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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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