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Anesthesiologists versus ASA Anesthesia Care Team Guidelines
In a May 2009 article entitled "The Standard of Care in Anesthesia....not what you think" , the Law Med Blog describes the jeopardy that Anesthesiologists face when American Society of Anesthesiologists Anesthesia Care Team (ACT) guidelines are used against them.
"...The ASA practice guidelines are inconsistent with state nurse practice laws and actually have the effect of putting the anesthesiologist at risk for litigation. Yet lawyers, insurance companies, risk managers and “experts” often use them as a benchmark for the practice of anesthesia by nurse anesthetists, much to their own peril...".
Perhaps its time for ASA to update the ACT guidelines to reflect current practice ? The article describes the dilemma a Maryland Anesthesiologist faced.
"The complaint alleged that Dr. Berstein failed to provide the standard of care by not supervising the nurse anesthetist (who had 30 years of experience) appropriately. The Board of Physicians agreed, and issued a sweeping reprimand which detailed multiple violations which were based on the ASA Anesthesia Care Team position statement. Despite their findings creating a supervision standard contrary to the Maryland Nurse Practice Act, the Board commented that they did not rely on laws governing nurses to determine the medical standard of care. Had the case been in a courtroom in a malpractice action, the standard of care for supervision would have been defined very differently. Had the case been before the Board of Nursing, a different conclusion would also have been reached. It all depends on who asks, and who answers the question."
"ASA Standards, Guidelines and Statements provide guidance to improve decision-making and promote beneficial outcomes for the practice of anesthesiology. They are not intended as unique or exclusive indicators of appropriate care. The interpretation and application of Standards, Guidelines and Statements takes place within the context of local institutions, organizations and practice conditions. A departure from one or more recommendations may be appropriate if the facts and circumstances demonstrate that the rendered care met the physician’s duty to the patient."
If "any anesthesiologists" accept the ACT guidelines as the exclusive indicator of appropriate care, that position is in conflict with the American Society of Anesthesiologists, the organization that developed these guidelines.
How can "certain physicians" not oppose the ACT guidelines when they are being used against them and interpreted as the standard of care by other physicians, when ASA acknowledges that was not the intention ?