• Can CRNAs Get Sued?

    The thought of getting sued is a terrible one, for even the most established and seasoned professionals. As a CRNA, lawsuits may not be on your mind. 

    Most people often don’t think about getting sued until it is too late. However, that doesn’t mean you aren’t at risk. It’s critical to understand that CRNAs can be sued. 

    On a positive note, there are ways to mitigate risk by protecting yourself and addressing any worries that you may have about being sued as a result of carrying out your professional duties. It’s important to consider these factors before you’re in the throes of a lawsuit. 

    This article will address everything you need to know about being sued and how to protect yourself, your career, and your assets. 

    Do CRNAs Really Get Sued?

    You may be asking yourself, “Do CRNAs really get sued?”

    The short of it – yes. CRNAs absolutely can – and do – get sued. 

    Typically, the anesthesiologist is named in the lawsuit, but the CRNA can be jointly named as well. The CBS 2018 Benchmarking Report, analyzed liability cases from over 60,000 medical professionals and found that liability tended to fall largely on physicians or organizations. 

    However, individual nursing professionals, including CRNAs, were sued in 14 percent of all cases. Though this may seem like a small number, it does show the potential of reliability, and the number has been increasing slowly over time.

    Many professionals fear that this number will steadily increase as lawsuits and malpractice claims increase. This is due to more states allowing CRNAs to work independently instead of under the supervision of a physician. 

    Do CRNAs Get Sued Often?

    CRNAs don’t get sued a lot, however, the risk is still there. The number has climbed in recent years and the nurse anesthetist lawsuit rate is expected to continue to rise.

    While in years past, CRNAs weren’t typically named as defendants in lawsuits, this has increased dramatically, either by being named as co-defendant or being sued on their own. This is because more and more often, CRNAs are able to practice on their own, without physician requirement. 

    As of September 2021, there were no physician supervision requirements for CRNAs in ambulatory surgical facilities across the District of Columbia and 31 other states. This number is expected to increase, which means that CRNAs will generally have more autonomy- as well as responsibility and accountability- over patient care. This can lead to a higher nurse anesthetist lawsuit rate as more and more CRNAs are practicing under their own authority. 

    Why Do CRNAs Get Sued?

    Certified Registered Nurse Anesthetists encounter liability risks daily, so it’s important to manage these risks to protect their livelihoods and careers, while also improving patient outcomes. 

    The most frequent reasons that CRNAs are named as defense in lawsuits are: 

    • Improper treatment or intervention during a clinical procedure
    • Medication errors
    • Failure to monitor the patient’s condition 
    • Lax documentation 
    • Inadequacies in the overall anesthesia plan 

    For CRNAs to be sued, there has to have been:

    • A deviation or violation of the standard of medical care. 

    Certified Registered Nurse Anesthetists are held to acceptable standards of medical care. A patient has many rights, including the right to informed consent and to expect that CRNAs will deliver care that is consistent with the standards of care. Omission or negligence is established when the standard of medical care isn’t upheld by CRNAs. 

    • An injury that resulted in serious damage. 

    For a medical malpractice case to be able to litigate, it must be shown that there was an injury that caused significant damage. The patient must prove that the injury resulted in suffering, hardship, pain, disability, significant medical bills or loss of income, up to and including death. 

    • The substantial injury or death was caused as a result of negligence or omission. 

    For medical malpractice to have actually occurred, the injury or death must have been the result of a deviation from the acceptable standard of care. An unfavorable outcome isn’t enough to claim medical malpractice. Instead, omission or negligence had to have occurred.

    One such example of a lawsuit that met this criteria occurred when a CRNA and physician anesthesiologist were found to have breached the standard of care by failing to properly monitor. A 7 year old boy was undergoing a routine procedure, a tonsillectomy and adenoidectomy. 

    However, the patient suffered hypoxia during the surgery, and it was not caught until the end of the surgery. The CRNA tried several interventions and called a Code Blue, at which time the physician anesthesiologist and several other medical professionals responded. 

    The patient suffered brain damage as a result of the hypoxia. He was diagnosed with anoxic encephalopathy, diagnosed as being profoundly and severely brain damaged. The case was settled during mediation for the amount of $6,500,000, with a structured settlement. If the child lives a normal life expectancy, the payout will be in the amount of 45 million dollars. 

    Do CRNAs Get Sued More Often than RNs?

    It is a bit more likely for a CRNA to be sued than an RN, due to the nature of the work, being under one’s own authority, and the specialized level of care involved. Any professional who has independent practice autonomy should absolutely be prepared to defend against malpractice allegations as a decision maker. This is especially true of CRNAs, who practice independently and have a critical role in patient outcomes. 

    That being said, being a CRNA doesn’t come with an excessive risk for lawsuits that you have to worry about. Like any career, there are risks. Preparing and preventing them from happening is, however, good practice for any advanced nursing practitioner, including CRNAs. 

