$21 Million BOTCHED Anesthesia Case

[@jeffkim6515]

I'M AN EXPERIENCED BOARD CERTIFIED ANESTHESIOLOGIST. Thank you Dr. Cellini. You're analysis of this case is pretty spot on. I just wanted to add to what you've already laid out. First of all, this was a 27 year old patient who seemed relatively healthy as far as I can tell. These tend to be one of those anesthesia cases that we feel that even a beginning anesthesia resident should be able to handle. When these cases go wrong, it's usually something that's either horribly unfortunate, or gross medical misconduct. Second, I am really perfectionistic about my patients and I don't like supervising anyone in general, including residents or CRNAs. There are some fantastic CRNAs out there, don't get me wrong, but I have had many experiences with CRNAs who have intubated a patient without informing me, extubated a patient without informing me, performing epidurals without informing me, pushing back on my medical direction or even flatly refusing. I once ran into an OR where things got bad, and instead of calling the attending assigned to the room, he or she called his or her fellow CRNA. And another situation where I gave a CRNA a morning break only to realize that there was something seriously wrong with the breathing tube, and while trying to save the patient, the CRNA returns only to curse at me and "talk shit to me" while I'm trying to fix the emergency situation. Third, the 1:4 model really makes anesthesiologists so busy, that we are almost incapable of swinging by the ORs. It can work if most of the patients are healthy and the CRNAs are trustable, skilled, and quick to ask for help, but already that's a lot of "ifs." Fourth, I've seen a lot of hypotension in my life, and especially in a healthy appearing 27 year old, it's hard to believe that that was the real cause, unless the BP was maintained at 40/20 or worse for a long time. More likely IMHO is that there was some oxygenation issue caused by a misplaced endotracheal tube or LMA, running the anesthesia at needlessly deep levels or ventilator settings that were incompatible with life. Fifth, it's not uncommon for us to give each other breaks. That's a necessary part of our days so we can get more coffee, use the toilet, or stay fed. What is not acceptable is to leave a patient unattended to for 12 minutes. In closing, I will say that I'm critical even of my anesthesiologist colleagues as well, but IMHO in my experience, I've seen a difference and I'm certain that this will not be the only catastrophe of this sort, based upon what I have observed. There is a movement coming down the pipeline where the CRNA training program will be a PhD program so that they can introduce themselves to patients as "doctors" further confusing and deceiving patients.

[@FatherDuck80]

Well I have to say I wouldn’t let a CRNA touch me and and only a board certified anesthesiologist and even then I have vetted all the doctors / surgeons and anesthesiologist that my and and our family have used . And when I say vetting we run federal back ground check on them , their schooling , the hospitals they work at and even their personal life. Med schools are popping out a bunch of inexperienced butchers and irresponsible frauds posing as professional when in realty are nothing more than lazy money hungry k-llers. No amount of money can bring back your lost loved one or reverse the damage because of CRNA or doctor’s neglect and malpractice. This is criminal and all you doctors need to be re-vetted and it has to be made public.

[@mangosteen4230]

Your frustration is completely justified and entirely earned. This sounds like an awful situation. However, I also want to add that if you are not reporting these cases of gross medical overreach by the CRNAs you're overseeing, you are ethically and possibly also legally responsible for any adverse outcomes patients experience. Please report these dangerous practitioners working on patients independently when they have no right to, especially given I'd bet it's often without the patient's informed consent. If you genuinely believe this will not be the only catastrophe, not reporting the nurses who seem to be okay with play cowboy with anesthesia will directly ensure more happen.

[@FatherDuck80]

@@mangosteen4230 these cases individually are being investigated and yes I agree there has to be transparency and informed consent as to who is performing what on you. I also believe firmly the days before and not minutes before you must meet with both the Surgeon the anesthesiologist when meeting with the pre-op nurse when they are doing your pre-op testing. This is something many from personal experiences they won’t do often but you have to demand it. Especially if you have a history of predisposition to anesthesia. Note: this lack of transparency is occurring at some of the big name major hospitals and we we’re shocked how eager they want to put you in harms way and carry out procedures you as a patient are not comfortable with. We shouldn’t let them tell you what’s good for you only. The patient is the boss and they have to listen to the patients as well. But the use of CRNA’s has to come into more review based on the final outcomes of these cases. Thank you for your comment and professionalism and you and your family have a happy healthy new year. G-D bless 🙏

[@CHRIS-tg5cn]

Nice way of throwing CRNA's under the bus. As a self described "experienced board certified anesthesiologist," you have done thousands of cases in your career, I presume. You have a way of cherry picking the few negative events involving CRNA's; yet, I don't see you complimenting or remarking on any of the times I'm sure they saved your ass when recognizing a mistake of yours, or catching something that you or or the rest of the healthcare team didn't. Also, don't forget it was an anesthesiologist who mishandled Joahnne Rivers's airway and caused her to have a hypoxic brain injury leading to her death days later. You conveniently forgot to bring that up in your analysis of anesthesia providers. If you're going to point out the few wrongs, how about mentioning the right's also. This would lend more credibility to your post. As someone whose worked in the medical field also, I can describe to you an a ten-fold number of times that I've seen lazy and incompetent MDA's who surgeons have chosen CRNA's to work with for a multitude of reasons......MDA not wanting to learn regional anesthesia or sucking at it, laziness on their part (It's 3PM I'm outta here!), overpaid based upon production (or lack of), cancel cases based upon very flimsy rationales, etc. etc.I could go on and on, but I won't, considering there are more aspects to point out. I applaud your "perfectionist" approach; however, it is very much encroaching on judgmental. You admit this toward your own colleagues. Unless you are in a supervisory or chief role with anesthesiologists, stay in your lane. Do your own thing. You handle you, and let them do them. Also, If you knew anything about CRNA's, then you would know that their largest association, the AANA, encourages ongoing education (as does every field of employment), but does not endorse providers from calling themselves "doctors" in front of patients. This is based off a study done several years ago in which patients were confused as to who had which role when providing care. So, your last sentence is another failed attempt to throw shade at CRNA's, only further showing your bias. Finally, get used to CRNA's. They aren't going anywhere. CRNA's were here before MDA's, who only arrived when they figured out how to make anesthesia lucrative. For the majority of surgeries, CRNA training is more than adequate. MDA's are still needed, yes, absolutely. CT, high risk OB, transplants, pediatric cardio......yes I'd agree that you guys are still needed. However, should CRNA's get their own fellowships in the previously listed fields, well, things will continue to further change. As more facilities and governing boards see data that prove CRNA care is just as good as MDA care with better financial outcomes, the MDA-only model will continue to disappear. It is not a financially viable option any longer (due to many factors, the majority of which is bundled payments from insurance companies and reduced overall reimbursement).

[@vwynnr]

Thank you Chris. I am a CRNA (many years of experience) and over the years have worked with excellent providers - both CRNA and MD- in military service, private practice, teaching hospitals, outpatient and office based clinics etc. But I have also worked with some less than stellar providers - both MD and CRNA - as well. So I agree, no one should be throwing CRNAs OR MDs under the bus. The particular practitioner involved in case and lawsuit is ONE provider. One. Doesn't matter the credentials.

