Medical-Legal Aspects of Nurse Anesthetist Practice
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Transcript of Medical-Legal Aspects of Nurse Anesthetist Practice
Medical-Legal Aspects of Nurse Medical-Legal Aspects of Nurse Anesthetist PracticeAnesthetist Practice
Jeffrey Groom, PhD, CRNA, ARNPFIU Anesthesiology Nursing Program
• A Professional Study and Resource Guide for the CRNAChapters 5,6,7
• AANA General Counsel Gene Blumenreich, JD• AANA Legal Briefs – Newsletter/Journal/AANA Web• Lecture does not constitute legal advice and does
not substitute for the services of an licensed attorney
Medical-Legal Aspects of Nurse Anesthetist
Practice
Relationship of Medicine & Law
• Forensic Medicine• Regulation of service
& health professionals• Regulation between parties
Patients & Providers
Sources of Law
• Constitution– US Constitution– State Constitution
• Statutes– Federal and State– Administrative Regulations
• Common Law– Case law – Doctrine of Stare Decisis– Fair, Consistent, Predictable, Effectuates public policy
Federal – State – Local
Interrelationship of LawsCONSTITUTION
Government
Legislative JudicialExecutive
Administrative Agencies
Enacts
Statutes
Creates
Empowers Enforce
LawsAmend
or Abolish
Administrative Regulations
Interpret Creates
Constitution
Common Law
Create-Execute-Judge
AdministrativeAgencies
Attorney Gen
Boards
CRNA’s and the LAW
• Federal vs State vs Local• Criminal vs. Civil
– Adult/Juvi/Family vs Contracts/Torts
• Substantive vs Procedural• Laws vs. Administrative Rules
CRNA’s and the LAW
ADMINISTRATIVE CRIMINAL CIVILPerception is biggest area of concern is
malpractice (civil)In reality, the numbers show just the opposite….
CRNA’s and the LAW
• Florida Nurse Practice Act– ARNP
• Federal/State Regulatory Statutes– DEA, FDA, HICFA
• Council on Certification of NAs– CRNA
• Practice Facility– JCAHO, Credentialing & Staff Privileges
• Practice Group– Protocols and Policies
• Liability Insurance Provider– Policy Terms – Limits - Provisions
• Medicare and Medicaid Regulations– National Provider Identifier ( http://npienumerator.com/ )
CRNAs and the LAW
• Florida Nurse Practice Acthttp://www.leg.state.fl.us/Statutes/index.cfm?Mode=View%20Statutes&Submenu=1&Tab=statutes
• Laws vs. Administrative Ruleshttp://www.leg.state.fl.us/Statutes/index.cfm?Mode=View%20Statutes&Submenu=1&Tab=statutes
• Department of Health – Medical Quality Assurance Servicehttp://www.doh.state.fl.us/mqa/index.html
• Florida Nurse Practice Acthttp://www.leg.state.fl.us/Statutes/index.cfm?Mode=View%20Statutes&Submenu=1&Tab=statutes
• Laws vs. Administrative Ruleshttp://www.leg.state.fl.us/Statutes/index.cfm?Mode=View%20Statutes&Submenu=1&Tab=statutes
• Department of Health – Medical Quality Assurance Servicehttp://www.doh.state.fl.us/mqa/index.html
• Florida Nurse Practice Acthttp://www.leg.state.fl.us/Statutes/index.cfm?Mode=View%20Statutes&Submenu=1&Tab=statutes
• Laws vs. Administrative Ruleshttp://www.leg.state.fl.us/Statutes/index.cfm?Mode=View%20Statutes&Submenu=1&Tab=statutes
• Department of Health – Medical Quality Assurance Servicehttp://www.doh.state.fl.us/mqa/index.html
• Individual vs Group Practice• Fiduciary Relationship• Privileged Communications
Provider – Patient Relationship
Provider – Patient Relationship
•Contractual Relationship(Service contract vs Sale contract)
–Offer–Consideration–Acceptance
Duty of Providers to Patients• Practice at professional level• Make full disclosure• Protect confidence• Offer continuing treatment• Seek consultation when indicated
Provider – Patient Relationship
Provider – Patient Relationship
Duty of Patients to Providers• Make full disclosure• Full cooperation in treatment• Pay for services rendered
Provider – Patient Relationship
Breech of Contract vs Negligence
DUTIES
1. Professional Care
2. Disclosure
3. Confidence
4. Treatment
5. Consultation
Professional Negligence
Breech of Contract
Intentional Tort
Breech of Duty
Criminal and Negligence
Action
• Abandonment• Assault• Battery• Breech of Confidence• Defamation• False Imprisonment• Fraud• Intentional infliction of emotional harm• Invasion of privacy
Intentional Torts
• Malpractice is negligence within a professional activity
• Tort is a civil wrong committed by:– action or omission– intentional or negligent
Professional Negligence
Most actions for negligence are for: - omission (what should have been done and was not) - negligence (no reason not to have done what was omitted)
Perception- most malpractice is for something done wrong
• Anyone can allege or sue for negligence. (Didn’t listen – Didn’t care)
• Whether or not negligence occurred is decided in court.
• Proof of negligence:– Duty– Breech– Injury– Causation– Damage
Professional Negligence
Dowe, Shaftem & Nailem
305-555-1212
305-555-1212
Analysis of negligence:• Duty – contractual relationship• Breech – standard of care• Injury – substantiated injury• Causation – proximate causation• Damage – special, general, punitive
Professional Negligence
Standard of Care• Reasonable person vs. professional• Local practice vs nationwide• Anesthesia care – single standard of care• Standards of Practice
– Professional Organizations– Practice Standards and Guidelines
• Changing standards– Advances in practice (Washington vs. Washington Hospital – 1987)
– Common law
• Standard of Care in the Courtroom
Professional Negligence
Professional Negligence
Res ipsa loquitur• Defendant in exclusive control• Patient not contributory negligent• Patient did not observe negligence• Could not have occurred otherwise• Common knowledge that the act
would cause injury
Defenses to Negligence Action• Immunity• Conduct met standard of care• Contributory negligence• Comparative negligence• Assumption of risk• Consent
Professional Negligence
1. Dose of anesthetics required to produce general anesthesia is very close to, or exceeds the LD50.
2. General anesthetics deprive patients of their protective respiratory reflexes risking obstruction and aspiration.
3. Airway management problems are not uncommon thus risking hypoxia or anoxia.
4. Some general anesthetics and all muscle relaxants depress or obliterate spontaneous respiration.
Liability of Anesthesiology
• Some components of balanced general anesthesia adversely affect sympathetic activity, vasomotor tone, myocardial function, especially in patients on antihypertensives. Stage is set for potential hypotension, myocardial depression, and circulatory collapse.
• Some forms of regional anesthesia, spinal and epidural, may cause cardiovascular collapse from total spinal or cardiotoxicity.
Liability of Anesthesiology
• Attempts to produce spinal anesthesia may result in a high or total spinal, or produce spinal nerve or spinal cord injury.
• Techniques of invasive monitoring may produce adverse complications or death.
• Short term patient contact, and differing personnel from preop to intraop and postop.
• Team delivery is also team liability
Liability of Anesthesiology
Medical-Legal Aspects of Nurse Anesthetist Practice
Jeffrey Groom, PhD, CRNA, ARNPFIU Anesthesiology Nursing Program