Three things that you can do to reduce the serious risks of anesthesia
Botched anesthesia care can cause heart and breathing issues and even death
Whether it is given in a hospital operating room, doctor’s office, or dentist’s office, general anesthesia presents serious risks. As a Texas medical malpractice lawyer, I frequently get called by patients and families who have been seriously injured, or worse, as a result an anesthesia mishap.
Just recently, a family called about the tragic death of a husband and father. It all started with a bout of food poisoning that was so bad that it caused blood clots to form in both of his legs.
The man went to a Houston area hospital, where a doctor took him to the operating room to remove the clots in one of his legs. He was discharged with some medications to help break down or bust the clots in his other leg.
He returned to the hospital a few weeks later to have the clots in his second leg removed, but died on the operating room table. The family was in a state of shock, but the doctors and nurses did not give them much of an explanation as to what happened.
When the death certificate finally arrived, it said that the cause of death was reaction to anesthesia. The preliminary investigation has revealed that the only anesthesia provider in the room when this patient was induced, or put under general anesthesia, was a nurse anesthetist (CRNA).
This may surprise you, but it is not unusual for an anesthesiologist physician to be absent from the operating room during all or most of a surgical procedure. To save costs, nurse anesthetist groups and insurance companies have successfully lobbied hard to allow CRNAs to handle all aspects of anesthesia care without supervision by a doctor.
Although federal law requires CRNAs to practice under the supervision of a licensed doctor—usually an anesthesiologist or surgeon—there is a big loophole that applies. In 2001, a new rule went into effect that allowed states to opt out of the federal law. So far, 17 states have opted out of the law, which means that in those states nurse anesthetists can practice totally independent of oversight by a doctor.
From my experience in handling anesthesia death cases, I am glad that Texas is not one of the opt-out states and, frankly, feel sorry for patients who live in the other 17 states.
An anesthesiologist once told me that general anesthesia is the process of using medications to take someone to death’s door, only to turn around and bring them back to life. The powerful anesthetic medications that are used to put people to sleep are designed to depress, or lower, a patient’s breathing rate, heart rate, and general metabolism.
Generally speaking, the riskiest time periods for a patient receiving general anesthesia are induction (when the anesthesia medication is started and puts you under, or makes you unconscious) and emergence (when you wake up from the anesthesia).
In my experience, I have seen many of things that can go wrong with anesthesia.
Sometimes the anesthesiologist or CRNA overdoses the anesthetic medication, which makes it very hard, and sometimes impossible, to bring back the patient.
Other times, the anesthetic medication can have an adverse effect when mixed with another medicine that the person is already taking.
Still other times, anesthesia can add-on to pre-existing heart or respiratory condition, causing the patient to stop breathing, or his or her heart to stop beating.
Any time that the person who is under anesthesia starts having problems breathing or has a heart issue arise, there needs to be a rapid medical response. Otherwise, things can quickly spiral out of control, with the respiratory problem leading to a heart issue and even death.
In my experience, although nurse anesthetists often do a fine job in routine cases, they are not the people that you want in the room when something goes wrong. They simply lack the significant medical training that anesthesiologists have.
Questions to ask before signing an anesthesia consent form
There are some things that you can do to lower your risk for injury of death by botched anesthesia services.
First, before your procedure, talk to your anesthesiologist or nurse anesthetist about all the medications that you took at any time the two to four weeks before the procedure. It is crucial to your safety that this list be as complete as possible. Even though you may not be currently taking a medication, it could still be lingering in your system and having a biological effect on you. Ask if any of those medications might increase the risk of going under anesthesia.
Second, make sure that you tell your anesthesia provider about any heart, lung, or respiratory problems that you have had. Ask if you need to be cleared by a cardiologist or some other doctor before having your surgery.
Third, find out exactly who will be providing your anesthesia services. In my observation, many times a “bait and switch” takes place. You may meet with an anesthesiologist medical doctor before a surgery or procedure, who then leaves the room only to turn over your anesthesia care entirely to a CRNA.
There are different levels of involvement of anesthesiologists in this day and age. These are the options in Texas, but bear in mind that you will never, ever be presented these options by your doctor, unless you know about them and ask.
The highest level is personally performed anesthesia care, which means the anesthesiologist doctor performs all the services and is continuously in the room during the procedure.
The next level is medical direction, which is where the anesthesiologist may be involved in up to four patient cases at one time. In other words, there is one doctor overseeing anesthesia for up to four patients in four different rooms at once.
The lowest level of anesthesiologist involvement is medical supervision, which is where the doctor may be involved in five or more cases at once. This means there is one anesthesiologist to oversee anesthesia services to five or more patients in five or more rooms all at one time.
It is up to you to decide what level of anesthesiologist involvement that you are comfortable with, but I always request for my family members that the anesthesiologist personally perform all of the services. This is my recommendation for the safest anesthesia care available. After all, if something goes wrong with the anesthesia during a procedure, it is “all hands on deck” and you want the anesthesiologist there without delay to get things under control.
Whatever you decide, be sure to express your wishes to the anesthesia team before you sign the consent form, and make sure that the pre-printed consent form is modified accordingly to be consistent with your decision.
We are here to help
If you or someone you care for has been seriously injured by a reaction to anesthesia or botched anesthetic care, call 281-580-8800 for a free consultation with an experienced medical malpractice attorney at Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]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 [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
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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