Anesthesia malpractice: Two ways to improve patient safety

 

Nurse anesthetists frequently start, monitor, and end general anesthesia, with an anesthesiologist physician in the room

 
October 17, 2017

Anesthesia has become so commonplace in healthcare that many patients, and sometimes doctors, forget that it alone poses risks to patient safety.

 As a Houston, Texas medical malpractice attorney, I can think of many examples, but one, in particular, immediately comes to mind. A woman in her 40s was having an elective upper endoscopy at a Memorial Hermann Hospital in the Houston area. An endoscopy is the procedure where a physician inserts a scope with the camera down the patient’s throat to be able to see the esophagus, stomach, and first part of the small intestines (the duodenum). She was given propofol to induce general anesthesia, but quickly went into respiratory arrest and suffered from a brain injury. She died within a week.

The expanding role of nurse anesthetists

I represented that patient’s family and filed a medical malpractice lawsuit against the anesthesia providers who were involved in the care. During our investigation of the case, we discovered that the anesthesiologist was not even in the room when the anesthesia was started. Instead, it was being managed by a certified registered nurse assistant (CRNA).

While CRNAs have advanced training over that of a regular registered nurse, their level of training and experience comes nowhere near that of an anesthesiologist medical doctor.

In my experience, most hospitals are moving toward a model where CRNAs handle virtually every aspect of anesthesia care. Quite often, hospitals have one anesthesiologist roaming among several procedure rooms, where CRNAs are starting patients on anesthesia, monitoring them during the procedure, and waking them up from anesthesia.

If you scratch the surface, you will find a simple explanation for why so many hospitals are moving in this direction. It is cheaper to have nurse anesthetists handle cases than anesthesiologists.

I certainly believe that most of the time things work out fine when CRNAs handle all aspects of anesthesia care for a surgical patient. In my experience, though, when there is a complication or something goes wrong, many nurse anesthetists lack the training and experience to handle the situation on the run. Instead, there is a mad, frantic scurrying to get an anesthesiologist into the room before the patient ends up with a devastating brain injury from a lack of oxygen.

The pre-anesthesia assessment

The standard of care requires an anesthesia provider to perform a pre-anesthesia assessment before any procedure. In the pre-anesthesia assessment, the anesthesia provider takes a medical history of the patient and tries to identify any medical conditions, medications, or other factors that create an increased risk for the patient. Based on that history, as well as the goals of the surgery, the anesthesia provider then forms an anesthesia plan.

Based on my personal experience, as well as many conversations with clients, the pre-anesthesia assessment is often done by anesthesiologists, who are, of course, highly-trained physicians. What the anesthesiologist typically seems to leave out of these conversations is that the anesthesiologist will not be in the room during the surgery, but that all aspects of the anesthesia will be managed by a certified registered nurse anesthetist.

I think that patients should be aware of this potential and should directly ask the anesthesiologist who will be performing the anesthesia services for their case. Some patients may be comfortable with having a nurse anesthetist manage their case, but I believe it all patients should know before the procedure exactly who will be taking care of them from an anesthesia perspective.

My preference is to have a board certified anesthesiologist in the procedure or operating room the entire time. That way, if something goes wrong, the anesthesiologist is already there to deal with it.

In addition to presenting an opportunity to learn what anesthesia provider will be involved in your care, the pre-anesthesia assessment is the time to be thorough with the information that you provide to the anesthesia provider, in terms of your medical history and any medications that you have recently taken. Anesthetic medications are powerful. Anesthesiologists and nurse anesthetists need to know about any other medications that you have recently taken, which could interfere with the anesthesia and endanger your life.

If you find yourself in a situation where the anesthesia provider is rushed and is not collecting the necessary information to have a complete patient history, I encourage you to speak up. I recently read about a case involving an elderly man who suffered from a hunched back caused by a condition called advanced ankylosing spondylitis.

The patient had an MRI that identified a suspicious mass near his liver, and his doctors wanted to obtain a biopsy of that mass. An anesthesiologist recommended general anesthesia for the biopsy procedure, but there was no known medical history in the patient’s chart and the anesthesiologist did not take the time to collect a patient medical history of his own. During the biopsy procedure, the anesthesiologist and intubated the patient before placing him under general anesthesia. After the biopsy procedure, they discovered that the intubation had caused a severe spinal fracture, which led to the patient’s death a few months later. This would likely have been avoided if the anesthesiologist had taken a patient history before the procedure.

We are here to help

If you or someone you care for has been seriously injured as a result of problems with general anesthesia, or other anesthetic treatment, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case. Our medical malpractice attorneys have experience in investigating and handling cases against anesthesiologists, certified registered nurse anesthetists, and anesthesia practice groups.

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Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He files medical malpractice and wrongful death lawsuits on behalf of patients and family members against anesthesiologists, certified registered nurse anesthetists, anesthesia practice groups, and hospitals. A former hospital administrator, Houstonia magazine and H Texas magazine recognized Robert Painter, in 2017, as one of Houston’s top lawyers.

Robert Painter

Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.

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