On This Episode:
Today we're going to dive into an interesting topic: some medical legal considerations. And weโll talk a little bit about being an expert witness. We'll cover anesthesia standards created and published by the American Association of Nurse Anesthesiology, and share some of our own experiences acting as expert witnesses in medical legal complaints filed on behalf of patients. Perhaps just as important though, we're going to talk about ways that you can keep yourself out of hot water and keep your patients safe.
It's important that as providers we periodically review the standards by which we're expected to practice. Both for the benefit of our patients and to make sure that we're practicing at the highest levels of anesthesia care every single day.
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Hereโs some of what we discuss in this episode:
- Reviewing the Standards for Nursing Practice from the Professional Practice Manual.
- The most common problems that I have seen that have resulted in litigation fall into four main categories.
- Who evaluates whether or not the standard of care has been satisfied?ย ย ย ย ย ย ย
- The difference between a deposition and trial testimony and how it impacts you.
References
American Association of Nurse Anesthesiology (AANA) Professional Practice Standards: https://www.aana.com/practice/professional-practice-manual/
Adams, J. P., Bell, M. D. D., & Bodenham, A. R. (2012). Quality and outcomes in anaesthesia: lessons from litigation. British Journal of Anaesthesiaโฏ: BJA, 109(1), 110โ122. https://doi.org/10.1093/bja/aes188
Argo, A., Zerbo, S., Lanzarone, A., Buscemi, R., Roccuzzo, R., & Karch, S. B. (2019). Perioperative and anesthetic deaths: toxicological and medico legal aspects. Egyptian Journal of Forensic Sciences, 9(1), 1โ12. https://doi.org/10.1186/s41935-019-0126-6
Chattopadhyay, S., Rudra, A., Ray, M., Sengupta, S., & Goswami, S. (2016). Legal Aspects in Obstetric Anesthesia. Nepal Journal of Obstetrics & Gynaecology, 10(2), 3โ9. https://doi.org/10.3126/njog.v10i2.14327
Cook, T. M., Morgan, P. J., & Hersch, P. E. (2011). Equal and opposite expert opinion. Airway obstruction caused by a retrosternal thyroid mass: management and prospective international expert opinion. Anaesthesia, 66(9), 828โ836. https://doi.org/10.1111/j.1365-2044.2011.06650.x
Crosby, E. (2007). Medical malpractice and anesthesiologyโฏ: literature review and role of the expert witness. Canadian Journal of Anesthesia, 54(3), 227โ241. https://doi.org/10.1007/BF03022645
Dutton, R. P. (2023). Expert Advice for the Expert Witness. Advances in Anesthesia, 41(1), 111โ125. https://doi.org/10.1016/j.aan.2023.06.001
Early, D. S., Lightdale, J. R., Vargo, J. J., Acosta, R. D., Chandrasekhara, V., Chathadi, K. V., Evans, J. A., Fisher, D. A., Fonkalsrud, L., Hwang, J. H., Khashab, M. A., Muthusamy, V. R., Pasha, S. F.,
Court of Appeals of Texas, First District, Houston. (2015, November 5). Mangin v. Wendt, 480 S.W.3d 701. 2015 Tex. App. LEXIS 11495. (Mangin v. Wendt, 480 S.W.3d 701). (Overview: Expert anesthesiologist's report and curriculum vitae did not demonstrate his qualification to offer specific expert opinions regarding the care rendered by a cardiologist when a coronary artery was perforated during a catheterization and during subsequent complications, contrary to Tex. Civ. Prac. & Rem. Code Ann. ยงยง 74.401(c) and 74.351(a))
Hollingsworth v. Springs, 353 S.W.3d 506, 2011 Tex. App. LEXIS 7028 (Court of Appeals of Texas, Fifth District, Dallas, August 30, 2011, Opinion Issued). https://advance-lexis-com.ezp.twu.edu/api/document?collection=cases&id=urn:contentItem:53NT-CN51-F04K-B0P3-00000-00&context=1516831.
Saltzman, J. R., Shergill, A. K., Cash, B. D., & DeWitt, J. M. (2018). Guidelines for sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy, 87(2), 327โ337. https://doi.org/10.1016/j.gie.2017.07.018
Ferreres, A. R. (2022). Expert Witness Testifying Against Colleagues. In Difficult Decisions in Surgery: An Evidence-Based Approach(pp. 241โ254). Springer International Publishing. https://doi.org/10.1007/978-3-030-84625-1_18
Informed Consent: AANA document ([mentioned but not directly linked in the podcast]): https://www.aana.com/
Iyer, P. W. (2020). The Expert Fact Witness: Medical Summary Preparation and Testimony. In Legal Nurse Consulting Principles and Practices (4th ed., Vol. 1, pp. 775โ796). Routledge. https://doi.org/10.4324/9780429283642-32
Liang, B. A., & Walman, A. T. (2003). Who can be an expert in anesthesia malpractice suits? A case of general anesthesia, cardiopulmonary risk, and patient death. Journal of Clinical Anesthesia, 15(5), 395โ397. https://doi.org/10.1016/S0952-8180(03)00104-1
Murphy, E. K. (2005). The expert nurse witness. AORN Journal, 82(5), 853โ856. https://doi.org/10.1016/S0001-2092(06)60278-0
Nicholson, E. (2014). Dallas Anesthesiologist Being Sued Over Deadly Surgery Admits to Texting, Reading iPad During Procedures. Retrieved from: https://www.dallasobserver.com/news/dallas-anesthesiologist-being-sued-over-deadly-surgery-admits-to-texting-reading-ipad-during-procedures-7134970
Radvansky, B. M., Farver, W. T., Svider, P. F., Eloy, J. A., Gubenko, Y. A., & Eloy, J. D. (2015). A Comparison of Plaintiff and Defense Expert Witness Qualifications in Malpractice Litigation in Anesthesiology. Anesthesia and Analgesia, 120(6), 1369โ1374. https://doi.org/10.1213/ANE.0000000000000673
Second victim phenomenon: https://pubmed.ncbi.nlm.nih.gov/37688607/
Semo, J. J. (2014). Legal Aspects of Ambulatory Anesthesia. Anesthesiology Clinics, 32(2), 541โ549. https://doi.org/10.1016/j.anclin.2014.02.009
Stevens, A. (2011). Reliability and cogency of expert witness evidence in modern civil litigation. Anaesthesia, 66(9), 764โ768. https://doi.org/10.1111/j.1365-2044.2011.06857.x
Weaver, J. M. (2009). What is the standard of care for anesthesia? Who determines it? Anesthesia Progress, 56(1), 1โ2. https://doi.org/10.2344/0003-3006-56.1.1
White, S. M. (2014). Ethical and legal aspects of anaesthesia for the elderly. Anaesthesia, 69(s1), 45โ53. https://doi.org/10.1111/anae.12519
Wright, G. (2010). Pediatric Anesthesia 2009: the child who refuses to undergo anesthesia and surgery: a case scenario-based discussion of the ethical and legal issues. European Archives of Paediatric Dentistry, 11(2), 101-.
