ADMIN
11-05-2006, 04:23 PM
This was an interesting thread which i thought might get some responses here in regards to MDA and CRNA liability issues.
ORIGIONAL POSTER
year 2000, penn.
Mr toogood got a nerve block for recurring jaw pain from a dental pain clinic, and the dentist requested an ANESTHESIOLOGIST to administer the block. The pt suffered a collapsed lung and sued the anesthesiologist, the dentist and the clinic. The anesthesiologist died and he directed his suit just towards the dentist....
Mr Toogood had brought suit against the anesthesiologist, The Pain Center that employed the anesthesiologist, and the dentist, who was the owner of The Pain Center. When the anesthesiologist died, the court had no choice but to dismiss the claim against the anesthesiologist. Under the Pennsylvania dead man's statute, the plaintiff was prohibited from testifying against the deceased anesthesiologist and there would not be any testimony to establish the anesthesiologist's liability. However, the dead man's statute did not apply in the plaintiff's suit against The Pain Center or the dentist. For those who know surgeons who are afraid to work with nurse anesthetists for fear that the negligence of the nurse anesthetists could be imputed to the surgeon, the Toogood case is just another case where an injured plaintiff is suing someone (in the Toogood case it happens to be a dentist, but it could just as easily have been a plastic surgeon or other physician) because of the negligence of an anesthesiologist. The trial court awarded $465,000 in favor of the patient against dentist
In all the recent flurry of activity over supervision, the policy makers often seem unaware that anesthesiologists make mistakes, too. How can anesthesiologists suggest supervision of nurse anesthetists as a cure-all when anesthesiologists make the same mistakes? If they promote the anesthesia care team as preferable to nurse anesthetists working directly with surgeons, why aren't they promoting it over Anesthesiologists working directly with surgeons?
Just some thoughts...what is best for the patient? Does title make a good anesthetist alone. NO. It is skill and education...whether a CRNA or an MDA puts my children to sleep does not matter to me one bit. HOWEVER, what does matter to me is who that MDA or CRNA is. I want an excellent provider of anesthesia to put my child to sleep and bring them back with no adverse affects.
If you had to pick a provider for your child. Would it be guided by titles, name calling, or political bashing? Or would you choose based on their ability to provide the best care for your child? Would you want a fresh out of school cocky, who thinks he/she knows it all.....or the seasoned skills of a veteran to the art and science of anesthesia...which provider for your child would you pick...without regards to titles and BS.
REPLY FROM A MDA Resident:
Skill matters but Md's have 6 YEARS MORE TRAINING THAN CRNA's.... You can not overcome that kind of studying especially once the MD gets out and also gains clinical experience.
Your post is almost silly. Why do ANESTHESIOLOGISTS get sued for surgeons mistakes? that is the reverse of the arguement. WE ALL GET SUED BECAUSE WE ARE a team and they can get more money if they sue us all not just one of us - Out
REPLY from the origional poster
You must have read the article wrong...the surgeon (in this case the dentist) got sued and had to pay damages because of the anesthesiologist's mistake...just another case to PROVE that just because you work with an anesthesiologist does not release any responsibility....which was the argument a few posts ago. It is unfortunate that greed fuels most of the ASA's attacks and not patient safety. Very unfortunate. And to illustrate my point I have a question...What model of anesthesia care works best? ACT or independent provider?
And I am very interested in knowing how you came up with 6 more years training? From my view point it looks like this, MDAs 4 yrs pre-med (most people agree that you get no MEDICAL(especially anesthesia) traing in pre-med, so scratch that, 4 yrs med school, some pt experience, + 3-5 yrs residency (more for CC etc), just dealing anesthesia, so that equals 9 on the high end.... Now for me BSN 4 yrs, all pt related, 1-2 or more ICU exp. (i had three), 2-3 yrs crna school, so that (on the high end) equals 9yrs plus....so where is the 6 yrs more training.
Just one man's opinion
Reply from Resident
You are ridiculous. Get a life and stop imagining your BSN and ICU experience bathing patients, changing diapers, giving meds, hanging fluid, taking verbal orders from a resident, starting drips when you were told to , were equivalent to four years of med school and two years of residency. If you were in charge of patient care rather than taking orders from a resident, you'd have more credibility but we all know that is not the case.
BSN degrees are so easy to earn all you need is a pencil to fill out the application form. Now go get a degree in chem E, chemistry or EE and come back and tell me how easy it was compared to BSN. You are a darn fool and the sad part is you don't even recognize it.
Final reply from Origional Poster
WOW, got under your skin rather easily....must feel real insecure about your position in the food chain. In many ICU's,(usually larger one's with a teaching school) have residents that realize when they come out to the real world..that they know very little about pt's and their care....many, at least 10-12 residents and attendings have told me that residents do not know how to care for patients when they get out. So....what did those years of medical school and did you say 2yrs of residency?? You seem real ballsy about what ICU nurses do and don't do...here in a forum behind a mask of anonymity...lets see you walk up to a nurse ICU PACU and tell her all they are good for are baths and diapers. You woudl be killed, and if you think that is what happens...hmmmm...your education has served you a grave disjustice...to much time sniffing fumes in chemistry class maybe......but on a serious note...if CRNA's were not as competent as MDA's to administer anesthesia, then why do the studies not substantiate the claim...and they don't, because they are equal in quality of administration. Now CC fellowships, advanced pain fellowships, that is not my league. But that does not change my competence to provide anesthesia to surgical patients. You never answered my question about which model of care is best for the patient? ACT or solo practice?
I know that huge arguments get started all the time....but the simple fact is that both professions are here to stay....both are proven equally effective ( i can list the studies and court cases) and what should be the focus of everyones intent should be on the lawyers(for making malpractice awards a game), and politicians for making people not acountable for their healthcare needs. Good luck with your career.