    CRNA Controversy in Medical Malpractice 

    More than any other specialty, the distinction and lines have become blurred in anesthesiology. The confusion of roles and responsibilities can occur between a CRNA and the supervising surgeon. 

    Some physicians have argued that they are unfairly burdened by supervision of CRNAs because in states requiring supervision, the lawsuit often falls to the overseeing physician. As technology advances and changes are made in anesthesia, the controversy has become even greater over CRNA autonomy and what this means to medical malpractice and patient responsibility. 

    However, the literature shows that CRNAs are indeed high quality, educated, safe, and cost effective practitioners who should practice to the full extent of their abilities and education. Peer reviewed studies confirm time after time that there are similarly low rates of adverse outcomes and events for anesthesia providers, delivery models, and CRNAs. 

    Furthermore, the literature also shows that there are no differences in care and outcomes between physician anesthesiologists and nurse anesthetists. Exhaustive amounts of literature both in the United States and on a global scale confirm that CRNAs are just as effective and skilled as their physician counterparts. 

    That being said, not all states allow CRNAs to practice independently without being supervised by an anesthesiologist or surgeon. However, in states that do allow private practice, the CRNA has more autonomy, which means more risk and responsibility, which can open CRNAs up to more liability. 

    What Can You Do to Reduce Your Risk as a CRNA?

    CRNAs encounter huge liability risks every day, so it’s important to be able to properly identify- and know how to mitigate these risks. 

    Some of the biggest issues facing CRNAs are how to reduce risk. This can not only help you from not being sued in the first place, but also lower the potential of being in future lawsuits as well.  It also helps to improve patient care, and if you are sued, prevail in court. This can make a significant difference in your career. 

    Here are some of the most critical things that you can do to reduce your risk: 

    • Maintain your Competencies 

    Make sure you maintain all competencies, including federal, state, local, and hospital guidelines for continuing education. This will help you stay abreast of new knowledge, procedures, and safeguards that should be in place when performing your duties. 

    • Document, Document, Document. 

    Make sure you document all pertinent information in your patient records. Lax record keeping is both dangerous to patients and can result in being more prone to lawsuits. Make sure to include all critical information, including full medical history, complaints about pain or discomfort, allergies, and more. 

    • Obtain Informed Consent 

    It is essential for CRNAs to get informed consent from their patients. Patients must give this consent to all anesthesia and medical procedures if they are able to do so. If they can’t give consent, their representative must give the consent. They should be informed on all information, including the complications involved. 

    AANA recommends that the informed consent process be seperated. Anesthesia informed consent and surgical/procedural informed consent should not be combined. Doing so not only deemphasizes the role of anesthesia, but also can increase the chances a CRNA will be exposed to lawsuits. 

    • Note any Changes in Practitioner’s Orders 

    If a physician or practitioner makes any changes, it is essential to ensure that it is thoroughly documented in writing. If any issues arise regarding standard of care, you will have clear evidence regarding the change. By doing so, you can protect your patient and yourself. 

    • Chart Treatment Response as well as Changes to Patient Status 

    It’s essential that you keep track of patients’ responses to treatment. Any changes or complications in a patient’s condition should be reported to the physician or surgeon in charge of care immediately. This is critical as failure to do so can leave you liable. 

    • Report incidents Promptly 

    When an issue arises, it is critical to report it right away. It may be tempting to try to fix the issue or hope the problem goes away, but this adds unnecessary risk to the patient and pressure upon the practitioner. It’s critical to report incidents immediately. Failure to do so could cause preventable harm to your patient, resulting in injury or death, as well as open you up to a lawsuit. 

    In one such case, a CRNA began treatment on a 33 year old man, giving anesthesia without a doctor present in the operating room. The CRNA gave the patient Propofol and other medications. Almost immediately after the anesthesia had started, the patient began having breathing problems. Despite this, it took over 20 minutes before the CRNA got the anesthesiologist into the operation room. By then, the patient had irreversible permanent brain damage. The case was settled in a confidential agreement of the parties. 

    • Ensure Malpractice Insurance is Sufficient 

    Reducing risk is essential. You can reduce your risk by adhering to the above tips. However, this doesn’t make you immune from a lawsuit. It’s critical to have malpractice insurance in place in case you find yourself facing a lawsuit. Even if you can prove you weren’t liable and didn’t do anything wrong, the legal fees alone can be astronomical, with an average defense cost of $40,720

    Relias Media highlighted a case study of a CRNA who performed a peribulbar eye block patient prior to cataract surgery. The CRNA was the only medical professional sued after the patient suffered from an adverse outcome. When the patient refused to settle, the matter went to trial. The legal battle took three years, and even though a defense verdict was found, the legal fees added up to a whopping $270,000. 

