In my view, anesthesiology is one of the most demanding medical specialties. Anesthesiologists put patients to sleep so they can’t experience pain, but they can’t over-sedate them without risking being able to bring them back.
Unfortunately, the practice of anesthesia medicine has gone in the wrong direction. Insurance companies, lobbyists, and others have pushed for increasing rights and recognitions for lesser-trained nurse anesthetists. In fact, in Texas, these certified registered nurse anesthetists (CRNAs) largely run the show in most operating rooms (ORs), with one anesthesiologist in the hallway supervising the work of up to five CRNAs in five different operating rooms at once.
A recent review of closed medical malpractice claims reveals the three most common types of anesthesiology-related cases:
• Poor management of patients under anesthesia: 32% of all claims
In my experience and observation, there’s been an uptick in medical malpractice cases in this area because of the overreliance on CRNAS. Anesthesiologists can’t be in five operating rooms at once, so when there is an emergency they need to be located and get to the OR pronto.
In many emergency situations, the anesthesiologist wasn’t present in the OR for 30 minutes or more and was largely clueless of what had been going on. Getting up to speed takes precious time, which is a danger to patients in a cardiac or respiratory crisis. That’s when mistakes in emergency resuscitation tend to be made.
• Sub-standard performance of anesthesia procedures: 27% of all claims
In addition to administering anesthetic drugs, anesthesiologists should have expertise in carrying out different procedures. For example, anesthesiologists are airway experts who are the go-to providers when it comes to intubating patients. Intubation is the process of inserting an endotracheal breathing tube down a person’s throat to secure an airway. Sometimes this is done before surgery begins, but on other occasions, it’s an emergency.
I’ve handled Texas medical malpractice cases where anesthesiologists attempted intubation but missed the windpipe when inserting the breathing tube. This is called esophageal intubation and is dangerous and useless to the patient. It can cause brain injury and death if not promptly recognized and corrected.
Other procedures anesthesiologists sometimes botch is injecting anesthetic medication into the wrong place, whether a peripheral nerve or the spinal cord itself. The standard of care requires anesthesiologists to carefully select and monitor the correct location for administering medications.
• Improper positioning: 6%
While the surgeon and OR nurses also have a role in properly positioning the patient for an operation, most of the responsibility falls on the anesthesiologist (or, when an anesthesiologist isn’t there, the CRNA). The idea behind positioning is making sure that the bony prominences on the body, such as the elbows, are protected by padding or pillows to prevent nerve compression injuries.
The most common positioning nerve injury that I’ve seen in my practice is to the ulnar nerve, which runs right along the funny bone (aptly named the humerus). When the nerve injury is permanent, it causes muscle atrophy along the medial part of the forearm and hand plus typically contracture of the pinky and fourth finger.
Anesthesiology cases are complex and require careful attorney and medical expert review. If you’ve experienced an operating room or anesthesia injury, your best bet is to contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
