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Medical-Legal Aspects of Nurse Anesthetist Practice Jeffrey Groom, PhD, CRNA, ARNP FIU Anesthesiology Nursing Program
<ul><li>A Professional Study and Resource Guide for the CRNA Chapters 5,6,7  </li></ul><ul><li>AANA General Counsel Gene B...
Relationship of  Medicine & Law <ul><li>Forensic Medicine </li></ul><ul><li>Regulation of service & health professionals <...
Sources of Law <ul><li>Constitution </li></ul><ul><ul><li>US Constitution </li></ul></ul><ul><ul><li>State Constitution </...
Interrelationship of Laws CONSTITUTION Government Legislative Judicial Executive Administrative Agencies Enacts Statutes C...
CRNA’s and the LAW <ul><li>Federal vs State vs Local </li></ul><ul><li>Criminal vs. Civil </li></ul><ul><ul><li>Adult/Juvi...
CRNA’s and the LAW ADMINISTRATIVE  CRIMINAL  CIVIL Perception is biggest area of concern is malpractice (civil) In reality...
CRNA’s and the LAW <ul><li>Florida Nurse Practice Act </li></ul><ul><ul><li>ARNP </li></ul></ul><ul><li>Federal/State Regu...
CRNAs and the LAW <ul><li>Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&...
<ul><li>Individual vs Group Practice </li></ul><ul><li>Fiduciary Relationship </li></ul><ul><li>Privileged Communications ...
Provider – Patient Relationship <ul><li>Contractual Relationship (Service contract vs Sale contract) </li></ul><ul><ul><li...
<ul><li>Duty of Providers to Patients </li></ul><ul><li>Practice at professional level </li></ul><ul><li>Make full disclos...
Provider – Patient Relationship <ul><li>Duty of Patients to Providers </li></ul><ul><li>Make full disclosure </li></ul><ul...
Provider – Patient Relationship Breech of Contract vs Negligence <ul><li>DUTIES </li></ul><ul><li>Professional Care </li><...
<ul><li>Abandonment </li></ul><ul><li>Assault </li></ul><ul><li>Battery </li></ul><ul><li>Breech of Confidence </li></ul><...
<ul><li>Malpractice is negligence within a professional activity </li></ul><ul><li>Tort is a civil wrong committed by: </l...
<ul><li>Anyone can allege or sue for negligence.  (Didn’t listen – Didn’t care) </li></ul><ul><li>Whether or not negligenc...
<ul><li>Analysis of negligence: </li></ul><ul><li>Duty – contractual relationship </li></ul><ul><li>Breech – standard of c...
<ul><li>Standard of Care </li></ul><ul><li>Reasonable person vs. professional </li></ul><ul><li>Local practice vs nationwi...
Professional Negligence <ul><li>Res ipsa loquitur </li></ul><ul><li>Defendant in exclusive control </li></ul><ul><li>Patie...
<ul><li>Defenses to Negligence Action </li></ul><ul><li>Immunity </li></ul><ul><li>Conduct met standard of care </li></ul>...
<ul><li>Dose of anesthetics required to produce general anesthesia is very close to, or exceeds the LD50. </li></ul><ul><l...
<ul><li>Some components of balanced general anesthesia adversely affect sympathetic activity, vasomotor tone, myocardial f...
<ul><li>Attempts to produce spinal anesthesia may result in a high or total spinal, or produce spinal nerve or spinal cord...
