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CRNA: Liability And Responsibility

Certified Registered Nurse Anesthetics (CRNA)

Anesthesia lets medical practitioners perform precise surgery with little worry of unexpected patient reactions, However; accidents can happen with this very precise part of the medical process. Liability is a complicated term in the medical field, but Christensen Law provides this article to help clarify some of the uncertainties involving liability of certified registered nurse anesthetists (CRNAs).

Written By: Blake D. Christensen, DO, Adam W. Christensen, JD, MBA, and S. Sandy Sanbar, MD, PhD, JD

Certified registered nurse anesthetists (CRNAs) have different educational and training requirements than anesthesiologists or anesthesia assistants. This article focuses on CRNAs, anesthesiologists, and surgeons. In Oklahoma, when a CRNA administers anesthesia, who is liable for CRNA negligent acts; the CRNA, anesthesiologist, or the surgeon?

For the CRNA, the practices of nursing and medicine overlap. CRNAs had been required to practice under direct supervision until 2001, when federal laws enabled states to determine if supervision was or was not required.* Effective Nov. 1, 2011, the OKLAHOMA NURSING PRACTICE ACT (ONA) states that “[a] Certified Registered Nurse Anesthetist, under the supervision of a [doctor], … , and under conditions in which timely, on-site consultation by such [doctor], … , shall be authorized, pursuant to rules adopted by the Oklahoma Board of Nursing, to order, select, obtain and administer legend drugs, … only when engaged in the preanesthetic preparation and evaluation; anesthesia induction, maintenance and emergence; and postanesthesia care.”**

The ONA does not limit the definition of a supervising physician to only an anesthesiologist. The CRNA “supervisor” is any individual licensed to practice as a physician who supervises the CRNA and who is not in training as an intern, resident, or fellow. Furthermore, the ONA requires the supervising practitioner to provide timely onsite consultation with the CRNA as warranted by medical conditions and circumstances. In this respect, medical professionals, in the exercise of his or her professional judgment, may establish what constitutes “timely onsite consultation.”***

Specialties in medicine have nearly caused the “Captain of the Ship Doctrine” to fall by the wayside and be replaced by vicarious liability. This doctrine was originally created to hold surgeons liable because injured patients could not sue hospitals under the old “Charitable Immunity Doctrine.”*^ This doctrine aids in finding a supervising surgeon directly responsible for an alleged error or act of alleged negligence by an assistant despite the assistant’s position as a hospital employee. Standard of care for the supervising physician is established by determining whether he or she needs to be physically present for the onsite timely consultation, and has been required in Oklahoma for nearly 60 years.

In 1995, the Oklahoma Supreme Court held in Jackson v. Oklahoma Memorial Hospital*^^ that the supervising physician owes the patient a duty of reasonable care in that supervision. Among factors affecting the supervising physician’s standard of care:

  •  The complexity of the medical or surgical procedure being carried out
  • The level of training, skill, and knowledge of the health professional
  • Any written guidelines and procedures prescribed by the healthcare facility.

A supervising physician may be liable for negligence of a CRNA under of vicarious liability, which is based on agency or contract law. The supervising surgeon may be liable for an anesthesia-related injury if the surgeon (a) abandons an unstable patient, (b) overtly directs the anesthetic plan, or (c) utilizes an unqualified anesthesia provider.

Physicians Liability Insurance Co. and other carriers calculate medical malpractice premiums by specialty and do not increase or decrease depending on supervision.*^^^ If an anesthesia mishap does occur, most courts will rightfully be able to delineate the difference in roles between the anesthesia provider and the surgeon.

The majority of mishaps occur due to reasons directly related to the underlying medical conditions or the surgical procedure. The degree of control over the delivery of the anesthetic will ultimately determine the liability. Liability should not be imputed on the surgeon for simply requesting a patient be asleep during a procedure but the law must be followed to ensure patient safety.

* Centers for Medicare & Medicaid Services, HHS. 42 CFR Ch. IV (10–1–11 Edition)
** Okla. Stat. Ann. tit. 59, § 567.3 (West)
*** 2012 WL 6560752 (Okl.A.G.)
*^ Walker, James Smith. Hospital Liability. Law Journal Press. 1985. 10(74-80)
*^^ 909 P.2d 765,774 (Okla.1995)
*^^^ Physician’s Liability Insurance Company. Physicians Professional Liability Insurance Policy (Claims – Made and reported). 2008

There are still many other facets about liability. Should you need assistance, the lawyers at Christensen Law in OKC can help to answer any questions involving this complicated term.