    If you are found to have committed medical malpractice, the costs could be astronomical. If you don’t have sufficient coverage, you can face financial ruin. One CRNA was found liable for wrongful death in a ten million dollar medical malpractice verdict. A CRNA in Iowa was found to have committed medical negligence against an 80 year old patient. The patient had surgery to address bladder cancer, and then developed complications that required additional surgery. The CRNA was found to have breached the acceptable standard of care by failing to empty the patient’s stomach, resulting in the contents of his stomach aspirating into his lungs. The CRNA was then found to have failed to seal his airway after inserting the breathing tube, resulting in his death.

    Am I more likely to get sued if I have my own malpractice insurance?

    This is a common misconception about holding medical malpractice insurance for an advanced nursing practitioner such as a CRNA. However, there isn’t actually an increased likelihood or probability of being sued because you have malpractice insurance. Anyone who considers taking action against you in a lawsuit does not know the details of your medical malpractice insurance. Furthermore, a mistake doesn’t have to be made for a lawsuit to even happen. Malpractice insurance protects you in any event, whether a mistake was made or not and is a valuable tool for CRNAs.

    Should CRNAs Obtain or Supplement Malpractice Insurance Coverage Separate From Their Employer?

    It’s never a bad idea to look into your options. At the very least, it’s a good idea to understand your existing coverage and talk to insurance experts to see if you need supplemental coverage. 

    Depending on the employment setting, you may not want to rely only on employer sponsored coverage. This is because coverage may only go up to a certain amount of liability, which may not end up being enough to cover all staff sued in the event of a malpractice lawsuit. If an employer has a $1,000,000 per occurrence policy and multiple medical professionals are named in the lawsuit, this may not be enough to cover the CRNA.  Additionally, the policyholder may settle the case without notifying the CRNA that they are covering. This becomes public record, which can be damaging for a CRNA’s career. 

    CRNA malpractice insurance may be really beneficial, depending on your circumstances and the type of coverage you already have. AANA Insurance Services has friendly, knowledgeable experts that can help you determine if and what kind of coverage you may need to protect yourself in the event of a medical malpractice suit.

    How Much Insurance Should CRNAs Carry?

    It’s tough to put a dollar amount on the liability coverage that a Certified Registered Nurse Anesthetists should carry, since this depends on several factors, such as the location and type of group, entity, and practice the individual works with. 

    Additionally, each state has its own regulations when it comes to medical malpractice requirements. It’s important to know the requirements of the location you work to ensure sufficient coverage. Standard policy coverage options are typically up to $3 million annually and 1 million per claim. 

    The amount of insurance that you should carry as a CRNA professional will depend on: 

    • The state laws in which you work
    • The affordability of coverage 
    • What you are comfortable with 
    • The assets you hold

    You can easily get recommendations about how much coverage that you should carry from insurance providers, including AANA Insurance Services. 

    Final Thoughts

    You can’t always prevent a lawsuit. Even if your standard of care and treatment was perfect, an injured patient or family member may believe that their medical care was mishandled, which can cause a lawsuit. 

    Though you may not be able to prevent a lawsuit, you can try your best to make sure that you are taking every step to protect yourself, including implementing the tips given on reducing your risk. 

    Maintaining knowledge and current clinical skills, communicating clearly with patients and ensuring informed consent are imperative to advanced nursing practice. It’s critical that CRNAs document clear and supportable reasons for not taking specific actions, as well as recording response to interventions, recognizing the need for referral and consulting, nurturing relationships, and taking other protective practices for CRNAS

    The proactive CRNA should consider purchasing individual occurrence malpractice insurance, as this is one of the best ways to be prepared. For over three decades, AANA Insurance Services has specialized in providing CRNA malpractice insurance, including the development of innovative insurance products to meet the constant and ever changing necessities of AANA members. No other insurance agency has a more diverse range of coverage options for CRNAs.  

    It’s really easy to put off thinking about insurance and assuming that a medical malpractice lawsuit will not happen to you during your career. If you are involved, your livelihood, employment, and assets can be at risk without sufficient coverage. Even if you win, you could spend thousands and thousands of dollars on legal fees. Don’t make the mistake of believing that you can’t get sued or that the coverage you have is enough to get you through it. 

    AANA Insurance Services have a wide range of policies for CRNAs in any situation. Even if you have employer sponsored medical malpractice insurance, you can probably benefit from additional coverage if you are sued.  AANA offers many benefits including: 

    • Pure consent to settle and having the final say in how your medical malpractice case is handled 
    • An attorney that is dedicated to your own interests rather than your employers
    • Unlimited defense costs
    • Occurrence coverage that doesn’t require a tail

    Being prepared, giving the best possible care, reducing your risks, and making sure you have sufficient medical malpractice insurance can protect you in the event of a lawsuit, including giving you peace of mind.

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