Medical-Legal Aspects of Nurse Anesthetist Practice Jeffrey Groom, PhD, CRNA, ARNP FIU Anesthesiology Nursing Program
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Transcript of "Medical-Legal Aspects of Nurse Anesthetist Practice"

  1. 1. Medical-Legal Aspects of Nurse Anesthetist Practice Jeffrey Groom, PhD, CRNA, ARNP FIU Anesthesiology Nursing Program
  2. 2. <ul><li>A Professional Study and Resource Guide for the CRNA Chapters 5,6,7 </li></ul><ul><li>AANA General Counsel Gene Blumenreich, JD </li></ul><ul><li>AANA Legal Briefs – Newsletter/Journal/AANA Web </li></ul><ul><li>Lecture does not constitute legal advice and does not substitute for the services of an licensed attorney </li></ul>Medical-Legal Aspects of Nurse Anesthetist Practice
  3. 3. Relationship of Medicine & Law <ul><li>Forensic Medicine </li></ul><ul><li>Regulation of service & health professionals </li></ul><ul><li>Regulation between parties Patients & Providers </li></ul>
  4. 4. Sources of Law <ul><li>Constitution </li></ul><ul><ul><li>US Constitution </li></ul></ul><ul><ul><li>State Constitution </li></ul></ul><ul><li>Statutes </li></ul><ul><ul><li>Federal and State </li></ul></ul><ul><ul><li>Administrative Regulations </li></ul></ul><ul><li>Common Law </li></ul><ul><ul><li>Case law – Doctrine of Stare Decisis </li></ul></ul><ul><ul><li>Fair, Consistent, Predictable, Effectuates public policy </li></ul></ul>Federal – State – Local
  5. 5. Interrelationship of Laws CONSTITUTION Government Legislative Judicial Executive Administrative Agencies Enacts Statutes Creates Empowers Enforce Laws Amend or Abolish Administrative Regulations Interpret Creates Constitution Common Law Create-Execute-Judge Administrative Agencies Attorney Gen Boards
  6. 6. CRNA’s and the LAW <ul><li>Federal vs State vs Local </li></ul><ul><li>Criminal vs. Civil </li></ul><ul><ul><li>Adult/Juvi/Family vs Contracts/Torts </li></ul></ul><ul><li>Substantive vs Procedural </li></ul><ul><li>Laws vs. Administrative Rules </li></ul>
  7. 7. CRNA’s and the LAW ADMINISTRATIVE CRIMINAL CIVIL Perception is biggest area of concern is malpractice (civil) In reality, the numbers show just the opposite….
  8. 8. CRNA’s and the LAW <ul><li>Florida Nurse Practice Act </li></ul><ul><ul><li>ARNP </li></ul></ul><ul><li>Federal/State Regulatory Statutes </li></ul><ul><ul><li>DEA, FDA, HICFA </li></ul></ul><ul><li>Council on Certification of NAs </li></ul><ul><ul><li>CRNA </li></ul></ul><ul><li>Practice Facility </li></ul><ul><ul><li>JCAHO, Credentialing & Staff Privileges </li></ul></ul><ul><li>Practice Group </li></ul><ul><ul><li>Protocols and Policies </li></ul></ul><ul><li>Liability Insurance Provider </li></ul><ul><ul><li>Policy Terms – Limits - Provisions </li></ul></ul><ul><li>Medicare and Medicaid Regulations </li></ul><ul><ul><li>National Provider Identifier ( http://npienumerator.com/ ) </li></ul></ul>
  9. 9. CRNAs and the LAW <ul><li>Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes </li></ul><ul><li>Laws vs. Administrative Rules http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes </li></ul><ul><li>Department of Health – Medical Quality Assurance Service http:// www.doh.state.fl.us/mqa/index.html </li></ul><ul><li>Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes </li></ul><ul><li>Laws vs. Administrative Rules http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes </li></ul><ul><li>Department of Health – Medical Quality Assurance Service http:// www.doh.state.fl.us/mqa/index.html </li></ul><ul><li>Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes </li></ul><ul><li>Laws vs. Administrative Rules http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes </li></ul><ul><li>Department of Health – Medical Quality Assurance Service http:// www.doh.state.fl.us/mqa/index.html </li></ul>
  10. 10. <ul><li>Individual vs Group Practice </li></ul><ul><li>Fiduciary Relationship </li></ul><ul><li>Privileged Communications </li></ul>Provider – Patient Relationship
  11. 11. Provider – Patient Relationship <ul><li>Contractual Relationship (Service contract vs Sale contract) </li></ul><ul><ul><li>Offer </li></ul></ul><ul><ul><li>Consideration </li></ul></ul><ul><ul><li>Acceptance </li></ul></ul>
  12. 12. <ul><li>Duty of Providers to Patients </li></ul><ul><li>Practice at professional level </li></ul><ul><li>Make full disclosure </li></ul><ul><li>Protect confidence </li></ul><ul><li>Offer continuing treatment </li></ul><ul><li>Seek consultation when indicated </li></ul>Provider – Patient Relationship