ORIGIONAL POSTER
year 2000, penn.
Mr toogood got a nerve block for recurring jaw pain from a dental pain clinic, and the dentist requested an ANESTHESIOLOGIST to administer the block. The pt suffered a collapsed lung and sued the anesthesiologist, the dentist and the clinic. The anesthesiologist died and he directed his suit just towards the dentist....
Mr Toogood had brought suit against the anesthesiologist, The Pain Center that employed the anesthesiologist, and the dentist, who was the owner of The Pain Center. When the anesthesiologist died, the court had no choice but to dismiss the claim against the anesthesiologist. Under the Pennsylvania dead man's statute, the plaintiff was prohibited from testifying against the deceased anesthesiologist and there would not be any testimony to establish the anesthesiologist's liability. However, the dead man's statute did not apply in the plaintiff's suit against The Pain Center or the dentist. For those who know surgeons who are afraid to work with nurse anesthetists for fear that the negligence of the nurse anesthetists could be imputed to the surgeon, the Toogood case is just another case where an injured plaintiff is suing someone (in the Toogood case it happens to be a dentist, but it could just as easily have been a plastic surgeon or other physician) because of the negligence of an anesthesiologist. The trial court awarded $465,000 in favor of the patient against dentist
In all the recent flurry of activity over supervision, the policy makers often seem unaware that anesthesiologists make mistakes, too. How can anesthesiologists suggest supervision of nurse anesthetists as a cure-all when anesthesiologists make the same mistakes? If they promote the anesthesia care team as preferable to nurse anesthetists working directly with surgeons, why aren't they promoting it over Anesthesiologists working directly with surgeons?
Just some thoughts...what is best for the patient? Does title make a good anesthetist alone. NO. It is skill and education...whether a CRNA or an MDA puts my children to sleep does not matter to me one bit. HOWEVER, what does matter to me is who that MDA or CRNA is. I want an excellent provider of anesthesia to put my child to sleep and bring them back with no adverse affects.
If you had to pick a provider for your child. Would it be guided by titles, name calling, or political bashing? Or would you choose based on their ability to provide the best care for your child? Would you want a fresh out of school cocky, who thinks he/she knows it all.....or the seasoned skills of a veteran to the art and science of anesthesia...which provider for your child would you pick...without regards to titles and BS.
REPLY FROM A MDA Resident:
Skill matters but Md's have 6 YEARS MORE TRAINING THAN CRNA's.... You can not overcome that kind of studying especially once the MD gets out and also gains clinical experience.
Your post is almost silly. Why do ANESTHESIOLOGISTS get sued for surgeons mistakes? that is the reverse of the arguement. WE ALL GET SUED BECAUSE WE ARE a team and they can get more money if they sue us all not just one of us - Out
REPLY from the origional poster
You must have read the article wrong...the surgeon (in this case the dentist) got sued and had to pay damages because of the anesthesiologist's mistake...just another case to PROVE that just because you work with an anesthesiologist does not release any responsibility....which was the argument a few posts ago. It is unfortunate that greed fuels most of the ASA's attacks and not patient safety. Very unfortunate. And to illustrate my point I have a question...What model of anesthesia care works best? ACT or independent provider?
And I am very interested in knowing how you came up with 6 more years training? From my view point it looks like this, MDAs 4 yrs pre-med (most people agree that you get no MEDICAL(especially anesthesia) traing in pre-med, so scratch that, 4 yrs med school, some pt experience, + 3-5 yrs residency (more for CC etc), just dealing anesthesia, so that equals 9 on the high end.... Now for me BSN 4 yrs, all pt related, 1-2 or more ICU exp. (i had three), 2-3 yrs crna school, so that (on the high end) equals 9yrs plus....so where is the 6 yrs more training.
Just one man's opinion
Reply from Resident
You are ridiculous. Get a life and stop imagining your BSN and ICU experience bathing patients, changing diapers, giving meds, hanging fluid, taking verbal orders from a resident, starting drips when you were told to , were equivalent to four years of med school and two years of residency. If you were in charge of patient care rather than taking orders from a resident, you'd have more credibility but we all know that is not the case.
BSN degrees are so easy to earn all you need is a pencil to fill out the application form. Now go get a degree in chem E, chemistry or EE and come back and tell me how easy it was compared to BSN. You are a darn fool and the sad part is you don't even recognize it.
Final reply from Origional Poster
WOW, got under your skin rather easily....must feel real insecure about your position in the food chain. In many ICU's,(usually larger one's with a teaching school) have residents that realize when they come out to the real world..that they know very little about pt's and their care....many, at least 10-12 residents and attendings have told me that residents do not know how to care for patients when they get out. So....what did those years of medical school and did you say 2yrs of residency?? You seem real ballsy about what ICU nurses do and don't do...here in a forum behind a mask of anonymity...lets see you walk up to a nurse ICU PACU and tell her all they are good for are baths and diapers. You woudl be killed, and if you think that is what happens...hmmmm...your education has served you a grave disjustice...to much time sniffing fumes in chemistry class maybe......but on a serious note...if CRNA's were not as competent as MDA's to administer anesthesia, then why do the studies not substantiate the claim...and they don't, because they are equal in quality of administration. Now CC fellowships, advanced pain fellowships, that is not my league. But that does not change my competence to provide anesthesia to surgical patients. You never answered my question about which model of care is best for the patient? ACT or solo practice?
I know that huge arguments get started all the time....but the simple fact is that both professions are here to stay....both are proven equally effective ( i can list the studies and court cases) and what should be the focus of everyones intent should be on the lawyers(for making malpractice awards a game), and politicians for making people not acountable for their healthcare needs. Good luck with your career.