[@toottoot24]

When my father worked for a private hospital system, they tried replacing most of the anesthesiologists with CRNAs to save money. He tried to garner the support of his colleagues to prevent this from happening. However, his effort was futile, compelling him to start his own practice. Favoring profit over the lives of patients is a terrible thing

[@evano8312]

Sadly, welcome to healthcare

[@happylistener4628]

Yes. I busted my butt working 24 years in healthcare, retired at 60 and happily left the rat race workforce free of debt in 2021. It’s all about profits, profits, profits for these greedy, insatiably money hungry, wealth hoarding monster corporations; even at the cost of employees’ and patients’/consumers’ well-being. No more time consuming commutes to and from work in horrid traffic, no more expensive fuel consumption and cost; no more being micromanaged, no more B.S. workplace politics. No more fighting for my well earned annual merit increases. That sucked. Not to mention, extremely stressful. During my last merit evaluation, which was my best review, I finally realized all my hard work isn’t worth the effort only to be forced to fight for the reward. I was done with all their shiz! and “Quiet Quit” until I retired in 2021. Retirement is good. God is good😊. Now I enjoy my morning coffee in peace, swing in our backyard patio hammock, play and cuddle time with our dogs and sweet cats, spa day(small bin with water for our tortoise to soak in) with our turtle, sharing delicious home cooked meals and connecting with family and friends. Tasty food and good company just can’t be beat. Life is good. God bless.

[@evano8312]

@@happylistener4628 congrats, I just started my RN job lol, I see right through the industry

[@happylistener4628]

@@evano8312 Thank you. I appreciate you. I wish you all the best. Stay safe.

[@pamcoleman6502]

@@happylistener4628 Corporations have no business being in healthcare. My wonderful not for profit community hospital was purchased by HCA. They have ruined it. Nurse to pt ratios are at a critical level. I could go on and on.

[@keriXianne]

My blood pressure dropped while I was in the ER and I stop breathing. I basically had a stroke at 23yrs old. I was in a coma for less than a month regain consciousness and now I’m paralyzed from the waist down. It’s been 17 yrs and I’m still paralyzed but I have learn to accept my fate.

[@BLUEGENE13]

No one understands what the sick go through in life

[@christianfiguroa7147]

God Bless Heal Up

[@sandraressork860]

The cases of malpractice lawsuits (that we've heard) with CRNAs involved are cases of "non life saving" surgeries/procedure, like leg surgeries or dental procedure. So proving it was easier. It makes me wonder if there was malpractice in "life saving" surgeries where CRNAs are involved.

[@youubik]

Charts went missing in this case ... this dummy nurse should have gone to prision

[@brendalg4]

I would think it would just be considered to be from the life-threatening issue. Such as if you are undergoing open heart surgery, and die because of how the anesthesia is handled... Doctors might assume it's because of your heart condition. (Just guessing, I'm not a doctor.)

[@ideasmatter4737]

As a nurse, I think the most important factor in this is integrity. Therefore I think a person should have more experience in ICU care before being eligible for for nurse anesthetist training. A provider’s integrity is tested over time. That’s the biggest benefit to the residency training for physicians-they are tested over time. I also believe the integrity of all anesthesiologists is crucial. I can’t help but think there is something fishy in this case. Corners were cut along the way for some reason. I’ve always maintained that while patients think choosing their surgeon is the most important thing, being able to choose your anesthesiologist is at least as important!

[@xxMurmaiderxx]

>Therefore I think a person should have more experience in ICU care before being eligible for for nurse anesthetist training Are we under the impression this CRNA did this out of lack of knowing? I thought it was negligence, but the comments here seem to be implying that the CRNA had no idea that leaving a patient with dangerously low blood pressure unattended for 12+ minutes is a bad thing.

[@ideasmatter4737]

@@xxMurmaiderxx What I intended was that if a person has to have more experience, there is more time to inspect or judge their integrity. Of course, that doesn’t necessarily mean they will be weeded out from a program. I would hope character would be part of what is evaluated.

[@youubik]

Botched surgery ... is there any other type

[@KD-vg2yn]

1 year minimum is insane, idk why that’s even a thing. You’ve barely been out of orientation and already going to school to practice at a higher level

[@PropofolAhoy]

@@KD-vg2ynone year minimum AFTER orientation. Nonetheless, the average CRNA student has 3.5 years of ICU experience before matriculating as per the COA which is the accrediting body of nurse anesthesia programs.

[@janetttyminski7295]

This story is not simply about one really bad CRNA. The surgeon & the OR staff were all negligent in allowing this situation to occur. Apparently, they all kept their mouths shut about what really happened. Certainly SOMEONE SHOULD HAVE DEMANDED anesthesia coverage BEFORE the CRNA was allowed to leave the room.

[@realestatedevelopment2572]

How a CRNA bailed out on a surgery is insane

[@jonathantran7102]

well, it's also not clear whether there was coverage or not, it simply says the CRNA stepped out. That could have been with coverage present

[@lisarene1786]

What a horrible thing that could have been prevented! My prayers go out to this man and his family.

[@HappeningsatLamgoFarms]

Such a horrible case. And no amount of money will bring his quality of life back. I’m here in Texas. Baylor almost killed my daughter. Zero trust for them.

[@Reclaim-the-Rainbow]

Which site? I work at one in Round Rock. 😬

[@HappeningsatLamgoFarms]

@@Reclaim-the-Rainbow my daughter was at Waxahachie- but this was before they moved. I do believe they are better now. Not sure which location is the botched anesthesia though.

[@jill9405]

I've had anesthesia many times and always had my vitals monitored. How does the hospital think this is proper Care? The staff was negligent.

[@AgaTSC2]

Things in this case are just not adding up. As a former recovery RN, I've worked with some amazing CRNA's and some ding dong anesthesiologists. It was my experience that MD's were in on the more complicated cases and CRNA's on the more elective cases. Our patients also never were given the option to choose one over the other. They were always monitored and everything recorded electronically unless there was some kind of system wide EMR outage, which still happens, then it would be paper charting which the copy of was given to the recovery RN along with a report and another copy scanned into the system. Also, the pt would NEVER be left unattended. And, where was the surgeon or the surgical RN? Because when any of the vitals fall outside of set parameters, there are LOTS of alarms that go off. I feel like there is missing info. Poor patient.

[@leslie6039]

You are right on point ! Thank you , RN 30+ years & a patient of a CRNA When my own surgery went very wrong as in I woke up during the surgical procedure!!!! As my Ass signed CRNA was being shouted at by the OR Nurses & all the alarms going off !! Yes, it could of been a horrible outcome not just a Horrific experience. I wish they would have given me a few extra doses of Midazolam during & after, so could have forgotten all of that. Now that I have to have two more surgeries coming up. I am making sure in writing that I advocate for my care during anesthesia. And yes The Big Medical Center Hospital tried everything unethical to cover up the "Incident" while they were as you said, Giving me," Excellent Care"

[@sidology1.0]

Oh wow. I always thought it was mandatory to monitor vitals while someone is in surgery/ after being given medication, etc. I can't believe someone would gamble with people's life like this. I think with that horrific quote it's for legal reasons. "Never admit responsibility" even though this case clearly speaks for itself.. super sad and preventable. He probably immigrated here for a better life and this was his outcome. Just sad

[@DrCellini]

It is!

