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07/05/2021    Allen Jacobs, DPM

PA Law Now Allows Podiatrists to Supervise CRNAs

I read with interest the decision in the state of
Pennsylvania that a podiatrist may act as
supervisor for a CRNA. Based on my prior
experience I would suggest that one approach this
with caution as an example of being careful for
what you wish for.

Some years ago I acted as a defense expert in a
wrongful death case. In this particular state,
absent the physical presence of an
anesthesiologist in the operating room, the
“surgeon“ was responsible for the actions of the
CRNA. In this particular case the nurse
anesthetist gave a medication by bolus which was
contra indicated. The podiatrist was busily
performing an excision of a ganglionic cyst.
Unfortunately the patient expired.

In addition to suing the anesthesia group, the
podiatrist was also held liable due to the fact
that the surgeon was by law in this particular
state responsible for the actions of the cRNA.
Following a large settlement against the
anesthesia group, the podiatrist was eventually
released from the lawsuit.

In another case in which I acted as an expert
witness, a patient expired from anesthesia during
the amputation of a toe for gangrene. The
anesthesia administered was that of anesthesia
with sedation. Unfortunately the patient suffered
a cardiac event and died. The podiatrist had
dutifully obtained cardiac clearance for the
patient however, the cardiologist cleared the
patient only for local anesthesia. The
anesthetist decided to administer sedation in
addition to the local anesthesia. The podiatrist
was held responsible for not clearly
communicating the cardiologists wishes to the
nurse anesthetist although the records appeared
to indicate that the podiatrist did in fact
provide the anesthesia department with the
recommendations of the cardiologist.

Neither of these cases resulted in any award of
damages against the podiatrist. However, there
was the obvious aggravation of dealing with a
malpractice case.

The question is whether or not you wish to assume
that responsibility. In a third wrongful death
suit in which I also acted as an expert witness,
a patient died of a pulmonary embolism and
following an Austin bunionectomy. The podiatrist
was held responsible for failing to diagnose DVT
prior to the fatal pulmonary embolism. I remember
the testimony of the plaintiff expert, a
pulmonary specialist from Harvard university. His
quote was “if a podiatrist wishes to act like a
real doctor, they must also take responsibility
as would a real doctor“.

The question goes beyond the legal ability of a
podiatrist to supervise a nurse anesthetist. The
real question is whether or not you feel
comfortable that you have adequate expertise,
experience and knowledge to do so. Again, be
careful what you wish for.

Allen Jacobs, DPM, St. Louis, MO

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