A sad story was recently in the news about an 18-year-old woman named Emmalyn Nguyen, who’s now in a minimally-conscious state—she can’t talk, eat, or move—after she went to a plastic surgeon for a $6,000 breast augmentation procedure.
As I read the news story, I immediately thought to myself that I bet two things were involved. Sadly, I was correct on both of them.
Office-based versus hospital operating rooms
First, I guessed right that the breast augmentation surgery was done at an office-based plastic surgery center instead of a hospital.
Many plastic, cosmetic, and other types of surgeons have realized that moving surgeries that used to be done in a hospital operating room to their own office-based surgery centers rakes in big profits for them.
The problem is that freestanding and office-based surgery centers simply aren’t as safe as hospitals when it comes to handling emergencies.
In my experience, many plastic surgery practices persuade patients to agree to surgery in an office suite, rather than the hospital, by telling them it’ll save them money. While that’s often true, I’ve yet to see a case where a surgeon has explained to a patient that there’s an increased risk of a serious injury or death, in the event of a complication, for operations done outside a hospital.
In contrast, accreditation and licensing standards require hospitals to be equipped with the staff, equipment, and supplies that are immediately necessary to handle any operating room emergency.
In Texas, freestanding and office-based operating rooms must have a transfer agreement with an acute care hospital to handle their emergencies. I see this as basically an admission that these independent operating rooms can’t handle at least some emergencies that may come up. That’s why I think, if it’s at all possible, that it’s safer to have any surgery involving general anesthesia in a hospital setting.
There wasn’t an anesthesiologist
Second, I correctly predicted that this patient’s anesthesia was handled by a certified registered nurse anesthetist (CRNA), rather than an anesthesiologist physician.
Many states, like Texas, allow CRNAs to function largely independently. I just finished working on a case in litigation where one anesthesiologist physician was supervising five CRNAs in five different operating rooms in a freestanding surgery center at once. Other states allow CRNAs to have total independence and no physician supervision.
In Emmalyn Nguyen’s case, there apparently wasn’t an anesthesiologist on site at the plastic surgeon’s office operating room.
Despite the aggressive CRNA lobby’s arguments that CRNAs are just as safe as anesthesiologists, I’ve never found that to be true in the many anesthesia and surgical medical malpractice cases that I’ve handled.
It all comes down to training and experience. CRNAs are registered nurses with additional anesthesia training. Anesthesiologists are doctors with advanced training in anesthesia and critical care. While most CRNAs may be suited to handle routine anesthesia care, when there’s an emergency things can quickly go over their heads.
According to the lawsuit involving this patient’s care, the CRNA started the patient on anesthetic medications and then left her unattended for 15 minutes. After that time elapsed, a nurse noticed that the patient’s lips and face were blue. Her heart rate had slowed down (bradycardia) and she had gone into cardiac arrest.
These are some shocking allegations.
The standard of care requires an anesthesia provider to monitor the patient constantly once anesthetic medications are administered up until the time the patient wakes up (emerges) from anesthesia. The American Society of Anesthesiologist recommends “standard ASA monitors” for all patients to allow the anesthesia provider to keep an eye on basic physiologic functions. Standard ASA monitors include running a pulse oximeter, electrocardiogram, blood pressure, and temperature from start to finish.
If you’ve been seriously injured or have a loved one who died from questionable anesthesia or operating room care, then contact a top-rated Houston, Texas medical malpractice lawyer for help in investigating your potential case.