[@Danoliveira3]

It is but here in South America we don't monitor brain activity that often, we don't have ready access to monitors, but we have a extremely good record in surgery, just monitoring basic vitals as blood pressure and heart rate closely could have saved this patient from a life of pain, here we have 6 years of med school followed by a 3 year residency to become a anesthesiologist

[@s96822]

@@Danoliveira3 what country?

[@youubik]

This happens all the time, whats unusual is that it got uncovered and published

[@terryheaton31]

I had an outpatient procedure 6 weeks ago and asked if I could have the same anesthologist that had one year before for another outpatient procedure . I was bummed to hear the group dissolved. I really liked that anesthesiologist because I felt safe. He was very detail oriented. That CRNA changed many lives by his/ her negligence.

[@pamcoleman6502]

When I have had surgery the Anesthesiologist was there in the beginning and end and even checked on me in recovery. Thank goodness.

[@jncchang176]

Electronic notes are not failsafe. I’ve been in offices where the computer crashed and now everyone just stands around incapacitated. I’ve also been in a computerized hospital undergoing surgery and my file has someone else’s pre-op info on it. Very scary because I was given allergies I don’t have and the surgical team doubted what I said. I had to re-do all the blood work to re-confirm everything. Then after all the blood was drawn, just as I was about to be released to be re-scheduled; they found my actual medical file. Phew!

[@dianeridley9804]

EPIC fail!!

[@anniesshenanigans3815]

@@dianeridley9804 yes it was probably EPIC

[@williamleedy8821]

CRNA's are allowed to practice independently in the State of Texas. I have been doing so for many years.

[@Ms.Opinionated]

Hey Dr. C! I am confused: Why didn't the OR RN or Surgeon not notice there was no CRNA/Anesthesiologist?

[@The_arms_race]

Did you watch the video to the end

[@Ms.Opinionated]

@@The_arms_race yes

[@brendalankester7573]

I am a retired RN. I also was wondering why other surgical staff were not aware of monitor alarms or changing BP while CRNA was gone from room? Did other staff attempt to page him/her back to room. Also, I wanted to say that I have worked with some CRNA s in critical care who were very focused and serious about their work, extremely knowledgeable, and I have personally have had them care for me during various procedures without any problems whatsoever. Thank you. My thoughts and prayers go out to this young man and his family.

[@gracekelly2810]

I have surgery scheduled for Monday 11/21/22. I've been through many surgeries due to a drunk driver & grateful to all the excellent care I've received. Now that I'm older, all of the sudden I am nervous about this anesthesia. Thx for helping me with a few more questions to talk to my anesthesiologist before surgery.

[@moirasul]

Botched Spinal Anesthesia - my case - healthy 52 yr old admitted for broken femur surgery- the Anesthesiologist put my spinal in wrong location and I was awake so they weren’t monitoring me. I went into cardiac arrest and they didn’t notice until I turned blue. I arrested and they resuscitated me 3 times. I now have Action Myoclonus and it has destroyed my life.

[@ronalowy5552]

I've seen many cases in hospitals where precious time is lost, brain and life, not "believing" what the blood pressure or oxygen levels were. So they retest, get another monitor or machine, and the patient ends up like this out worse.

[@AllisonChains08]

I work with CRNA’s during MRI anesthesia and they watch that blood pressure like hawks!

[@n70199]

Watching blood pressure closely and knowing how to treat it effectively if it falls outside of acceptable range can be two completely separate skills. CRNAs may not be as good with the latter.

[@AllisonChains08]

When I say watch I mean watch and treat appropriately.. the anesthesiologist isn’t just sitting in our department too.

[@SK-mr6ov]

@@AllisonChains08 crna aren’t anesthesiologists

[@AllisonChains08]

@@SK-mr6ov ? I’m aware they’re not anesthesiologists. I didn’t say they are.

[@benevivunt1256]

@@AllisonChains08 they hate to see other people being capable unless they have the title physician.

[@jessicaalmondjoy7706]

11:08 Ok so...... the article said a nursing degree and an extra year of training = a CRNA. It's actually 4 yrs of nursing school, 3+ years of ICU employment, and 3 years of anesthesia training in ALL specialties (OB, peds, cardiovascular, neuro, spine, ortho, etc.) and all types of anesthesia (incl. general, MAC, and regional incl. PNBs, spinals, epidurals) with over 2,000 hours of direct anesthesia care. ALSO, an anesthesiologist does NOT have to be board certified in order to practice anesthesia - in fact, less than 75% of U.S. anesthesiologists are board certified. As opposed to the requirement that ALL CRNAs have to be board certified and continuously renew their certification throughout their career. I get that anesthesiologists have a whole different path and set of requirements, but why so blatantly lie about the discrepancy between the two professions? There are good and bad anesthesiologists and CRNAs, just as there are good and bad interventional radiologists, pediatricians, family doctors, nurses, etc. This case above all is about negligence - not training or knowledge.

[@KD-vg2yn]

You can apply to many CRNA schools with 1 year of ICU experience which is nothing. Barely out of orientation, definitely not a competent nurse

[@jessicaalmondjoy7706]

​@@KD-vg2yn The average is 3yrs, though many SRNA have 10+ yrs experience as bedside RNs. A few have 1yr maybe, but I haven't met one myself because there's a lot of competition for just a few spots. Regardless, MDs do, always, become a resident anesthesiologists never having put in an IV, drawn up a med, given blood, or cared for a patient over a 12 hr shift. Med school in a classroom does not equate to caring for critically ill patients on the floor - but no one claims they're incompetent, because they're not, they just have to learn how to be anesthesia providers over a very rigorous program, just like the rest of us. Once we're in that position, CRNAs and residents learn about anesthesia from the same textbooks, taking care of the same patients. Again, the back and forth is banal, we should be supporting each other as a profession, but it seems that some MDs only support CRNAs when it suits them - i.e. when it comes to providing care in rural areas with underserved populations and limited resources that are undesirable for MDs. Then, suddenly, CRNAs are viewed as perfectly capable.

[@KD-vg2yn]

@@jessicaalmondjoy7706 im not talking down on CRNAs, I’m pursuing that career path now. I’m just saying 1 year requirement is crazy because it negates the entire point of nursing advanced practice. The requirement should be higher. I do know two people who got in with 1 year experience and I wouldn’t want them putting me to sleep.

[@jessicaalmondjoy7706]

@@KD-vg2yn agreed, requirement should be higher.

[@PropofolAhoy]

@@KD-vg2ynas per the College of Accreditation (COA), which is the accrediting body of CRNA schools, the average CRNA student has 3.5 years of ICU experience (not including orientation) before matriculating into their respective programs. One year of ICU experience is a minimum and a relative rarity.

[@suzannstaszewski9352]

Thank you so very much for providing details about this unfortunate sad outcome. From you covering this information it will help so many people as we will pass this along! Many aren’t aware that as a patient we are permitted to be fully informed prior to procedures of those who are on the team throughout caring for us and have choices as well.

[@mariecarlton5768]

Thank you for the education for all people, this information is of paramount importance. Some patients may not be aware of questions to ask before their surgical procedure. I’m impressed you brought this to the surface. As an operating room nurse for over three decades (retired now), this and other information is overdue. Thank you for making patients safer through education.