  13. 13. Provider – Patient Relationship <ul><li>Duty of Patients to Providers </li></ul><ul><li>Make full disclosure </li></ul><ul><li>Full cooperation in treatment </li></ul><ul><li>Pay for services rendered </li></ul>
  14. 14. Provider – Patient Relationship Breech of Contract vs Negligence <ul><li>DUTIES </li></ul><ul><li>Professional Care </li></ul><ul><li>Disclosure </li></ul><ul><li>Confidence </li></ul><ul><li>Treatment </li></ul><ul><li>Consultation </li></ul>Professional Negligence Breech of Contract Intentional Tort Breech of Duty Criminal and Negligence Action
  15. 15. <ul><li>Abandonment </li></ul><ul><li>Assault </li></ul><ul><li>Battery </li></ul><ul><li>Breech of Confidence </li></ul><ul><li>Defamation </li></ul><ul><li>False Imprisonment </li></ul><ul><li>Fraud </li></ul><ul><li>Intentional infliction of emotional harm </li></ul><ul><li>Invasion of privacy </li></ul>Intentional Torts
  16. 16. <ul><li>Malpractice is negligence within a professional activity </li></ul><ul><li>Tort is a civil wrong committed by: </li></ul><ul><ul><li>action or omission </li></ul></ul><ul><ul><li>intentional or negligent </li></ul></ul>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
  17. 17. <ul><li>Anyone can allege or sue for negligence. (Didn’t listen – Didn’t care) </li></ul><ul><li>Whether or not negligence occurred is decided in court. </li></ul><ul><li>Proof of negligence: </li></ul><ul><ul><li>Duty </li></ul></ul><ul><ul><li>Breech </li></ul></ul><ul><ul><li>Injury </li></ul></ul><ul><ul><li>Causation </li></ul></ul><ul><ul><li>Damage </li></ul></ul>Professional Negligence Dowe, Shaftem & Nailem 305-555-1212
  18. 18. <ul><li>Analysis of negligence: </li></ul><ul><li>Duty – contractual relationship </li></ul><ul><li>Breech – standard of care </li></ul><ul><li>Injury – substantiated injury </li></ul><ul><li>Causation – proximate causation </li></ul><ul><li>Damage – special, general, punitive </li></ul>Professional Negligence
  19. 19. <ul><li>Standard of Care </li></ul><ul><li>Reasonable person vs. professional </li></ul><ul><li>Local practice vs nationwide </li></ul><ul><li>Anesthesia care – single standard of care </li></ul><ul><li>Standards of Practice </li></ul><ul><ul><li>Professional Organizations </li></ul></ul><ul><ul><li>Practice Standards and Guidelines </li></ul></ul><ul><li>Changing standards </li></ul><ul><ul><li>Advances in practice (Washington vs. Washington Hospital – 1987) </li></ul></ul><ul><ul><li>Common law </li></ul></ul><ul><li>Standard of Care in the Courtroom </li></ul>Professional Negligence
  20. 20. Professional Negligence <ul><li>Res ipsa loquitur </li></ul><ul><li>Defendant in exclusive control </li></ul><ul><li>Patient not contributory negligent </li></ul><ul><li>Patient did not observe negligence </li></ul><ul><li>Could not have occurred otherwise </li></ul><ul><li>Common knowledge that the act would cause injury </li></ul>
  21. 21. <ul><li>Defenses to Negligence Action </li></ul><ul><li>Immunity </li></ul><ul><li>Conduct met standard of care </li></ul><ul><li>Contributory negligence </li></ul><ul><li>Comparative negligence </li></ul><ul><li>Assumption of risk </li></ul><ul><li>Consent </li></ul>Professional Negligence
  22. 22. <ul><li>Dose of anesthetics required to produce general anesthesia is very close to, or exceeds the LD50. </li></ul><ul><li>General anesthetics deprive patients of their protective respiratory reflexes risking obstruction and aspiration. </li></ul><ul><li>Airway management problems are not uncommon thus risking hypoxia or anoxia. </li></ul><ul><li>Some general anesthetics and all muscle relaxants depress or obliterate spontaneous respiration. </li></ul>Liability of Anesthesiology
  23. 23. <ul><li>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. </li></ul><ul><li>Some forms of regional anesthesia, spinal and epidural, may cause cardiovascular collapse from total spinal or cardiotoxicity. </li></ul>Liability of Anesthesiology
  24. 24. <ul><li>Attempts to produce spinal anesthesia may result in a high or total spinal, or produce spinal nerve or spinal cord injury. </li></ul><ul><li>Techniques of invasive monitoring may produce adverse complications or death. </li></ul><ul><li>Short term patient contact, and differing personnel from preop to intraop and postop. </li></ul><ul><li>Team delivery is also team liability </li></ul>Liability of Anesthesiology
  25. 25. Medical-Legal Aspects of Nurse Anesthetist Practice Jeffrey Groom, PhD, CRNA, ARNP FIU Anesthesiology Nursing Program
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