How exactly does a surgeon "supervise" a CRNA?

loisane · Sep 27, 2007

I know I am new here, but I wish only CRNAs would reply to these legal and practice topics. It seems like misinformation has a way of multiplying until someone presents the facts.

Amen, amen, amen, AMEN!

Did I say AMEN?

loisane crna

zrmorgan · Oct 13, 2007

so back to the OP....those of you who have surgeons "supervise"

how do they do it? do they sign all your charts? do they simply do it so medicare(caid) will send the check?

it seems that is the reality that the opted-out states have accepted (ie what is the friggen point of supervision then if the supervisor is uninterested / undereducated in anesthetic technique?)

i would love to say i was "supervised", or "managed", or whatever, if the person who was the "supervisor" had a clue, and was interested in the goodANESTHETIC outcomes of the patient....but that is where we all have to draw the line...

they have to have a clue about anesthesia, and they have to be interested

we must not forget the rigorous training many surgeons have endured, I see a lot of undue disrespect in some earlier posts...but I do feel a lot better about surgeons who utilize more of their time sharpening their surgical practice, and less time being concerned about what anesthesia is doing. they can have their expectations of what a good anesthetic but they should leave the plan to the CRNAs and anesthesiologists.

Collaboration, no matter what setting, whether you are solo, or the surgeons hand-maiden, is cruicial. It is unfortunate "collaboration" often gets slipped in with "supervision" as I beleive they are entirely different (yes apples and oranges yet again)

zrmorgan · Oct 13, 2007

I dont get it. A surgeon knows NOTHING about gas at all.
So I'm confused when I hear some CRNAs say that their "supervising physician" (in states that require a supervising physician) are the surgeons running the case.
Explain to me exactly how a surgeon can "supervise" or "collaborate" wtih a CRNA.

"supervise" I dunno... I had the same question....

"collaborate"....

CRNA: "Hey Steve, this guys a trainwreck do you mind if we admit him overnight and get someone from internal med to manage his (insert problem here) before we bring him to the OR"

Surgeon: "Well we could do that, but I was just planning on injecting sub lethal doses of local at the surgical site, I was thinking at most you could give a couple of versed, but its up to you..."

CRNA: "Hey, its your wifes birthday today, did you remember?"

Surgeon: "So, who's on call for internal med tonight?"

foraneman · Oct 14, 2007

So you are claiming that its impossible for a surgeon to be liable for a CRNA's error, even when the state law EXPLICITLY states that some kind of "supervision" is required?
I dont doubt that its a very rare occurrence, but its not as open and shut as you say. If what you said was true, then no surgeon would EVER be sued for anything that happens in terms of bad anesthesia outcomes unless they "interfered" with the anesthesia plan by changing orders or sedation protocols.
1. State law requiring "supervision" has nothing to do with surgeon liability.
2. A surgeon can be sued for anything that happens to the patient under their care. The question is will they be found liable.
3. Yes, I AM telling you that a surgeon is not liable for mistakes made by a CRNA, if these were not under the surgeons direct control. A surgeon is NO MORE liable when working with a CRNA alone versus a CRNA and MDA team....PERIOD.
4. Again, "supervision" is not used in this instance as it tends to imply. There is NO "direction" or "control" over the anesthetic. A CRNA would be found liable if they followed a surgeons orders running contrary to the standard of care, found in the best judgment of the CRNA.:studyowl:

foraneman · Oct 14, 2007

so back to the OP....those of you who have surgeons "supervise"
how do they do it? do they sign all your charts? do they simply do it so medicare(caid) will send the check?
it seems that is the reality that the opted-out states have accepted (ie what is the friggen point of supervision then if the supervisor is uninterested / undereducated in anesthetic technique?)
i would love to say i was "supervised", or "managed", or whatever, if the person who was the "supervisor" had a clue, and was interested in the goodANESTHETIC outcomes of the patient....but that is where we all have to draw the line...
they have to have a clue about anesthesia, and they have to be interested
we must not forget the rigorous training many surgeons have endured, I see a lot of undue disrespect in some earlier posts...but I do feel a lot better about surgeons who utilize more of their time sharpening their surgical practice, and less time being concerned about what anesthesia is doing. they can have their expectations of what a good anesthetic but they should leave the plan to the CRNAs and anesthesiologists.
Collaboration, no matter what setting, whether you are solo, or the surgeons hand-maiden, is cruicial. It is unfortunate "collaboration" often gets slipped in with "supervision" as I beleive they are entirely different (yes apples and oranges yet again)

Collaboration and supervision ARE the same thing in this context. The surgeon does not supervise or dictate the manner in which the anesthetic is delivered...ever....in any state.