[@jenatsky]

The reason fax machines are still utilized is they are not part of Hippa compliance as telephone lines are not considered electronic transmission which is what Hippa is all about and an easy way to share patient reports quickly

[@DrCellini]

And also a very clunky and not secure way to send patient information. Nothing like papers with patient data sitting in the fax machine for anyone to see

[@jeannesherrill]

E-faxing is not always reliable because institutions or medical offices are not upgrading their servers. Enormous amounts of data packets keep pinging an already too full lines

[@jackccrofootjr7228]

I later went on to Med School, but started as a CRNA. My IQ is 166. The CRNA program I attended in the 70's was taught by an Anesthesiologist who felt that CRNA didactic training should be similar to M.D. as he just came from teaching Anesthesiologists. He was big into Chem, Pharm and Physiology. (the backbone of Anes.). Our hospital served mainly patients with Black Lung and Malnutrition so the most were ASA Class III+ patients with little lung capacity or health reserve. He arraigned Neuro Affiliations for us to travel to Large Univ. with Neuro programs. Our trauma experience was mostly crush injuries from Coal Mine Cave-ins. And since it was still the Hatfields and McCoys, we have more gunshot wounds than Detroit receiving (where I later worked) He made sure we were all proficient in Spinal/Epidural/Regional Blocks. We had to all become proficient with Central Line and Swanz Line Placements to keep track of Blood/Fluid replacement with wedge pressures with all the massive blood loss cases we managed. Even though outdated, he made us learn open drop ether anesthesia using gauze layers rubber banded over a stainless steel sieve like mask. Using eye signs and respirations to determine Anes. Depth. Our OR's still had carbon impregnated floors, machine tubing and tires and we wore shoe covers with a carbon strip that tucked against our skin inside our socks. To prevent static sparks that could cause explosions. The program exceeded CRNA Accreditation Standards and he was notified the he was spending too many hrs with unnecessary didactic classes. That did not stop his teaching. He had been a Missionary and made us learn to do Anesthesia with old outdated equipment in case we found ourselves in a Foreign 3rd World Country (Military etc), we could still safely adm. Anes. Just so happened that I ended up in 3 of those Countries and the MD's did not have a clue how to use the equip. I spent the first day making cheat sheets for everyone (Copper Kettle Vaporizers). And "J" tanks for O2 and N2O. No EKG Monitors and few ET tubes. I taught them how to hold a mask with their pinky finger in front of the ear to monitor the rate and quality of the pulse and the other hand on the breathing bag and constantly looking at the bleeding in the operative field to eval. SaO2. Before Med School, worked Anes. Dept Head over 17 CRNA's and 7 MDA's. Fired a few CRNA's who I felt were incompetent and worked with the MDA Group Head to get him to train his low performing MDA's They came mostly from the UofM and were big with egos and little with clinical skills that still needed developing as they were all new grads. Not suggesting this was ideal, but these high mountain probracitos would never have received needed surgical intervention. It was that or nothing. Later in Med School the only thing new to me was Virology and Embryology. (Straight A's) I became particularly proficient in Virology. Thankfully, it made me realize what a dunce Fauci is, Few know this but his training is in Allergy Medicine and NOT VIROLOGY. Since CRNA School, I spent at least 1 hr/day reading research and new techniques, and continued while in Med School. So, Dr. Cellini, I present to you it is not the title but the training and drive of the individual that makes the difference in Pt. care and Safety. And I might add that CRNA were the first formally trained Anesthesia Providers in the USA. It all started with the Mayo Brothers Clinic insisting on only using Alice McGraw to provide they Ether Anes. She ended up writing a book of Techniques of Ether Anes. and Published in the Lacet. Doctors came the world over to learn to safely administer Ether Anes. from her. Her delivery of fourteen thousand anesthetics without an anesthesia-related death established a record for the safety of the practice of anesthesia by nurses.[3] She incorporated hypnotic anesthesia and the Open Drop method in her work, needing less chemical anesthesia with both techniques which helped reduce the risk of overdose.

[@brounwynsmith848]

Holy shit that was ALOT to take in, but amazing. Thank you!

[@alvinyakatori3909]

As someone who is new in the medical field, thank you for sharing your story. I picked up so many things just from that short anecdote and I can’t imagine the wealth of knowledge you have built up over the years.

[@JM-ig4ed]

My X had an anesthesia error when he had open heart surgery (at a major world class hospital) and was awake during the whole procedure. The surgeon after surgery said he didn't know when the patient (my X) would wake up because he had such a bout of high blood pressure. After 4 days when the ventilator came off, my X blurted right out - "I felt the whole thing". The nurse in attendance said... "Well, it is our word against his". What a strange reactive comment. So I asked the surgeon when he made rounds what he made of the fact my X believed he was awake - the surgeon said... well, he very well might have been - that's probably what caused his blood pressure to spike so high. My X did not want to pursue legal action because he felt his life was in the hands of this hospital for ongoing medical problems - so we didn't. I will probably always believe his was a case of the anesthesiologist either being grossly negligent or was a resident/ingern or CRNA without proper supervision. Sadly, we willl never know - but has bothered me ever since. My X has since passed away.

[@surgerystudio7654]

Being awake and feeling the surgical procedure is rare but does occur. It’s one of every anesthesia provider’s nightmares. If your X had a cardiac surgery it was definitely not a CRNA who provided the anesthesia. For very high acuity surgeries, they only use anesthesiologists. I had a procedure and woke up toward the end, I could hear and feel everything but couldn’t move. All I could do was cry and hope someone noticed my tears. It sucked 😢

[@JM-ig4ed]

@@surgerystudio7654 Al the more concerning since this was at a world-class hospitall and the response from the nurse to basically prove it. The surgeon when confronted did acknowledge - would have made a big difference if they had acknowledged it up front. Thanks for responding. Sorry it happened to you. It is so traumatic. What was the hospital's response when you told them?

[@edwardherrera846]

Your information regarding CRNA independent practice is incorrect. In 22 states, CRNA's have opted out of medicare/medical requirements for reimbursement of anesthesia services where physician supervision is a requirement. But this is for reimbursement purposes only and the supervision can be any physician (does not have to be a physician anesthesiologist), and in fact can also be a podiatrist or dentist (which doesn't make any sense because what can a podiatrist or dentist do to help when they have less training than a CRNA?). CRNAs are independent licensed board-certified anesthesia providers and can practice independently in all 50 states. With that said, any state or local hospital can adopt whatever practice they want and can require supervision if they so desire. Now that this is cleared up - any negligence is unwarranted. Often when a case if brought up and it has not do with non-physician providers (CRNA, Nurse Practioner, Physican assistant, etc) it always becomes heightened and magnified. Why? Because it becomes an opportunity to attempt to belittle or downplay the education and experience of the person at hand. Physicians have the exact same problem and if anything have more negligent events that happen yet these often are brushed under the rug and not brought up to the public attention. If the majority of events were happening to non-physician providers then you would hear about these events on a regular basis and the governing bodies that oversee these groups would have to make some serious changes. However, the opposite happens and these groups have slowly expanded their scope of practice of the decades. People should focus on the event that took place irrespective of who was involved and find ways to learn from the mistakes and move forward as healthcare providers as a group because the patient is the most important thing. Pointing fingers or saying this person has more training or years of experience doesn't do anything other than put more of a divide between different organizations.

