Dr. Kenneth Hughes, Harvard-trained, board-certified plastic surgeon, has AAAASF accreditation for his surgery center in Los Angeles.  Dr. Hughes utilizes a rotating group of hospital anesthesiologists who perform anesthesia autonomously in surgery centers as well.  There has long been debate about the need for supervision of CRNA supervision in anesthesia cases.  Apparently, there is no need for anesthesiologists.

A hospital in Wisconsin has replaced its anesthesiologists with certified registered nurse anesthetists (CRNAs).  The CEO said that the hospital is moving to a CRNA model in its anesthesia department.  This individual stated that this was a a common standard for hospitals and that care quality and outcomes are just as good with CRNAs.

A medical malpractice attorney had some thoughts that he expressed on his website about this decision.  Wisconsin hospital fired all anesthesiologist physicians and replaced them with less trained, cheaper CRNAs.   This attorney understands that many hospitals look to reduce costs even at the expense of quality of care and patient safety.

Decades ago, hospital and insurance bean counters figured out that physician assistants (PAs) and nurse practitioners (NPs) were far less expensive to pay than doctors. Back then, PAs and NPs were referred to as physician extenders and work in tandem with doctors. PAs and NPs were assigned responsibility for routine medical needs in primary care practices, for example—things like colds, earaches, sore throats. This allowed practices to see more patients and freed up physician time for more complex patients and medical needs.

Over the years, the financial motivation spread to PAs, NPs, and, definitely, nurse anesthetists, and their lobbying groups. They funded bogus studies that concluded that their quality of care was equivalent—or better—than that of physicians, who generally have far more training.  When they try to take on responsibilities beyond their training and competence, though, it’s a danger to patients. That’s why I believe that some PAs, NPs, and CRNAs—with the cooperation of hospital and practice group leaders—are selling patients a phony bill of goods.

The lawyer also states that CRNAs don’t have equivalent training and experience. According to the American Society of Anesthesiologists, physician anesthesiologist have 12,000–16,000 of clinical patient care in their curriculum, while CRNAs have just 1,650 hours. It’s that lack of additional training that makes the average CRNA less able to handle an emergency. And anesthesia emergencies are such that even a short delay in rendering the correct medical response can mean the difference between life and death, or brain injury or recovery.

• CRNAs are a lot cheaper than anesthesiologists for hospitals and surgery centers to hire.

• CRNAs lack equivalent or comparable training to physician anesthesiologists for handling anesthesia emergencies.

• When there’s an OR emergency, most CRNAs panic and focus on getting the anesthesiologist into the OR for help.

• In medical malpractice litigation, most CRNAs subtly shift blame on anesthesiologists involved in medical direction or supervision.

Regardless of what misinformed legislatures and misguided hospital administrators decide regarding the CRNA scope of practice, patients have the right to ask and know with 100% certainty who will be providing their anesthesia care in the OR before their put to sleep.   At Hughes Plastic Surgery, you do not have to ask.  You will always receive anesthesia from an experienced anesthesiologist with the training and understanding you deserve.

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