Anesthesia Consents- question

Specialties CRNA

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Hi...I have a question. Our anesthesiologists at our hospital always talk to the patients pre op to get a thorough H&P. However, when they get the pt to sign the anesthesia consent they always tell them what they will be doing for them intra op/ and post op. But...when the procedure starts they often times get another anesthesiologist to do the case or get a SRNA to do the case and they do paperwork in the office and only wander in for the intubation and induction and extubation. The patients belive the anesthesiologist that got them to sign the consent will be present and managing their entire case. My question is this: When a anesthesiologist gets a patient to sign a consent for the surgery do they have the obligation to physcially do their case or can they substitute another anesthesia MD ....or even get a student SRNA do the case without the patients knowledge?

I cant help but think of it like this- If I get a cardiothoracic sugeon to do my open heart surgery, and that CT MD gets me to sign a consent for the surgery.....then to me ....that MD better be doing my surgery.....or else my consent is invalid . But with anesthesia is it the same ....what is ok ?

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Specializes in Critical Care.

He shouldn't lead them to believe he's doing the case if he's not. But if you read the consent form it will probably say. I give permission to "So and So" and/or the associates of his or her choice to perform on "patient's name" "said procedure."

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He shouldn't lead them to believe he's doing the case if he's not. But if you read the consent form it will probably say. I give permission to "So and So" and/or the associates of his or her choice to perform on "patient's name" "said procedure."

Doesn't the consent form also list the actual names of the MDA's associates/assistants???

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That is probably correct,....it probably does have that his/her associates can do the case. Thanks!:yeah: But I cant help but think that most people are not reading the fine print there.....and it is kinda misleading to them.

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Specializes in Critical Care.
Doesn't the consent form also list the actual names of the MDA's associates/assistants???

Ours doesn't, it only has enough space to write one name. Your giving consent you your procedure and the judgement to select those to perform certain aspects of it. Our consents list the surgeons name and the associates of his/her choice covers the OR nurses, first assist, any other surgeons that help with the case, and anesthesia. As an example I filled out a consent today for a TEE on a patient, the name on the consent was the cardiologist that ordered the procedure but he doesn't do TEE's so one of his partners (associate) is who performed the procedure.

But I cant help but think that most people are not reading the fine print there.....and it is kinda misleading to them.

They signed the paper; in court that means they read it, wether they did or not. Gotta read the fine print on everything you sign, healthcare not excluded. Regardless though, the MDA in question shouldn't be leading patients to believe he/she is doing the procedures if that's not the case. They should be explaining the ACT model. I haven't started school yet but so far every OR I've been in, if the CRNA is doing the procedure the CRNA has seen the patient prior to entering the OR. Maybe you are only seeing the MDA see the patient on the floor and the CRNA is seeing the patient in the pre-op area?

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ours doesn't, it only has enough space to write one name. your giving consent you your procedure and the judgement to select those to perform certain aspects of it. our consents list the surgeons name and the associates of his/her choice covers the or nurses, first assist, any other surgeons that help with the case, and anesthesia. as an example i filled out a consent today for a tee on a patient, the name on the consent was the cardiologist that ordered the procedure but he doesn't do tee's so one of his partners (associate) is who performed the procedure.

they signed the paper; in court that means they read it, wether they did or not. gotta read the fine print on everything you sign, healthcare not excluded. regardless though, the mda in question shouldn't be leading patients to believe he/she is doing the procedures if that's not the case. they should be explaining the act model. i haven't started school yet but so far every or i've been in, if the crna is doing the procedure the crna has seen the patient prior to entering the or.

maybe you are only seeing the mda see the patient on the floor and the crna is seeing the patient in the pre-op area?

my wife actually had a procedure done at our hospital too. the anesthesiologist said he was doing her case,...in the end even after we had specifically said "no" to a student srna he let the srna do the whole case while he wandered in/out. i was there for the pre op eval ,....all the way till they moved her to the main or. of course my coworkers told me as soon as she got to the pacu bc they knew id be angry. so..if they would do this to me......i feel fairly confident theyd do it to anyone.

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my wife actually had a procedure done at our hospital too. the anesthesiologist said he was doing her case,...in the end even after we had specifically said "no" to a student srna he let the srna do the whole case while he wandered in/out. i was there for the pre op eval ,....all the way till they moved her to the main or. of course my coworkers told me as soon as she got to the pacu bc they knew id be angry. so..if they would do this to me......i feel fairly confident theyd do it to anyone.

then you should complain to the hospital, the state medical board, and consider filing criminal charges against both the anesthesiologist and srna for battery.

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Specializes in Anesthesia.

I agree that it was not cool of the MDA to lie to you like that but you have to understand that this is the way it is in teaching hospitals. Why not just choose a non-teaching hospital if you don't want students partaking in your loved ones procedure?

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Specializes in Critical Care.

I'd pick that battle carefully. Most consents, especially at teaching hospitals also provide permission for students. If the signature is there then that action would go nowhere. Noone can prove speech.

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Specializes in CRNA.
Then you should complain to the hospital, the state medical board, and consider filing criminal charges against both the anesthesiologist and SRNA for battery.

I have to speak up for the SRNA, #1 Was the SRNA aware of the request? It is quite possible that they were not. #2 Was the SRNA able to say No to the the MD?

But I absolutely agree that the request should have been honored by the MD. In some practices in may have been a long time since the MD actually did hands on case management, and the SRNA could have been quite capable of providing a high level of care, but if that's what the agreement was, then it should be honored.

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It doesn't matter if it is a teaching institution or not. If you specifically state, written or orally, that you do not want a student nurse anesthetist (or a resident or whatever) to participate in your care, you have every right to do that, and every right to expect that request to be honored. To do otherwise is battery. It's that simple.

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Specializes in Critical Care.

I'm not disagreeing with you. The request should have been honored. But if it's in writing somewhere that it's ok for a student to provide care and it's signed then that's binding. Oral requests are also legally binding; but how is it proved? My point was that although the request should have been honored, it would be incredibly difficult to prove your point in court and would probably be a huge waste of money for the family. Especially given the patient is doing fine. A better course would be to learn from that and request it in writing next time.

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