[@logictd567]

You can't stop the tide. MD groups want the money CRNAs bring, hospital systems want the money they save on CRNAs.

[@Bobbert12345]

If it leads to bad patient care, the tide certainly will be stopped.

[@logictd567]

@@Bobbert12345 since when? lol

[@dr.stevenpennym.d.3241]

Interesting. If I was to have surgery, I would say the same thing. I would want a board certified anesthesiologist. What about the attending surgeon. As a double board trauma cardiothoracic surgeon, I am always aware of every possible situation; including blood pressure adjustments at all times. This was a negligent surgery. Plain and simple.

[@susanchristineknisely3546]

I was a very strong ICU RN primarily and ER secondary. The big reason I hesitated in advance practice was for the same reasons you described, not having enough training. I agree with you. People should have a choice between a CRNA and a MD Anesthesiologist but what happens if there is no MD available? Great video!

[@elizabethannferrario7113]

Hi Being a RN , we only have a certified anaesthetist which by the way are called here in the UK .and is illegal for a RN to be involved with any anaesthesia.we only take over the care of the patient once he or she has regained consciousness and has been transferred to recovery .

[@chrimar456]

Yeah. In the UK we don’t have CRNAs as such but the Royal College of Anaesthetists in 2021 announced the development of the new role of an “Anaesthesia Associate” (AA). These will be people who either have a biomed/biological science undergrad degree who go on to do an AA post-grad degree OR an allied health professional (including ODPs, nurses etc) who have worked for 3 years clinically before doing the AA post-grad degree. So frankly, not too dissimilar to a CRNA.

[@elizabethannferrario7113]

Hi , well after my neuroscience post grad degree , i know i am looking forward to my retirement , its not too long now ,its getting far to tedious now and to be frank i am getting tired and i think i might well retire early ,as we have lots of talent coming through , so yes nursing has changed dramatically from when i first qualified and with ongoing training , life is not your own any longer . but its good to know that nursing is moving on . my regards liz .

[@larrygabrieljr615]

Had surgery for a shoulder injury at work, a 90 minute surgery had me out for almost 6 hours, I haven't been right since

[@pissedoffpennsylvanian]

My shoulder surgery wasn’t wonderful in fact after they discharged me thank god I woke up at home due to the fact the anesthesiologist punctured the top of my lung and they never caught it, needless to say I was suffocating from the inside out, 3 chest tubes later, 10 days total in CCU I made it out alive! Oh during emergency surgery to put first chest tube in ER dropped the scalpel passing it off to nurse while I was under and just missed my carotid artery in my neck (required more stitches)… guess what couldn’t sue cause scars weren’t over 2 inches long and since I was fortunate my lung did fully regenerate and I didn’t die or have long term issues there was no “medical malpractice!” Talk about learning do not trust anyone or ever sign papers!!!

[@ericwendt2514]

While I think it’s ok to have a “preference”, setting a precedent for patients to choose An anesthesiologist vs a CRNA is not good. Many rural hospitals only employ CRNAs and more and more states have full practice authority, meaning no Anesthesiologist needs to be present and CRNAs run the show. According to NIH, complication rate for anesthesiologist only hospitals is 0.27 percent, compared to 0.23 percent in CRNA only hospitals . Granted, the former probably sees much higher acuity patients, so complication rates are naturally skewed, and rightly so…… A pt needing a double heart lung transplant, or high risk OB/in vitro surgery, or baaaad trauma case…., id want an anesthesiologist vs a CRNA for obvious reasons..but an orthopedic procedure and others like it are routine and I believe equally served by CRNAs. The difference here is gross negligence and malpractice, which can be committed by an anesthesiologist OR a CRNA. It’s bad people, not bad training….Furthermore, setting a precedent to get to choose a CRNA vs Anesthesiologist..if the question is presented like the lawyer in your video stated, it would undoubtedly “lead” the pt to choose the anesthesiologist……like its almost like asking do you want the lawyer with 3 years or the senior partner of the big law firm representing you…..I bet everyone would choose senior partners even tho the case could easily be won by the junior attorney(ALSO…. the lawyers quote of the training requirements was wrong…, CRNAs have several years high acuity ICU experience plus 3 years intensive didactic and clinical training). What if there’s not an anesthesiologist available? What if it’s a rural hospital or private practice that employs only CRNAs? You cannot “request” a service that is not there or that is not reasonable to accommodate. This precedent would then suggest a patient could “choose” to NOT be seen by an NP or PA in an ER or Clinic, because they’re “less qualified”, so how is that supposed to work? What if the doctor is not available? What if the only appointment available is with PA/NP? If people only want to be seen by anesthesiologists and the get their way, good luck getting any non emergent procedure or surgery done…because it won’t… Could they then get to choose between MD instead of DO, since DO programs are considered “easier “ to get into? Foreign trained physicians or US trained physicians? It sets a bad precedent to say people could “choose” between CRNA or Anesthesiologist …”in most cases”. The data shows that CRNAs provide just as safe and quality care and Anesthesiologists…it the person in that role that made the mistakes….not the role/title itself.

[@user-wd7nz7tw7c]

This is a great post, I agree that the access to healthcare is limited within rural areas and Advance practice providers fill that role. This video is full of misinformation and creates a false representation of how healthcare works in certain facilities. The only thing I slightly disagree with is wanting an MD anesthesiologist with higher acuity cases. It is like this because typically these higher acuity cases are done at academic or large institutions that give resident physicians the precedent to be able to pass training and take boards. They then have more experience in these fields, which make them more experienced for these cases. But this does not mean they are superior, they are simply more trained because they are given this opportunity. If CRNAs were placed in these same positions for training, I would have no doubt that they would perform to the same degree. Exposure is key to become an experienced anesthesia provider, and resident physicians are the primary focus of academic institutions. Great post though, it does highlight many important discussions that this one-sided video does not introduce.

[@o1o5o13]

Scrub tech here. When we do orthopedic cases, sometimes the surgeon will ask for the BP to be artificially lowered to prevent gross blood loss. It bleeds a lot during orthopedic surgery. Some procedures are unable to use a tourniquet (I kinda wonder if this was a TFN) I wonder if this is what happened- the surgeon asked the BP to be artificially lowered and the CRNA just got careless with it. I’ve watched some anesthesiologists deny their request for patient safety. Some of them lower it a tiny bit. Just curious if this was the case…

[@o1o5o13]

Just looked it up- apparently it was a tibial fracture. Really wonder if it was a plate or a nail. Which is odd; my surgeons use tourniquets for those. Then again, my co workers have told me they worked with some ortho guys at other places that didn’t use a tourniquet at all. Really odd.

[@nancyhope-landon9185]

I would say in many cases patients don't know/don't ask who will be giving them anesthesia. This scares me to death. If I need to have surgery I usually pick the doctor that will provide me with the best care/outcome. Fast forward to the day of the surgery your surgeon who you picked is ready to do your surgery and in most cases, you have not met the person who will put you to sleep who is arguably the most important freaking person in the room. If you have met them it is in passing Hi I'm so and so I will be doing your case today. I might not have surgery if I can put it off but if not I pick Kristina Braly for my Doctor :)

[@spiritmediumclaytonsilva649]

I disagree with this and there are tons of competent CRNAs. What happened here is the exception not the rule.

