FAQ

Is it safe to use a CRNA?

Absolutely. See “About CRNAs”. Multiple studies over several decades have demonstrated no discernible difference in patient outcomes when anesthesia is administered by an anesthesiologist, anesthesiologist/CRNA team, or CRNA alone. Here are just two examples.

The latest, a study published in the August 2010 issue of “Health Affairs” (a preeminent health care and policy journal) concluded that, “An analysis of Medicare data for 1999–2005 finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications”. The researchers also recommend that CMS allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist.

In 1994, the Minnesota Department of Health (DOH), as mandated by the state Legislature, studied the provision of anesthesia services by CRNAs and anesthesiologists. The department reached four conclusions, including the following: “There are no studies, either national in scope or Minnesota specific, which conclusively show a difference in patient outcomes based on type of anesthesia provider”.

Another very telling indicator is that between 1988 and 2004 CRNA liability insurance premium actually decreased 39% nationally!

 

As the “surgeon”, am I liable for the CRNA’s actions?

The short answer is “No”. Nurse Anesthetists provide anesthesia under the order of the “surgeon”. However, surgeons have no obligation to control the substantive course of the anesthetic process. The CRNA is relied upon as the “expert” provider of anesthesia and uses independent judgment in administering the anesthetic.

Courts have, however, held “surgeons” liable for anesthesia negligence in instances where the surgeon asserted direct control over the anesthesia providers’ actions, not merely supervised or directed the administrator.

 

Am I more liable using a CRNA to provide anesthesia?

Definitely not. Courts apply the same standard when judging whether surgeons are liable for the acts of an anesthesia provider, regardless of whether the provider is a nurse anesthetist or anesthesiologist.

In a January 1988 report of the Center for Health Economics Research (CHER), an independent Boston-area based research organization that analyzes and evaluates health-related policy issues, CHER concluded that “both legal doctrine and case history (as reviewed by the AANA and ASA) do not indicate a tendency on the part of the courts to hold surgeons liable more often when they work with nurse anesthetists than with anesthesiologists.”

Multiple examples of case law supporting these positions:

Courts have held surgeons liable for the negligence of anesthesiologists when the surgeons had control of the anesthesiologists’ actions.  

Schneider v. Einstein Med. Ctr., 390 A.2d 1271 (Penn. 1978) and Kitto v. Gilbert, 570 P.2d 544 (Colo. 1977)

 

Courts have found that the surgeon was not in control of the nurse anesthetist and, therefore, not liable for the negligence of the nurse anesthetist.

Cavero v. Franklin Benevolence Soc’y, 223 P.2d 471 (Cal. 1950); Fortson v. McNamara, 508 So.2d 35 (Fla. 1987); Franklin v. Gupta, 567 A.2d 524 (Md. 1990); Hughes v. St. Paul Fire and Marine Ins. Co., 401 So.2d 448 (La. 1981); Kemelyan v. Henderson, 277 P.2d 372 (Wash. 1954); Parker v. Vanderbilt, 767 S.W.2d 412 (Tenn. 1988); Pierre v. Lavallie Kemp Charity Hosp., 515 So.2d 614 (La. 1987); Thomas v. Raleigh Gen’l Hosp., 358 S.E.2d 222 (W. Va. 1987); Sesselmen v. Mulenberg Hosp., 306 A.2d 474 (N.J. 1954).

 

Numerous cases hold that mere supervision or direction of a nurse anesthetist is insufficient to hold a physician liable for a nurse anesthetist’s negligence.

Sesselmen v. Mulenberg Hosp., 306 A.2d 474 (N.J. Super. Ct. App. Div. 1973); Baird v. Sickler, 69 Ohio St.2d 652 (1982); Foster v. Englewood Hosp., 19 Ill. App. 3d. 1055 (1974); Elizondo v. Tavarez, 596 S.W.2d 667 (Tex. 1980); Whitfield v. Whittaker Mem. Hosp., 210 (Va. 176 (1969).