Hospital Propofol Policy Results In $3M Judgement In Patient Death

December 21, 2011 lawmed No comments

Here at the Law Med Blog we have mentioned more than once the minefield institutions create through their ill considered creation of various unnecessary policies and procedures. The incredible irony here is that these P&P are almost always created with the idea they will LIMIT liability and increase quality of care. Often times they serve to create local Standards of Care which deviate from nationally accepted standards. The hospital however can be held liable for violating their own policies, regardless of whether they followed national standards. Once implemented, patients are entitled to be treated under the hospitals published policies.

And this brings us to Enloe Medical Center in Chico, California. A Butte County Superior Court jury Monday ruled the hospital must pay the family of 50 year old Todd Stewart $3 million. Stewart, who died after a failed attempt to replace a faulty lead in an implanted cardiac defibrillator, underwent … (Continued…)

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Law Med Launches Nevada Hepatitis C Propofol Contamination Page

February 10, 2011 lawmed No comments

With criminal trials scheduled for this spring and more than 100 civil lawsuits already filed, the Nevada endoscopy clinic propofol contamination nightmare is heating up nearly 3 years after the story broke, we are launching ourNevada Hepatitis C Case Page. The Law Med Blog will be covering the events in detail. All relevant blog posts will be archived to this new page. Our list of special topic pages includes:

Nevada Hepatitis C Case Page

Anesthesia Drug Shortage Page

Anesthesia Standard of Care Page

Winkler County Page… (Continued…)

CA Physicians Vow To Appeal Medicare Opt Out To Supreme Court

February 04, 2011 lawmed No comments

On December 27, 2010, the Superior Court of California entered summary judgment in favor of the defendant governor and the California Association of Nurse Anesthetists in a suit arising out of the governor’s decision to opt out of three related federal rules requiring supervision of certified registered nurse anesthetists (“CRNA”) administering anesthesia as a condition of Medicare facility reimbursements.

As provided by the federal rules, a state can opt out of the CRNA supervision requirements if the state governor sends a letter to the Centers for Medicare and Medicaid Services (“CMS”) attesting that he or she (1) consulted the state’s medical and nursing boards about issues related to access to and the quality of anesthesia services in the state, (2) concluded that the opt-out is in the best interests of the state’s citizens, and (3) determined that the opt-out is consistent with state law. The California governor sent such a … (Continued…)

Nurses are an equal, if not superior choice, to administer anesthesia

January 15, 2011 lawmed 16 Comments

From Newsroom New jersey

BY DAVID L. KNOWLTON

Unlike so many others in the health care policy arena who find themselves concerned with bottom lines, gored oxen and political consequences, my job as President and CEO of the New Jersey Health Care Quality Institute is a relatively easy one. I have a clear focus: health care quality and patient safety.

So when the Institute was asked to weigh in on the issue of whether New Jersey Advanced Practice Nurse Anesthetists should remain the only Advanced Practice Nurses required to have the presence or direct supervision of a physician certified in their specialty (Anesthesiologists), we did not hesitate. The clear answer from a patient safety point of view is unequivocally “No.” The cause of health care quality is not advanced by requiring supervision and may, in fact, be harmed. In my view patient safety is the only issue that should matter … (Continued…)

Anesthesiologists Trained Before 1980 Order Unnecessary Pre-Op Testing

December 03, 2010 lawmed 1 Comment

Survey Study of Anesthesiologists’ and Surgeons’ Ordering of Unnecessary Preoperative Laboratory Tests.

Anesth Analg. 2010 Nov 16 ABSTRACT

Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction. Methods: The medical records of 1000 consecutive patients scheduled for surgery at our institution were examined for testing outside of our approved guidelines. Subsequently, 4 scenarios were constructed to solicit physician views of appropriate testing: a 45-year-old woman for a laparoscopic ovarian cystectomy, a 23-year-old woman for right inguinal herniorrhaphy, a 50-year-old man for a hemithyroidectomy, and a 50-year-old man for a total hip replacement. One or more of these scenarios were sent to directors of preoperative clinics (all), United States anesthesiologists … (Continued…)

FTC Warns Ala. Board of Medical Examiners On Limiting CRNA Practice

November 17, 2010 lawmed No comments

In July the Alabama Board of Medical Examiners, the state agency responsible for licensing and regulation of physicians, proposed that certain procedures involved in pain management be relegated to “physician only” status and that Certified Registered Nurse Anesthetists (CRNA) be prohibited from from performing them. The Board cited patient safety concerns. However, the Alabama Board of Nursing is the only state agency which can regulate the practice of nursing and it allows CRNAs to provide these pain management services when delegated by a physician.