[@xhaltsalute]

Your bias is unprofessional and unwarranted as a rule. Obviously this case is the exception to the rule. Just like tat MD who was putting cardiac meds into bags of IV fluids. Bad eggs are found everywhere.

[@ms.penguin6252]

CRNA has more patient experience and does their clinicals. I watch doctors literally sleep at their desk in my ER while the nurses do all the care. Including ordering per policy and then disturbing the Dr to get signatures on care plans.

[@spiritmediumclaytonsilva649]

@@ms.penguin6252 agree

[@spiritmediumclaytonsilva649]

@@xhaltsalute he’s not biased he said that he has mad respect for CRNAs he works with them daily.

[@undearwearman654]

Like there aren’t incompetent MDs

[@TheKoontzy]

I work for a //very// small long term care and rehab facility. We just changed over from paper to electronic. It was a huge shift for many of the staff who were use to the paper charts. It not just the cost of the program, and training. It is the cost of taking nurses off the floor, and any staff who work on charts. You have to pay them for training, and pay agency or other staff overtime to cover their shifts if you need to. It is so much money. Plus you have to invest in computers for people to use, and equipment to make the shift easier. We are a few months in and still hitting bumps. We are what I call the odd hybrid phase where we are 75% electronic but 25% paper on some things still. I am not surprised if some departments just aren't able to make the shift without literally pausing for a day or two just to make things smooth/safe for patient care.

[@allie9949]

I had an anesthesiologist openly brag to me after surgery that I was not in fact allergic to a medication that I told him I was. I was dumb founded. The entire time he refused to believe that I was allergic to Zofran. After the fact, I reported his behavior to the surgery center and my surgeon. I later found out that he pushed the med with steroids and benadryl. I have since (accidentally) been given it again and the nurse and surgeon watched as the hives spread up my arm. I now yell every anesthesiologist, that I am highly allergic, received the medication 3 times after knowingly reporting it as an allergy and now my anesthesiologists tell me they remove it from the room to ease my mind. I'm tempted to write it on my forehead now!

[@annebebee6764]

Why did you turn this into a debate about CRNA's? Also CRNA's have 4 years of nursing school, ICU experience and then 3 years of CRNA school, not what the lawyer said. Don't use this case to smear all CRNAs.

[@Ismaelbarca]

Exactly, bad providers everywhere

[@Sav1010]

Aside from the lawyer being incorrect about the education, I felt like this was a very fair video discussing the case. Where in this video did Dr. Cellini smear CRNAs?? He pointed out facts about the stark differences in training and education, which isn’t really debatable. And stated he would prefer to be in the care of someone who underwent training and board certification as a physician.

[@TheExclusiveB13]

LOL don’t be mad, med school reject

[@NurseBrit]

@@TheExclusiveB13 you should not be able to bash other providers. It’s disgusting that someone reputable like Dr. Cellini would allow that. Speaks volumes

[@jacksonbuechlein4694]

@@Sav1010 he painted it that md’s have so much more training when in reality the comparison of training and therefore care for MD vs CRNA is actually very comparable. When MD’s discount nursing school they negate how intense 2022 nursing schools have become. And in many states, you do not need a “supervising” anesthesiologist. For example, Kentucky, where I live.

[@cmozoo]

Decades ago, at hospital I worked at, a young man undergoing cosmetic surgery suffered anxoxia resulting a vegetative state. The anesthesiologist fell asleep during the surgery and never noticed the ET had slipped and the patient was not getting oxygen.

[@sarahrose1454]

Wow…..that’s awful 😢

[@strides1000]

I guess it really just depends on the person not the job title

[@natalievancouver8188]

Wow I’m pretty sure the whole show Dr Death showed most of his mistakes happened at Baylor Medical in Texas. Something needs to change that’s negligent for sure.

[@cannsmith]

Baylor Scott and White in Dallas accepts more healthcare plans including Health Insurance marketplace and medicare plans. Parkland and Dallas Presbyterian are ranked higher as far as having doctors of more experience however. This is something to consider as well

[@hyruler64]

Thanks for the insightful and rational discussion of this case. I'm in medical school now but before this, I was an RN who considered the CRNA route. It just did not sit right with me that they perform the job of a board-certified anesthesiologist with so much less training so I decided to go to med school instead. A BSN and having ICU experience are nothing close to physician training. The balance of implementing mid-level providers is tricky and it's unfortunate patient safety is at risk. Of course many other factors involved but that's my 2 cents.

[@shorty06111]

Crna's often have many years of icu experience before going back to school and and crna training is quite rigorous. This case does not reflect all Crnas. Negligence and complacency can lead to these types of mistakes, but MDs and Crnas, PAs, NP, and RNs can make that mistake.

[@cbl6520]

@@shorty06111 And yet many of these organizations that lobby for “physician lead care” always point to extreme outliers to prove their point, while simultaneously ignoring similar instances of incompetence at the hands of physicians. Look, no one in their right mind would argue that CRNA training is on par w/ an anesthesiologist, but to appeal to extremes is intellectually dishonest.

[@frostar701]

what! no criminal charges? If this kind of negligence happed to any one other then Priests, Cops or Medicine; you bet there would be charges. When a dr murder my wife due to negligence the hospital changed her medical records too. In my case they forgot to delete the original ones. I got sh!t for my pain and lost and no one went to jail.

[@huntingtonhayes]

That just isn't true about CRNA education. As of 2020 all CRNA programs are doctoral degrees. Most programs also require a 4 year bsn, 2 years of ICU nursing, and now a 3 year doctoral program. That's 9 years of training and experience. To say CRNAs are not trained to an appropriate and safe level in 2022 just is not accurate. This is just a case of someone being negligent, it says nothing about the profession as a whole.

[@unicornwineguild9152]

Absolutely. I agree. He is trying to say that any CRNA is an inferior clinician. So not true. This appears to be a case of coverup by the hospital and the staff and what about that anesthesiologist who tampered with the IV bags he talked about a month ago? Would Dr. Cellini rather have him for a provider than the CRNA because he was a DO or MD?

[@DrCellini]

What part of the video did I say CRNAs aren’t trained to appropriate and safe level?

[@DrCellini]

I am not trying to say that. And no, I most certainly would not want any incompetent or negligent person taking care of me regardless of credentials

[@unicornwineguild9152]

@@DrCellini you imply throughout the video that CRNAs are less competent than a physician and state you would choose a physician over a nurse anesthesiologist. I say you should also look at skill and experience. That goes for any practioner, no matter what specialty.

[@JustPeaceLoveAndKindness]

The institutions and nursing organizations are much more powerful than most people realize. $$$$ drives a lot of things. Many states, because of nursing lobbying, allow CRNAs to operate independently, and without any physician supervision. I do not think that is wise.

[@PropofolAhoy]

Based on what research don’t you think it’s wise?

[@anoxie1301]

1:4 is a poor ratio, it's 1:2 in France. But money...

