40-Year Career in Jeopardy

I have been practicing anesthesiology for more than 40 years, and maybe this account will keep someone else from getting into the situation I am in.

Briefly, I work in an eye center and had a patient who had cataract surgery after I performed a peribulbar block. Everything went smoothly, but after being home a few hours, the patient developed a fatal hemorrhagic stroke. She had hypertension, was a 45-year cigarette smoker and had two siblings and a father die of strokes. It is customary in the southwest area — after doing our eye block in the preoperative area and then going to the operating room and making sure the patient is awake and stable and comfortable with the surgery — to break off and go check out and prepare the next patient for surgery. The patient is monitored with pulse oximetry, BPs and electrocardiograms, and there is an advanced cardiac life support nurse in the room with the patient.

After being well along in a wrongful death lawsuit, my malpractice carrier is telling me that they will not pay for any award to the plaintiff’s family. In other words, I am on my own. They base this decision on ASA’s monitoring standards for monitored anesthesia care. I always stop back in and check the patient in the operating room, and in this case, accompanied the patient to the recovery room.

I always thought I was doing a nerve block procedure, where after the block was established and the patient was stable, it was possible to quit the billing for time and attend the next patient. Everything I have worked for more 40 years is now in jeopardy, and I desperately need help.

Name withheld upon request

Editor’s Note: There must be something missing here. Even assuming the doctor was negligent by not following ASA monitored anesthesia care guidelines, the very nature of professional liability insurance is to insure against the consequences of a negligent act. A consultation with a lawyer not affiliated with the insurance company would seem appropriate.

— M.J.L.

In Defense of AAs

The criticism of anesthesiologist assistants (AAs) in the June 2003 NEWSLETTER is unwarranted and misinformed. AAs have been described as “new, inadequately trained nonphysicians trying to do our [anesthesiologists’] jobs.”^1,2

AAs are not seeking to replace the physician anesthesiologist, but it would seem that there is a need for AA skills in the anesthesia care team. Mark J. Lema, M.D., Ph.D., observed that “… we [anesthesiologists] are going to feel the squeeze between a greater demand for our services and a greater desire to have adequate family or recreational time. With the anticipated shortage of as many as 3,800 anesthesiologists and as many nurse anesthetists, however, a workforce catastrophe while just trying to maintain our current practice is a real concern to all in active practice.”³ John B. Neeld, M.D., states, “For the past 30 years, AAs have demonstrated that they are safe, skilled, dependent anesthesia providers who work harmoniously with nurse anesthetists in the care team mode of practice. I encourage ASA members to consider AA employment in states where they have obtained practice privileges.”⁴

AAs obtain a master of science degree that concentrates on application of current knowledge in basic science to clinical practices in the operating room. Their national certification examination (and recertification every six years) is modeled after the American Board of Anesthesiology examination.

I urge that critics of those in the AA profession look more closely at the training, motivation and safety records of AAs.

Ronald L. Cechner, Ph.D.
Russell, Ohio

References:
1. Klick JC. Trying to keep nonphysicians from taking our jobs. ASA Newsl. 2003; 67(6):34.
2. Colley JE. Anesthesiologist assistants — another Trojan horse? ASA Newsl. 2003; 67(6):35.
3. Lema MJ. It’s been a hard day’s night. ASA Newsl. 2002; 66(3):1, 26.
4. Neeld, JB. Integrating anesthesiologist assistants into anesthesia care team practices. ASA Newsl. 2003; 67(3):11.

— M.J.L.

— M.J.L.

— M.J.L.