Based on the hate mail we’ve received from certified registered nurse anesthetists (CRNAs) in response to my recent article about them, it reveals that my article really hit a nerve in the CRNA community.
In my article, I explained what CRNAs do but I also explained that they are not medical doctors. In my experience, there are too many cases where nurse anesthetists have inadequate training and experience to provide competent emergency patient care. Anesthesia remains one of the mysteries of medicine and when it goes wrong, it is catastrophic because it causes permanent brain injury or death.
Here are just three of the many angry comments I’ve received from CRNAs over the past 24 hours:
• “I’m a CRNA. I’ll let providers know how this law firm feels.”
• From a CRNA who uses the word “Dr.” before his name:
“I am just curious how much it cost the ASA [American Society of Anesthesiologist] to have you write such garbage and nonsense? What a waste of your time and talents. If you’re that well-versed with how anesthesia functions, you should have been better informed . . . I do not rely on MDA (medical doctor anesthesiologist) to perform MY anesthetics and haven’t for almost 10 years. . . . Stop speaking in generalities and stop spreading fear-based propaganda immediately!”
• There “are other ‘doctors’ with other types of degrees doing anesthesia.” He referenced one such type of “doctor” as a holder of the DNP degree.
What CRNAs are
Certified registered nurse anesthetists (CRNAs) are nurses. Registered nurses and CRNAs are valuable parts of the multidisciplinary health care team, but approach anesthesia care from a nursing, not medical, perspective.
According to the American Association of Nurse Anesthetists, the minimum education and training necessary to become a CRNA:
• A bachelor’s or graduate degree in nursing or other appropriate major.
• A valid license to practice as a registered nurse (RN) or advanced practice nurse (APRN) in the United States.
• One year of full-time work experience, or its part-time equivalent, as a registered nurse in a critical care setting.
• A master’s degree from an accredited nurse anesthesia educational program.
Some states, such as Texas, require CRNA anesthesia providers to be medically directed or supervised by a physician anesthesiologist. Other states allow CRNAs free rein to provide anesthesia care without physician input.
What CRNAs are not
Certified registered nurse anesthetists aren’t physicians. Some CRNAs took a great offense and issue with the fact that I’ve used the word “doctor” to refer to physicians. It’s a sensitive area to some CRNAs, which is fine—on the other hand, the default meaning of “doctor” in ordinary English is “physician.”
While it is true that some registered nurses or CRNAs choose to complete doctoral-level work in either a DNP or Ph.D. program, such educational attainment is not equivalent to a medical degree.
CRNAs have not attended and graduated from medical school.
CRNAs have not completed a residency in anesthesiology or critical care.
CRNAs are not physicians.
While CRNAs continually host CRNA-funded studies about how their quality of care is just as safe as that of physician anesthesiologists, I don’t buy it. Based on my experience in handling numerous anesthesia-related medical malpractice cases, physician anesthesiologists are better equipped to handle life-threatening respiratory or cardiac emergencies during anesthesia care.
To add a little levity to this serious topic, perhaps that’s why when there’s an emergency, someone yells “get me a doctor,” rather than “get me a CRNA.”
Bait and switch or deception?
None of this is to say that CRNAs are not helpful part of the anesthesia team. In my opinion, CRNAs are perfectly suited to handle routine anesthesiology services on routine patients. Again, based on the cases that I’ve handled, many CRNAs lack the training and experience to manage complex patients or cardiac or respiratory emergencies.
Many of our anesthesia malpractice clients have been surprised to learn that the bulk of their operating room anesthesia care was provided by a nurse anesthetist, rather than a physician anesthesiologist. They have explained how a physician anesthesiologist performed the pre-anesthesia evaluation, including a physical exam and patient discussion.
Sometimes, the CRNA was introduced before induction of anesthesia, but other times there was no introduction. Consistently, though, our clients have informed us that there was no disclosure that a CRNA would be running the anesthesia show.
Now, of course, this is based on a limited sample of our firm’s anesthesia malpractice clients. It’s not to say that every anesthesia team operates this way. It’s easy to understand, though, how this could create a bait-and-switch situation for patients when this information isn’t disclosed in advance. I believe it should be part of the informed consent. In other words, the anesthesia team should inform patients of the physician anesthesiologist and CRNA roles in the operating room and obtain patient consent before proceeding.
There’s another issue here. Let’s say that a CRNA with a DNP or Ph.D. degree walks into a patient’s room wearing a white lab coat, with a stethoscope around the neck, and says to the patient, “Hi, I’m Dr. Smith. I’ll be handling the anesthesia for your surgery today.” Do you think that’s deceptive?
If you’ve been seriously injured by a CRNA masquerading as a physician anesthesiologist, or by any form of poor anesthesia care in Texas, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.