From Standards to Testimony: The Anatomy of Medical Legal Review

On This Episode:

Today we’re going to dive into an interesting topic: some medical legal considerations. And we’ll 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.


Here’s 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?       
  • The difference between a deposition and trial testimony and how it impacts you.



American Association of Nurse Anesthesiology (AANA) Professional Practice Standards:

Adams, J. P., Bell, M. D. D., & Bodenham, A. R. (2012). Quality and outcomes in anaesthesia: lessons from litigation. British Journal of Anaesthesia : BJA, 109(1), 110–122.

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), 1–12.

Chattopadhyay, S., Rudra, A., Ray, M., Sengupta, S., & Goswami, S. (2016). Legal Aspects in Obstetric Anesthesia. Nepal Journal of Obstetrics & Gynaecology, 10(2), 3–9.

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), 828–836.

Crosby, E. (2007). Medical malpractice and anesthesiology : literature review and role of the expert witness. Canadian Journal of Anesthesia, 54(3), 227–241.

Dutton, R. P. (2023). Expert Advice for the Expert Witness. Advances in Anesthesia, 41(1), 111–125.

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. §§ 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).

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), 327–337.

Ferreres, A. R. (2022). Expert Witness Testifying Against Colleagues. In Difficult Decisions in Surgery: An Evidence-Based Approach(pp. 241–254). Springer International Publishing.

Informed Consent: AANA document ([mentioned but not directly linked in the podcast]):

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. 775–796). Routledge.

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), 395–397.

Murphy, E. K. (2005). The expert nurse witness. AORN Journal, 82(5), 853–856.

Nicholson, E. (2014). Dallas Anesthesiologist Being Sued Over Deadly Surgery Admits to Texting, Reading iPad During Procedures. Retrieved from:

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), 1369–1374.

Second victim phenomenon:

Semo, J. J. (2014). Legal Aspects of Ambulatory Anesthesia. Anesthesiology Clinics, 32(2), 541–549.

Stevens, A. (2011). Reliability and cogency of expert witness evidence in modern civil litigation. Anaesthesia, 66(9), 764–768.

Weaver, J. M. (2009). What is the standard of care for anesthesia? Who determines it? Anesthesia Progress, 56(1), 1–2.

White, S. M. (2014). Ethical and legal aspects of anaesthesia for the elderly. Anaesthesia, 69(s1), 45–53.

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-.


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J. Cross CRNA
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This podcast is very well put together. I love the hosts Sharon & Jeremy, they do a fantastic job at presenting topics as well as getting great speakers on the show! This is my morning commute podcast everyday! Thank you for all that you do!
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I enjoy listening every morning. Great content and always a pleasure to learn something new.
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I started listening to this podcast religiously early on in my CRNA journey, a year before applying to CRNA school. The content in this podcast was one of my most helpful resources for getting into my first choice school, Wake Forest! It has also been a huge motivator for getting involved with the AANA now and throughout my career. I highly recommend this podcast to every prospective CRNA I meet.
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I appreciate hearing the latest and greatest in the world of Nurse Anesthesiology while also getting Class B credits. Just listen on your commute for a win/win experience. I love the perspectives from Jeremy and Sharon who both ask varied and insightful questions!
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If you’re a CRNA or any medical professional, I highly recommend giving this podcast a listen. Hosts have a great rapport.