Summitk2 · Oct 17, 2007

I know I am new here, but I wish only CRNAs would reply to these legal and practice topics. It seems like misinformation has a way of multiplying until someone presents the facts.

Angel (and loisane), I couldn't agree more. However, you may have noticed that CRNAs don't participate too much in this forum anymore. I think those of us who are not CRNAs and truly want to be correctly informed would love for a CRNA to set things straight. However, even the CRNAs don't seem to agree and others are vague. Is aana.com really the only reliable source of info? I noticed you (as a CRNA, I assume) didn't add anything to clarify this discussion aside from the aana website link. Do you have the correct info on this legal and practice topic? If so, please help clarify the answer to the OP's question. We need CRNA input on this CRNA forum.

zrmorgan · Oct 19, 2007

Collaboration and supervision ARE the same thing in this context. The surgeon does not supervise or dictate the manner in which the anesthetic is delivered...ever....in any state.

right....that is my point, "supervision" is misleading to some patients, surgeons, and obviously from this discussion, many of us...

the wording needs to be simplified "collaboration", so those people who don't have first hand knowledge of the setting to which this applies do not assume there is a supervisor / supervised relationship in anesthesia.

my main point being the context is flawed AEB the controversy.

foraneman · Oct 20, 2007

Angel (and loisane), I couldn't agree more. However, you may have noticed that CRNAs don't participate too much in this forum anymore. I think those of us who are not CRNAs and truly want to be correctly informed would love for a CRNA to set things straight. However, even the CRNAs don't seem to agree and others are vague. Is aana.com really the only reliable source of info? I noticed you (as a CRNA, I assume) didn't add anything to clarify this discussion aside from the aana website link. Do you have the correct info on this legal and practice topic? If so, please help clarify the answer to the OP's question. We need CRNA input on this CRNA forum.

I have tried to answer this as best I can. To put it simply, the surgeon "supervises" by being present in the room. Nothing else is required. The CRNA can bill insurance companies and medicare and medicaid independently. The surgeon is not required to sign the anesthesia record, nor have i ever had one sign it. I am a CRNA and a law school graduate. I hope this helps.

platon20 · Oct 20, 2007

the wording needs to be simplified "collaboration", so those people who don't have first hand knowledge of the setting to which this applies do not assume there is a supervisor / supervised relationship in anesthesia.

Fine, then lets throw out the term "supervision" and use "collaboration" instead.

How does a surgeon "collaborate" with a CRNA when the surgeon doesnt know jack about anesthesia?

Is a rocket scientist capable fo "collaborating" with a civil engineer?

Is a garbage man capable of "collaborating" with a McDonalds employee?

Of course not, because they are two totally separate jobs that have nothing to do with each other.

So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

xflyingfox · Oct 20, 2007

The CRNA forenaman has the answer, and IS a CRNA

foraneman · Oct 21, 2007

Fine, then lets throw out the term "supervision" and use "collaboration" instead.
How does a surgeon "collaborate" with a CRNA when the surgeon doesnt know jack about anesthesia?
Is a rocket scientist capable fo "collaborating" with a civil engineer?
Is a garbage man capable of "collaborating" with a McDonalds employee?
Of course not, because they are two totally separate jobs that have nothing to do with each other.
So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

Unfortunately, switching the terms does not help much either depending on your view of the definition of collaborate. Certainly persons of two diferent disciplines collaborate on projects all the time.

Etymology: Late Latin collaboratus, past participle of collaborare to labor together. (Websters)

So, the surgeon and the CRNA labor together. The real intention of state requirements for collaboration being written into a nurse practice act, as far as I have been able to surmise, is to provide that when a CRNA administers anesthesia, there will always be a reason. In other words, a CRNA cannot open an "anesthesia botique" in his or her basement anestheizing customers at will. Collaborating with a surgeon, there will always be a patient and a physician (dentist, podiatrist) prsent with the patient having a procedure done. Since changing the word to collaborate, you have to drop the common definition (and idea)of supervision since collaboration's definition is very diferent.

deepz · Oct 22, 2007

...... two totally separate jobs that have nothing to do with each other.
So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

Sheesh. Obviously you don't know what you're talking about.

And you give surgeons far too little credit.

d