The Board of Medical Examiners could conceivably prohibit physicians in the state from delegating the procedures thus effectively regulating nursing practice, and that is precisely what they intend. The Proposed Rule restricts the “interventional treatment of pain” to “qualified, licensed medical doctors and doctors of osteopathy” who “may not delegate to non-physician personnel the authority to utilize such procedures to diagnosis [sic], manage or treat chronic … (Continued…)

Understanding The California CRNA “Ruling” Requires NOT Asking A Physician

November 03, 2010 lawmed No comments

The American Medical News headline shouts “California nurse anesthetists can practice independently, judge rules” with the byline below proclaiming ”The decision puts patients at risk by allowing CRNAs to administer anesthesia unsupervised by doctors, physician organizations say“. Bah, stuff and nonsense. Physicians should stick to medicine since their understanding of the law is dismal.

So we have decided to help those legally challenged understand how this area of law works. Professional practice under a license required and issued by a state is governed by state law and for most professions, including physician and nurse, these state laws are administered and enforced by a designated government agency. When speaking about the practice of nurse anesthesia in California, this state agency is the California Board of Nursing. ONLY the California Board of Nursing, through the powers granted by the state legislature, regulates the practice of nurse anesthesia. It … (Continued…)

Anesthesiologist Misinformation Rampant In Medicare CRNA Opt Out

October 06, 2010 lawmed 1 Comment

We previously reported on radio ads running in Colorado sponsored by the Colorado Society of Anesthesiologists (CSA) aimed at needlessly frightening the public with claims of life and death hanging in the balance should the Colorado Governor Opt Out of Medicare CRNA supervision rules. The Governor has signed the legislation making the Opt Out a reality. Not satisfied that Colorado has become the 15th state to Opt Out of a federal rule requiring CRNAs be supervised by a physician, any physician with a pulse, the CSA is suing the state of Colorado, a move which will cost the sate a large chunk of cash for a lawsuit the CSA will lose.

Anesthesiologists have also taken to writing letters to the editor and op-ed pieces for newspapers large and small, mostly repeating dire warnings of death and injury poised to sweep across Colorado as nurse anesthetists are unleashed on an unsuspecting … (Continued…)

Hospital Policies Can Create a Standard of Care and Surprise Liability

September 27, 2010 lawmed No comments

Many health care workers might read their hospital’s policy and procedure manual in bits and pieces as the need arises, relying on fellow staff members to provide guidance as to ‘how things are done’. They do so at their, and the hospital’s, peril. Institutional policies and procedures quite often create a ‘local’ standard of care which if violated allow claims of negligence which otherwise might not be valid. It does not matter if an individual is doing things the way they have ‘always’ been done and the same way that the rest of the staff does them. If the P & P manual says things are to be done another way, patients can hold you to it.

An excellent example of how a specific hospital policy can wreak havoc with the professional is contained in our series on Dr. Bernstein and the Maryland Board of Physicians. This article will … (Continued…)

Supervision of a CRNA: A Concept Without a Reliable Definition

September 22, 2010 lawmed 2 Comments

Physician supervision of Certified Registered Nurse Anesthetists has been a hot topic lately. But just what IS physician supervision exactly? Good luck in answering that one without a manual answering the following questions, and good luck finding one of those:

Does a Certified Registered Nurse Anesthetist (CRNA) have to be supervised by an anesthesiologist?

Does a CRNA have to be supervised by any physician? If so, what kind?

What is that option available to states (the opt-out) to pass laws so that CRNAs do not have to be supervised? Isn’t that just a Medicare/Medicaid billing issue?

Don’t anesthesiologists say that CRNAs should be supervised by an anesthesiologist?

Isn’t there a law that requires CRNAs be supervised?

I am a surgeon and if a CRNA is giving anesthesia to my patient without an anesthesiologist supervising, am I liable if there is a problem related to the anesthesia procedures? If I have

… (Continued…)

American Society of Anesthesiologists Runs Terror Radio Ads In Colorado: Opt Out Of Medicare CRNA Supervision And Die

September 17, 2010 lawmed 5 Comments

In a desperate attempt to protect their turf by preventing the governor of Colorado from joining 15 other states in opting out of Medicare reimbursement rules requiring Certified Registered Nurse Anesthetists (CRNA) to be supervised by a physician in order to be paid for their services, the American Society of Anesthesiologists (ASA) is running radio spots aimed at misleading and frightening the public. And they are doing it knowingly and purposefully.

‘Supervision’, as defined by Medicare, is the physical presence of a physician, any physician with or without any training in anesthesia (a psychiatrist will do), in the operating room with a CRNA for certain portions of the anesthetic including induction and emergence. The Medicare guidelines also require the physician to be available for emergencies and to participate in the preoperative and postoperative care of the patient.

A recent study has shown that solo CRNA practice in states who have … (Continued…)

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Category Archives: Anesthesia Standard of Care

From Newsroom New jersey

BY DAVID L. KNOWLTON

Survey Study of Anesthesiologists’ and Surgeons’ Ordering of Unnecessary Preoperative Laboratory Tests.

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