Here is a pattern we are seeing more and more:
- A supposedly simple outpatient procedure
- The patient arrests, EMS is called to transport them to the hospital
- The patient either dies or suffers permanent brain damage
- When we investigate, we discover there was no anesthesiologist involved, anesthesia was administered solely by a nurse, and the “supervising” doctor was not an anesthesiologist
Is This Trend New in Anesthesia Practices?
Not exactly, but it is certainly increasing, and we are expecting to see even more of these cases in the future.
Real Patient Stories: When Anesthesia Goes Wrong
Here are some of the calls that made us ask: “What is going on with anesthesia?”
Caller 1 – The doctor said it would be a simple, one-day procedure, just a routine battery replacement for his spinal cord stimulator. We arrived that morning; they said we would be home by the afternoon. I was in the waiting area, ready to drive him home, when everything suddenly changed. Staff started rushing around, and EMS arrived to take my husband to the hospital. At the hospital they explained there was an anesthesia mishap. Six months in hospitals and rehabilitation centers. Now he has plateaued cognitively. He’ll never work again. He’s still in a wheelchair and he will need care for the rest of his life.
Caller 2 – My niece went for a tummy tuck. I went along to be her ride home. Four hours later they were wheeling her out the back door to meet an ambulance waiting in the alley. At the hospital they explained she just never woke up from the anesthesia. Opioid poisoning, they said. She spent several months in the hospital. Now she is home and has the mentality of a child. She can’t work anymore and can no longer take care of her two young children. The family takes turns watching her 24/7. Doctors say she’ll be like this the rest of her life.
Caller 3 – My husband went for an epidural steroid injection. It was his second one. The last one took less than half an hour. This time, at 45 minutes in everything changed. People started running around. EMS showed up and took him to the hospital. A few days later his daughters and I made the difficult decision to unhook him from the machines and let him go.
Why Is This Happening? Key Factors Behind Anesthesia Risks
From our research while working on these cases and others like them, this is what we have found:
- The number of anesthesiologists per patient has steadily decreased over the past several years and...
- At the same time compensation/reimbursement that anesthesiologists require has steadily increased, in part because…
- Ambulatory Surgical Centers (ASCs) surpassed hospitals as the primary facility where most surgical procedures occur, fracturing and multiplying the number of facilities that must be covered by the shrinking number of anesthesiologists per patient, which resulted in…
- An increased reliance upon Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia at this increased number of facilities, especially in rural and other challenging places, then…
- Covid-19 happened, with many patients suffering serious respiratory illnesses, which further increased reliance on CRNAs, and increased the trust placed in them, all while…
- ASCs continued to increase in numbers and began to supplant hospitals in certain services, like outpatient day surgeries, while their owners…
- Who include doctors, venture capitalists, and hedge funds, continued to look for more ways to increase resilience and profitability, while…
- Health insurers devised new reimbursement models that shared with ASCs the profits resulting from money saved on a given procedure, and…
- CRNAs lobbied in opposition to Anesthesiologist groups to change rules and laws to allow them greater practice independence from anesthesiologist, so we now have…
- Far more “CRNA-only anesthesia model” facilities, where patients are anesthetized by a CRNA who is delegated to by a non-Anesthesiologist doctor, like a surgeon, who is…
- Often not supervising the CRNA, and may not even be aware that in “delegating” to that CRNA they are legally responsible for and should be supervising that CRNA, and what is more…
- The facility no longer has an anesthesiologist contracted to prepare and train the staff for an anesthesia crisis, like a CODE BLUE, so...
- When there is a CODE BLUE due to anesthesia, the “anesthesia team” (which now means a single CRNA) may be slower to recognize it and less prepared to resuscitate and rescue the patient, which tragically causes…
- The patient to suffer a hypoxic brain injury so significant that it either ends the patient’s life or leaves them severely brain damaged for life.
Are CRNAs as Safe as Anesthesiologists?
Lobbyists and spokespeople for the CRNAs say studies show that anesthesia care by CRNAs is just as safe as that provided by anesthesiologists, depending on the provider. However, those speaking for anesthesiologists advise caution. “Regardless of how one interprets the literature, it is clear that the training of nurse anesthetists and physician anesthesiologists is not equivalent,” said the Texas Society of Anesthesiologists and the Texas Medical Association to the Texas Attorney General in 2019. “Nurse anesthetists receive approximately 2-1/2 years of training following a Bachelor's degree and anesthesiologists spend at least eight years preparing for practice after a pre-medical undergraduate education. The training and experience demanded to become a board-certified anesthesiologist prepares a physician to do more than administer anesthetic drugs and perform procedural tasks. It provides physicians with the ability to rescue patients who experience significant peri-operative problems, and to address underlying medical complications.”
The Bottom Line: Patient Safety Is at Risk
One thing is for sure; there is a significant shift happening in the way anesthesia is being provided for many patients and procedures. Some facilities are cutting anesthesia costs, earning higher profits, and not doing so safely. When a facility removes the anesthesiologist from the anesthesia team, the consequences to the patient can be devastating.
Need Help With an Anesthesia Injury Case?
If you get a call on a case like this, please call and let us help you with it.