[@GumriRN]

This is just the second video by Dr. Cellini but I’m getting the distinct impression he doesn’t have a good grasp of Critical Medical Care…. Perhaps he’s in Radiology. They’re known for being devoid of factual, clinical medical practice. He does appear to want to “NAIL” Nurses for Medical Malpractice. Pity too. There are many types of Nursing degrees which I believe, he has little knowledge of our educational background.

[@snuassauns]

I have to wonder if he had an anaphylaxis reactions to some medication. That can cause a sudden and rapid decrease in blood pressure.

[@Cc19283]

Would you let a physician assistant see you in an office? Reading these disparaging comments hating on mid level providers makes me so anxious to graduate from PA school. Even having 5 years of clinical experiences in multiple specialties at the same time before starting school and putting my 120% into school to provide the best care for my future patients still makes me worried that I won’t be good enough. I know PA school doesn’t replace a supervising doctor with years of schooling and residency at all, but it still stinks reading these comments. The only comfort I have is that I know I will be continuously motivated to do my best to stay up to date on new clinical practice guidelines and advocate for my future patients no matter what.

[@briannerk3373]

I actually think PAs are better than MDs in many cases (not always) because they are less likely to have an ego that gets in the way of listening to their patients intently for clinical data, among other things. It's a myth that longer and more brutal schooling always means that someone is better at their work. Practice, experience and supervision are what counts most IMO not cramming forgettable facts from a 1000 textbooks and being bullied by generic attendings; Every profession has its negative stereotypes, so I'd say that you have to and can learn to not let them affect you emotionally overtime.

[@grandma460]

You sound smart, humble, and dedicated to best practice. Our world lucky to have you. Old RN here :). Thank you for working so hard.

[@Cc19283]

@@briannerk3373 I agree, every profession has both good and bad apples. Thank you for believing in the PA profession; I’ll continue to work as hard as I can!!

[@Cc19283]

@@grandma460 I can’t thank you enough for the kind words and taking care of patients as well! I definitely feel more confident going into my clinical year now. :)

[@surgerystudio7654]

Don’t let these comments scare you, they’re coming from a place of ignorance. I know many excellent mid-level providers and many not so excellent MD’s. As long as you can read you will always have the chance to increase your knowledge and become just as much of an expert as your supervising physicians. Ask questions, and never stop learning! You’ll do great because you sound like you have the heart of a caring provider.

[@macpduff2119]

I Thank God that when I broke (compound) my leg I live just a 15 minute ambulance ride to North Carolina's premier Medical school. I was introduced to my anesthesiologist prior to surgery and he was introduced as "doctor". Of course I have no idea if he was the only one during my 4 hour surgery. All I know is that my leg was saved and my brain still seems intact 🙂. However, when we lived in a different city, my neighbor was an anesthesiologist at our local hospital. He was supervising the CRNA for a patient undergoing knee surgery. The patient died for lack of oxygen. The jury trial determined that the MD was at fault because even though the CRNA inserted the tube, the Anestestiologist approved the placement. Tragic.

[@JayyThao]

Okay let’s talk about IR catastrophes and poop on IR too. Everyone’s sh*t stinks. Patient care in the OR is not solely the responsibility of the anesthesia team. Every single person in the OR is responsible for caring for that one patient including the anesthesia provider and anesthesia tech, the surgeon, the surgical techs, the circulating nurses. Not sure why you’re just pooping on SPECIFICALLY CRNAs. Must be an ego thing 🤷🏻‍♂️

[@dianeridley9804]

Patients do NOT require "brain monitoring" in the majority of general anesthesia cases. If that were the case, such monitoring would be a standard of care, and it isn't.

[@vanessaforttini]

Why do CRNA’s even exist? You know, when properly trained Anesthesiologists are out there (I’m a foreigner so I just don’t get it)

[@whytho4346]

It's a usa thing worldwide.. in the whole other world nurses are nurses and doctors are doxtors

[@ndawn90]

Because there aren't enough anesthesiologists out there to do the job, especially in rural communities, and because nurses providing anesthesia actually pre-date physician anesthesiologists.

[@yarnmaniacs8936]

Didn’t even know we had an option…thank you for the insight! Missed seeing the educational videos, so this was a nice surprise!

[@traumarn100]

My husband was a CRNA for 35 yrs. The anesthesiologist was always there for induction and extubation. If there were issues with patients the anesthesiologist was called. The education now is a minimal of a masters degree. They are considered nurse practitioners in anesthesiologist. The reason I know about this is that I was an peri-operative nurse in the same hospital for 40 years. As an OR nurse I was always at the patient’s side during induction and extubation. I have never seen any anesthesia person ever leave the patient’s side. An operating room can be loud at times and most of our RN circulators can tune the noise out but we can hear a Sat monitor going down and are at the head with anesthesia and can call our MD covering and they’re right away in the room. I kind of was angry about the comments about the education of CRNA. They have to have a bachelor of Nursing degree, experience in the ED, ICU, CCU then they go for their masters degree, then take their Anesthesia Boards. They always shadowed with another MD or CRNA for a period of time. They never work alone on call. Anesthesiologist is always there on call. I trust any of the CRNA’s with my care and my family’s care.

[@bluethunder9102]

They have a minimal of a doctorate now

[@traumarn100]

That was just being mentioned in New Hampshire

[@PropofolAhoy]

As a matter of fact that is false. CRNAs are not nurse practitioners in anesthesia. They are either Doctors of Nursing Practice - Nurse Anesthetists (DNP-NA), which is not the same thing as a nurse practitioner (NP). Or they are Doctors of Nurse Anesthesia Practice (DNAP), which again is not the same thing as a nurse practitioner. The training between a CRNA is vastly different than that of a NP. The same way a Certified Nurse Midwife (CNM) is not the same as a NP. Even though the CNM is required to get a DNP.

[@jjk2one]

Where does anesthesia come from?

[@josephmaschak8652]

Oh, to be a fly on the wall while that case was in progress. Or when the department heads got wind of it.

[@LJStability]

Yo! Why do all the malpractice cases happen at Baylor lol

[@doug112244]

You'd have to dig around to compare them to other hospital SYSTEMS. I just looked it up. It's huge. This is from their website. "Today, Baylor Scott & White includes 51 hospitals, more than 800 patient care sites, more than 7,300 active physicians, over 49,000 employees and the Scott & White Health Plan." I have been getting care at one of their hospitals over the last 7 months that I'm happy with.

[@bebeerin]

i don't doubt that there is a high level of training that goes into CRNA programs but i still don't trust it 100% with my own life on the line. there's still a significant difference between people that had to through all the training of becoming a doctor to that of a nurse. i kno CRNA programs are competitive and intense but at the end of the day it's still a nurse. and i also think about the fact that CRNA schools are pulling from a pool of people that wanted to be nurses whereas an anesthesiology residency is pulling from a pool of doctors. it's just not the same even tho both end up with the same position (as far as what they're allowed to do in the job). im sure there are many nurses out there that are smart enough to have become doctors but not all of them are on that level. at the end of the day, if im on the operating table unconscious, i'd definitely want an anesthesiologist over a CRNA if i knew nothing of their experience, negative patient outcomes, near misses, patient death statistics, etc.

