthesia training and then passes a certification text. On the other hand, a board certified anesthesiologist typically has an undergraduate degree, a medical school degree earned from four years of study, and at least four years of training in a four-year anesthesiology residency program. After that, board certified anesthesiologists must practice for a certain period of time before taking and passing the American Board of Anesthesiologists exam, which is considered one of the toughest board exams in medicine.
We told the operating room nurse that we had questions about whether the anesthesiologist would be in the operating room during the surgery, and precisely what role the CRNAs would play. The nurse seemed surprised and said she would have a doctor come and answer our questions.
Based on my experience in handling cases where young patients died during so-called routine procedures (including an endoscopy and a simple exploratory procedure), I have advised my clients to pay close attention during the consent process, and request that an anesthesiologist be in the room at all times.
In many hospitals, the truth is that the only time you may see an anesthesiologist is during the consent process. Many such facilities use a “medical supervision” model, in which one anesthesiologist doctor will supervise five or more CRNAs who are involved in five or more operations going on at the same time. Other hospitals use a “medical direction” system, where one anesthesiologist is directing four or fewer CRNAs who are handling up to four operations at once.
It’s easy to see the uncomfortable potential risk that these situations present. What happens if there is a complication during one of those operations, which usually means that the patient is not breathing? Is the anesthesiologist in the room? In the likely event that the answer is “no,” how long will it take to get her into the operating room? What happens if there is a complication in two of the operating rooms at once, meaning that two patients are not breathing and need resuscitated?
Under those circumstances, would you be satisfied in having the anesthesia, CPR, and resuscitation efforts being managed by a nurse CRNA, or would you want a highly-trained anesthesiologist doctor in the operating room at the very moment things went south? For most people, this is any easy answer. And that is why I find the pre-printed hospital consent forms to be troubling and, in a sense, misleading to patients about what their true options are.
About 15 minutes after the nurse left the bedside, an anesthesiologist came to the bedside. I decided to follow my own advice and said, “We have been advised to have an anesthesiologist in the room during the whole procedure. What is the role of the CRNA, which we saw referenced on the consent form?”
The anesthesiologist could not have been any more understanding. She said that, based on that hospital’s staffing levels, if a patient consents to CRNA care, there would not be any anesthesiologist in the operating room, period. The anesthesiologist said that she would make sure that no CRNAs were involved in our surgery, and that an anesthesiologist doctor would handle the whole procedure.
A few minutes later, the nurse came back and asked if we had all of our questions answered and if we were ready to sign the consent form. I explained the conversation with the anesthesiologist and offered to cross out the CRNA language on the consent form. The nurse would have none of that and quickly (but politely) took the form back from me and said she would have to get a doctor to do that. I said, “No problem.”
As an attorney who sues doctors and anesthesiologists who injure patients during surgeries, I found this whole sequence of events amazing to watch. The hospital had procedure in place at all where a patient could opt out of nurse CRNA anesthesia care, which I consider to introduce unnecessary added risk.
In the end, it all worked out, and the nurse returned with the consent form, which had the CRNA section marked out an initialed by the anesthesiologist. My loved one signed the consent form and before too long was taken to surgery.
I think the back-and-forth probably added 45 minutes to the consent process, but it was all non-confrontational and professional. When asked, the nurses and doctors were helpful. I just feel sorry for the people who do not know what to ask.
Taking the Time to Talk Before Surgery
Another thing to consider before going into the operating room for surgery is to share with the doctors and nurses all of the medications that you are either currently taking, or have taken within the last month or so.
If you regularly take a number of medications, I recommend always keeping with you a list of the drug names, dosages, and how often you take them. Many people find it convenient to keep the list on their cell phone. Other people use their cell phone to take photos of the medication labels.
Doctors, surgeons, and anesthesiologists prescribe all kinds of medications during a surgery and hospitalization and they can interact with drugs you are already taking, or drugs that you took recently that are still in your system. This can happen with anesthesia drugs, like Propofol, that put you to sleep, and drugs like Zofran or Phenergan, that help reduced nausea and vomiting.
Knowledge is Power
Surviving a hospitalization or surgery is truly a team effort. The surgeons, doctors, and nurses are there to help you, as patients and family members, but you have to make sure to be an active participant in conversations with them. Tell them about other medical conditions and any medications the patient is currently taking.
And be aware of the health care team members that are taking part in our care—or who are being suggested to handle the important anesthesia care during a looming surgery. That means that we should never just sign off on a pre-printed consent form without asking questions and having an accurate understanding of the health care that is being offered.
The Houston-based medical malpractice lawyers at Painter Law Firm are experienced in representing clients in cases where a doctor, surgeon, anesthesiologist, or hospital injures or harms a patient by poor medical care. If you or a loved one finds yourself in that situation, call us for a free consultation at 281-580-8800.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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