Medical-Legal Aspects of Nurse Anesthetist Practice

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  • 1. Medical-Legal Aspects of Nurse Anesthetist Practice Jeffrey Groom, PhD, CRNA, ARNP FIU Anesthesiology Nursing Program
  • 2.
    • A Professional Study and Resource Guide for the CRNA Chapters 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
  • 3. Relationship of Medicine & Law
    • Forensic Medicine
    • Regulation of service & health professionals
    • Regulation between parties Patients & Providers
  • 4. 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
  • 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. 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
  • 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. 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/ )
  • 9. CRNAs and the LAW
    • Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes
    • Laws vs. Administrative Rules http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes
    • Department of Health – Medical Quality Assurance Service http:// www.doh.state.fl.us/mqa/index.html
    • Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes
    • Laws vs. Administrative Rules http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes
    • Department of Health – Medical Quality Assurance Service http:// www.doh.state.fl.us/mqa/index.html
    • Florida Nurse Practice Act http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes
    • Laws vs. Administrative Rules http:// www.leg.state.fl.us/Statutes/index.cfm?Mode =View%20Statutes&Submenu=1&Tab=statutes
    • Department of Health – Medical Quality Assurance Service http:// www.doh.state.fl.us/mqa/index.html
  • 10.
    • Individual vs Group Practice
    • Fiduciary Relationship
    • Privileged Communications
    Provider – Patient Relationship
  • 11. Provider – Patient Relationship
    • Contractual Relationship (Service contract vs Sale contract)
      • Offer
      • Consideration
      • Acceptance
  • 12.
    • Duty of Providers to Patients
    • Practice at professional level
    • Make full disclosure
    • Protect confidence
    • Offer continuing treatment
    • Seek consultation when indicated
    Provider – Patient Relationship
  • 13. Provider – Patient Relationship
    • Duty of Patients to Providers
    • Make full disclosure
    • Full cooperation in treatment
    • Pay for services rendered
  • 14. Provider – Patient Relationship Breech of Contract vs Negligence
    • DUTIES
    • Professional Care
    • Disclosure
    • Confidence
    • Treatment
    • Consultation
    Professional Negligence Breech of Contract Intentional Tort Breech of Duty Criminal and Negligence Action
  • 15.
    • Abandonment
    • Assault
    • Battery
    • Breech of Confidence
    • Defamation
    • False Imprisonment
    • Fraud
    • Intentional infliction of emotional harm
    • Invasion of privacy
    Intentional Torts
  • 16.
    • 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
  • 17.
    • 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
  • 18.
    • Analysis of negligence:
    • Duty – contractual relationship
    • Breech – standard of care
    • Injury – substantiated injury
    • Causation – proximate causation
    • Damage – special, general, punitive
    Professional Negligence
  • 19.
    • 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
  • 20. 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
  • 21.
    • Defenses to Negligence Action
    • Immunity
    • Conduct met standard of care
    • Contributory negligence
    • Comparative negligence
    • Assumption of risk
    • Consent
    Professional Negligence
  • 22.
    • Dose of anesthetics required to produce general anesthesia is very close to, or exceeds the LD50.
    • General anesthetics deprive patients of their protective respiratory reflexes risking obstruction and aspiration.
    • Airway management problems are not uncommon thus risking hypoxia or anoxia.
    • Some general anesthetics and all muscle relaxants depress or obliterate spontaneous respiration.
    Liability of Anesthesiology
  • 23.
    • 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
  • 24.
    • 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
  • 25. Medical-Legal Aspects of Nurse Anesthetist Practice Jeffrey Groom, PhD, CRNA, ARNP FIU Anesthesiology Nursing Program