CRNAs once again defamed...

duckboy20 · Jul 14, 2004

I think you said it right, uninformed, uneducated, and I would say sometimes, jealous. But I have not seen any reply from Vogue about the AANA presidents letter. I would be highly interested in seeing what they have to say!

UCDSICURN · Jul 14, 2004

Here's the link to the transcript for the show for that night...I'm in the process of reading it.

http://www.msnbc.msn.com/id/5436366

Donn C.

UCDSICURN · Jul 14, 2004

Copy and pasted from the transcript...it was rather long...enjoy..=/

NORVILLE: Olivia Goldsmith, the author of the novel "First Wives Club," which inspired that movie, died after she went into cardiac arrest under anesthesia during a chin tuck procedure last January. But the American Society of Plastic Surgeons says Olivia Goldsmith's death represents an extremely rare risk. Their study found only one death from cosmetic surgery in over 51,000 cases. So just how serious are the risks for either a bad result or perhaps even death? And how do you go about picking the right cosmetic surgeon?
Joining me now is Dr. Robert Kotler. He's a plastic surgeon on the faculty at UCLA Medical School and the author of "Secrets of a Beverly Hills Cosmetic Surgeon."
Doctor Kotler, thanks for being with us. I want to put up a picture, if we can, of some of the procedures that are most popular right now. Over two million botox, 900,000 laser hair removal, 850,000 microdermabrasion, and then over 300,000 liposuction, and close to that in terms of breast augmentation.
Those last two are surgeries. They involve anesthesia. We know that was a problem with Ms. Goldsmith's death. How risky are these surgical procedures?
DR. ROBERT KOTLER, PLASTIC SURGEON: Well, Deborah, in cosmetic surgery, the risk is not in the cutting and the sewing, it is in the anesthetic. And unfortunately, that's what happened to Olivia. There were problems with the anesthetic which shouldn't have occurred.
NORVILLE: And how can a person who has decided, through all the research, that he or she wants to go through one of these procedures, they find a great doctor--how can they make sure that the anesthetic part of the equation is to their satisfaction and they don't run the risk of this going on?
KOTLER: Well, you're right, that's the question, because there's that component, and also the facility, the location. But the anesthetic, I believe, should be given by a physician anesthesiologist. Unfortunately--not a nurse anesthetist.
NORVILLE: Which was the case in Goldsmith's case.
KOTLER: Yes. The state of New York was critical of the hospital because the nurse anesthetist was apparently unsupervised, as they described it. So I believe--and frankly, for myself and my family--I want a doctor anesthesiologist.

Get the torches.........

Donn C.

hipab4hands · Jul 14, 2004

I think you said it right, uninformed, uneducated, and I would say sometimes, jealous. But I have not seen any reply from Vogue about the AANA presidents letter. I would be highly interested in seeing what they have to say!

Amazing! By definition, a CRNA is supposed to be under the general supervision of an MD. So, if there was a failure in the Anesthesia, it would be the supervising physican's fault for not monitoring the CRNA.

loisane · Jul 14, 2004

Amazing! By definition, a CRNA is supposed to be under the general supervision of an MD.

No, hipa, this is NOT the definition of CRNA practice. But I am not familiar with New York state law. Are you saying this is the law in NY? Because it is not required in other states. Perhaps you could clarify your comment.

loisane crna

UCDSICURN · Jul 14, 2004

so, if there was a failure in the anesthesia, it would be the supervising physican's fault for not monitoring the crna.

according to aana legal briefs even if the supervision requirement exists the supervising person will not be held liable unless they were actually directing the anesthesia. in most cases , whether it's a crna or mda providing the anesthesia, the provider is liable for their own actions. working with a crna carries no more liability than working with an anesthesiologist.

here is an exerpt from the aana website legal area on supervision:

supervision alleged as a basis for liability
so, at a time when surgeons were beginning to escape liability as "captain of the ship" deteriorated, the very language of statutes designed to protect nurse anesthetists from unfair attack became the springboard for yet new attacks. in june 1985, h. ketcham morrell, md, the then president of the american society of anesthesiologists, wrote to jama: "...that the providing of anesthesia care is legally defined as the practice of medicine in every state of the union of which i am aware. for this reason, it should be noted, the operating surgeon or obstetrician who purports to provide medical direction of the nurse, in the absence of an anesthesiologist, carries a high risk of exposure, on a variety of legal theories, for the acts of the nurse."
the threat was clear. surgeons who "supervised" nurse anesthetists were allegedly assuming significant legal liabilities and risk because a nurse anesthetist had to be supervised while an anesthesiologist did not. the reality was that the same legal principles that governed the liability of a surgeon for the negligence of a nurse anesthetist also governed the liability of a surgeon for the negligence of an anesthesiologist and had nothing to do with supervision. the issue was whether the surgeon controlled the procedure that gave rise to the injury. liability depended on the facts of the case, not a statute requiring supervision. if the surgeon was in control, the surgeon was liable; if the surgeon was not in control, the surgeon was not liable, even if the surgeon was "supervising."
there are any number of cases in which surgeons were not liable when working with nurse anesthetists and while there are cases where surgeons were liable when nurse anesthetists were negligent, there were also cases where surgeons were sued and held liable for the negligence of anesthesiologists. counsel for the american society of anesthesiologists even agreed with this analysis of the law. in 1985, he wrote a letter to the aana journal responding to an article i had written. in it, he said, "in that article, mr. blumenreich correctly stated that whether a surgeon will be held liable for the actions of a nurse anesthetist depends on the facts of the case." nonetheless, enemies of nurse anesthetists continued to state, despite the authority to the contrary, that surgeons working with nurse anesthetists were automatically exposing themselves to great risk. tragically, they were believed. worse, enemies of nurse anesthesia convinced hospitals to adopt bylaws and policies expanding the nature of supervision to unnecessarily increase the exposure of surgeons working with nurse anesthetists. (see denton regional medical center v. lacroix, 947 s.w. 2d 941, (1997), harris v. miller, 438 s.e. 2d 731, (1994).)

in regards to dr. kotler, i believe his statement on supervision was in regards to the crna providing the anesthesia was not supervised by an mda, which is not required in any state, and thus his argument is invalid. unless the facility in which this operation took place adopted the asa's statement on the anesthesia care team as policy (which hospitals have done.), then there would be liability only in the context of failing to follow policy, not in regards to procedural negligence. this too has been documented thoroughly by the aana and they have case reviews demonstrating this as well.

donn c.

jwk · Jul 14, 2004

Someone correct me if I'm wrong on my recollection about this:

1 - I thought an MDA provided the anesthetic for this particular case. It was a "high profile patient", and I think I remember reading something to the effect that it was the "chairman of plastic surgery" and the "chairman of the anesthesia department". And wasn't this the same hospital and/or surgeon that had another plastic surgery patient death?

2 - From what I read about the case, it sounded very much like an intravascular injection of local anesthetic with epinephrine was the precipitating event - which of course would have been injected by the surgeon.

Again, someone let me know if my memory is faulty - I can't find the article I was reading about this a couple of months ago.

Brenna's Dad · Jul 14, 2004

Interestingly stuff,

According to this article,

http://newyorkmetro.com/nymetro/news/trends/columns/cityside/n_9981/

it seems that a NA administered the anesthetic for Olivia Goldsmith, but an anesthesiologist administered the anesthetic for a second recent death at the facility.

If you read through the article, it makes reference to the surgeon noting that Olivia's blood was crimson. Does this sound like methemoglobinemia to anyone else? It would explain the appearance of the "normal numbers."

athomas91 · Jul 14, 2004

jwk - i am trying to recall but from what i remember it was not a nurse anesthetist who administered the anesthesia...i have already written the editor of msnbc...and i am sure the AANA will get on it...

gaspassah · Jul 14, 2004

ya know there was a thread where discussions were made on the use of earpieces and some persons saying theirs were collecting dust etc. i routinely use my earpiece whether mac cases or geta. the article just mentioned that the author died because noone noticed her heart had stopped but still had electrical activity. i think an earpiece would be helpful. monitors are great and they really helpful, but you cant forget basic assessment skills, look listen and feel.

just my humble opinion.

d

duckboy20 · Jul 14, 2004

A nurse anesthetist did seem to be the anesthesia provider in the first case as it states in both articles. Brenna's Dad, in the case you have with the anesthesiologist, it said the blood was not crimson as it should be, looking at it now knowing it was deoxyhemoglobin causing it to be a dark red blood due to the PEA. Unfortunate situations, just wonder if the surgeon would have said the same thing if it had been an anesthesiologist in both cases instead of a CRNA in one and an anesthesiologist in the other. I doubt it!