Professional issues 2 Flashcards
A CRNA is relieved by another anesthesia provider four hours into a complex case. The outgoing CRNA provides a short report that results in a missed repeat antibiotic dose. The patient ultimately develops sepsis that results in an unexpected 3-day ICU stay. Which causes of action against the primary CRNA might apply to this scenario? (select 2)
a. loss of chance of survival
b. malpractice violation of the AANA standards of care
c. abandonment
d. vicarious liability for relieving anesthetist
b. malpractice violation of the AANA standards of care
c. abandonment
_________ is the physical act of touching another person without either expressed or implied consent
Battery
_________ is making a person feel or perceive that battery is imminent.
Assault
Causes of action against anesthesia providers include
lack of informed consent
abandonment
wrongful death
vicarious liability
Damages in medical malpractice cases are generally formulated around
the actual losses that the patient suffers or incurs (general or special damages)
___________ does not need to be proven when battery or assault charges are brought upon a provider.
Harm
___________ does not need to be proven when battery or assault charges are brought upon a provider.
Harm
Define statue of limitations.
a deadline before which a patient must file a lawsuit
As a general rule, the statute of limitations for a minor
doesn’t begin until the minor turns 18
Define vicarious liability.
one person (or entity) may be liable for the actions of another person
Describe general damages.
directly result from an injury (e.g. pain and suffering, emotional distress; non-economic in nature)
Describe special damages.
actual damages that result from an injury i.e. medical expenses, lost income, property damage, clearly quantifiable
Define punitive damages.
Rare, punishment for reckless or malicious behavior
Which law requires citizens to give the government an individual shared responsibility payment?
a. emergency in medical treatment and active labor act
b. health insurance portability and accountability act
c. health information technology for economic and clinical health act
d. affordable care act
D. affordable care act
Describe the Emergency in Medical Treatment and Active Labor Act (EMTALA).
this ensures public access to emergency services regardless of their ability to pay
Describe the Health Insurance Portability and Accountability Act (HIPAA).
this federal law prohibits the disclosure of individually identifiable health information
-disclosure can occur in any form including orally, written, or electronically
Describe the Affordable Care Act.
mandated that all individuals carry health insurance. in addition, insurers are no longer permitted to charge more for pre-existing conditions
The ACA requires medical insurance to cover certain
preventative health visits without a co-pay in order to promote the early detection of disease and prevent long-term morbidity
____________________ can remain on their parents’ plan, even if married, financially independent, or not in college.
Adult children up to the age of 26
This cannot be subject to either annual or lifetime dollar limits under the ACA rules.
essential healthcare benefits
Describe the schedule of the following drugs based on the Controlled Substances Act.
Heroin
Cocaine
Ketamine
Tramadol
Heroin- schedule 1
Cocaine- schedule 2
Ketamine- schedule 3
Tramadol- schedule 4
Describe the Controlled Substance Act (CSA).
schedules drugs according to their therapeutic benefit vs. abuse potential
Describe the Health Information Technology for Economic and Clinical Health Act.
was intended to create a healthcare information technology infrastructure in order to improve quality care and coordination between providers
Describe the Employment Retirement Income Security Act.
sets minimum standards for private employee benefit plans, including the health care benefits offered and provides protection for persons in these plans
Schedule 1 drugs are defined as
no currently accepted medical use with a high potential for abuse (marijuana is included here)
Schedule 2 drugs are defined as
high potential for abuse potentially leading to dependence (barbiturates, opioids)
Schedule 3 drugs are defined as
moderate to low potential for abuse and dependence (ketamine, tylenol with codeine)
Schedule 4 drugs are defined as
low potential for abuse and dependence (alprazolam, tramadol)
When a patient experiences a serious anesthetic complication, what information is most appropriate to offer to the patient’s relatives?
a. provide the names and roles of the party or parties at fault
b. disclose nothing until you are certain of the patient’s outcome
c. tell the family that risk management will contact them
d. describe the facts of the event while also expressing regret.
d. describe the facts of the event while also expressing regret
During a critical incident report- the provider should extensively document the events that occurred including:
what happened
what drugs and doses were given and when they were given
the time sequence of events
who was present (all parties- not just anesthesia)
In a critical event you should avoid documenting
speculation & documentation that is inconsistent with other sources
A critical incident report is best recorded in what form?
narrative
“Proof” in a juried malpractice case must include which components? (select 2):
a. absolute certainty that the provider was negligent
b. the highest standards of care were not followed
c. evidence of duty, breach, cause, and harm
d. more likely than not that negligence occurred
evidence of duty, breach, cause and harm
d. more likely than not that negligence occurred
Key steps in responding to a lawsuit include:
defendant’s initial response
working with an attorney
discovery
written interrogatory
deposition
Key immediate steps when encountering a lawsuit include
notifying your insurance carrier
not discussing the case with anyone
not altering records
gathering relevant records
making notes about all aspects of the case
The top injuries leading to malpractice claims are:
death- 30%
nerve damage- 22%
permanent brain damage- 10%
airway injury- 6%
Among the 40% of claims made for death or permanent brain damage, the majority are due to
airway management issues
What are the airway management issues that may result in death or permanent brain damage?
- inadequate ventilation (hypoxia, hypercarbia, or both)= 38%
- esophageal intubation (unrecognized)= 18%
- difficult intubation= 17%
Risks associated with increased odds of dying within seven days of an anesthetic include
physical status (ASA 3-5 vs. 1-2)
emergency vs. elective surgery
major vs. minor surgery
patient age ( 80 yrs vs. <60 yrs)
Almost 65% of anesthesia claims are made regarding
surgical anesthesia
followed by chronic pain procedures, obstetrical claims, and acute pain
What type of anesthetic procedures are experiencing an increase in malpractice claims?
chronic pain procedures
A 13-year-old Jehovah’s witness with a Cobb angle of 50 degrees presents for an elective spinal fusion. The parents refuse blood products for the child. What is the BEST approach for discussing the possible need for intraoperative transfusion?
a. agree, then perform an emergency transfusion if the need arises
b. delay surgery until the child is mature enough to join in the decision-making process
c. Tell the parents they will be reported to Child protective services if they refuse
d. Get a court order for transfusion despite the parent’s wishes
b. delay surgery until the child is mature enough to join in the decision-making process
The age of majority is
18 years
Emancipated minors are patients
younger than 18 years of age who a state court legally gives the rights of an adult
- may be married or a parent
The principle of ________________ is that the government serves as the legal protector of citizens unable to protect themselves
paren patrae (“father of the country”)
Paren patrae allows the state to
intervene in the event of child abuse and/or parental negligence
Jehovah’s witnesses with children will be informed that
despite all reasonable efforts to eliminate the need for transfusion, a court order for transfusion will be sought if an emergency occurs (should be sought before surgery if the likelihood of transfusion is high)
Developmentally able patients should be given the opportunity to participate in
the health care decision-making process and agree to the final decision (informed assent)
Criteria for emancipating a minor may include the fact that they are
married
a parent or is currently pregnant
in the military
economically independent
Pregnant minors may need ___________________ to have an abortion unless __________
parental consent; judicial bypass is sought and obtained
Mature minors who are at least 14 years old are considered to be
legally and ethically capable of giving informed consent under specific circumstances if granted by a court
The determination of whether to intervene founded on paren patriae is based on how
harmful the parental decision may be to the patient