[@kaileyveitch353]

While this is an absolutely horrendous case, I don't want to discredit the role of a CRNA, this video seemed to focus on the face that this person was a CRNA and shouldn't have been able to practice/wasn't qualified, but really the case is that this person was grossly negligent, could have been an anesthesiologist or a CRNA, it's just a person who made very poor decisions, but I just want to be clear, Anesthesiologists can and have made dumb decisions just like this person

[@aqualife88]

I completely agree with this! This person should not have been in the Healthcare field to begin with

[@spiritmediumclaytonsilva649]

I’m in TX and Baylor uses EPIC so that’s odd.

[@jeannesherrill]

Very odd. Doubt it was done during a scheduled downtime

[@spiritmediumclaytonsilva649]

@@jeannesherrill I agree. The symbol for anesthesia providers is the lighthouse their Job is to make sure you stay alive in surgery and watch you the entire time. I think it would be interesting to get Kristina Braley MD view she’s an anesthesiologist in Houston but Baylor hospitals are all over Texas. She’s a well known KZbinr.

[@bebeerin]

you kno what's even scarier, patients that are sedated 24/7 on ventilators in the ICU with only nurses monitoring the patients (there is no anesthesiologist or even CRNA present monitoring that sedation that is going 24 hours/day). it's just a person with the training of a nurse (which im not discrediting nurses but that's not a huge amount of training even with ICU experience). and each nurse has 2-3 patients they're taking care of at once. a blood pressure can drop at any point and there isn't always someone right there watching the patient's vitals 24/7. the nurse could be in another patient's room or on a lunch break. and when nurses take a break, that means another is nurse is covering that nurse's patients as well as their own patients since most hospitals don't have break nurses to do the lunch breaks. that is not close monitoring whatsoever for a patient that is in an incredibly critical and vulnerable state. there is a charge nurse in the ICU but they're not straight up sitting there staring at every single patient's vitals 24/7 and a lot of times they are away from the nurses station in one patient's room at a time. the patients are always "under" a nurse's care all the time but there is no dedicated person that is giving attention to all the sedated patients 100% of the time

[@pv8340]

Because of poor oxygen blood flow, can a person end up with hydrocephalus? Also, if I was poorly positioned, can one have ulnar nerve damage? in the supine position

[@anniesshenanigans3815]

After surgery I woke up with retinopathy in my left eye. Much later, after eye exams and tests, I realized it was from BP drop during my surgery. Of course there are never any notes about this so there is no way to prove it. If I had asked the doc while I was in the hospital I am sure I would have gotten something close to the truth. But now I realize that I was lucky it was not worse. I have had many surgeries since then and when I go in, I always ask who's there, did they get enough sleep the night before, etc...

[@davidvarner4089]

In Texas CRNA’s can practice independently of anesthesiologists

[@chrimar456]

I’ll be honest, I really wasn’t expecting you to say you’d prefer to have an anesthesiologist over a CRNA, given that your name, brand, and reputation is tied to your videos and how stating what you did could be seen by some as a doctor bashing ACPs. Mad respect for being honest, I think I wish more doctors were openly honest about this kind of thing. I’d also only be comfortable with a CRNA if they were under direct 1:1 supervision by an anaesthesiologist, for the exact same reasons you’ve succinctly stated yourself.

[@plant-basedmd8155]

Could it have been a pulmonary embolism, and cardiovascular collapse considering its a lower extremity fracture?

[@triciahartis9153]

You should do a story on ANOTHER Dallas case about ANOTHER Baylor anesthesiologist. Raynaldo Rivera Ortiz Jr., worked for a BAYLOR surgical center in a Dallas suburb and was fired (allowed to resign) after he was arrested for DV and shooting/killing his neighbor’s dog as revenge for helping the GF of Ortiz get away from him. Ortiz was then able to go to another Dallas area surgical center also owned by BAYLOR. The anesthesiologist is accused and in jail now for spiking some IV bags with Bupivicaine and caused several cardiac emergencies that required transfer to a major hospital. One of the spiked IV bags was taken home by one of Ortiz’s co-workers, another anesthesiologist, Dr. Melanie Kasparov, who took one of the spiked IV bags home to rehydrate herself because she had been I’ll and she died during the infusion. I can’t believe he was able to still be employed by Baylor, in May of this year he was fined $3000 by the State board for failing to maintain appropriate care for ANOTHER patient. Dr. Ortiz was caught on CCTV hiding an IV bag under his him hidden from site and putting it in the warmer.

[@FatherDuck80]

This is a prime example and result of all these third world butchers and frauds becoming doctors in this country. And the medical schools are to blame as well as well as these hospitals pushing them through after not passing their background checks. F-ing Criminal and downright f-ing evil.

[@davidvarner4089]

One of our anesthesiologists was adamant against electronic records. If the BP machine was to malfunction for example it might show a normal reading one minute, something else. Nothing wrong with the BP, but if it’s on the electronic record; Potential malpractice 8:15

[@user-wd7nz7tw7c]

It is good to point out difference between two professions and give patients the opportunity to choose the care they feel more comfortable with, but you must accurately depict the education and training from both sides. This information is highly inaccurate and states the minimum training required to apply to CRNA school, but does not accurately identify the typical and average training of the majority of CRNAs. Nurses must have a 4 year bachelor degree and pass boards and enter into an ICU. Majority of institutions prefer nurses to have 1-2 years of stepdown or med-surg nursing experience before entering ICU. Most students matriculated into CRNA school have 3-4 years of intensive care nursing background where they work with acutely ill patients and actively care for patients with a variety of disease processes (cardiac-surgery, neuro-surgery, general surgery etc.) CRNAs then complete a 3-3.5 year doctorate (DNP) program with a minimum of clinical hours and specialty cases, procedures, anesthetic types to even take board exams. CRNAs are trained in school to be independent providers and use the same textbooks and others that MD anesthesiologists use to study for board exams. Typically all students are well over the amount of hours and amount of independent done procedures. CRNAs can then choose to specialize in Cardiac surgery or Pain management with further certifications if they choose. I am not comparing two professions but simply stating the typical amount of training to even enter the profession, let alone practice for potentially over a decade in anesthesia and potentially have far more experience than a new MD anesthesiologist depending on practice structure, institution, and level of autonomy. These cases are highly anecdotal and there are good/bad CRNAs and good/bad MD anesthesiologists and good/bad residents. I would suggest looking into the literature that multiple highly reputable studies have shown no increase in mortality, morbidity, or prolonged hospitalization between CRNAs and MD anesthiologist with similar level of complexity case types. At the end of the day, you make your own decisions of who you would like to perform your anesthesia/medical care but it should be well informed.

[@PeterH-be1xe]

That's a nice presentation, but the bottom line is that a CRNA is not, and never will be, an anesthesiologist. Period. And no, I don't want a CRNA anesthetizing me any more than I want to see a PA in the ER or at my family physician office. That's not a doctor.

[@user-wd7nz7tw7c]

@ Well you are implying that CRNAs are attempting to be a MD anesthesiologist. Looking into the history of anesthesia, nurses were preferred upon its start during the civil war era. Only until anesthesia was found to be profitable, did physicians attempt to make it solely theirs. Anesthesia is not owned by MDs, as well as the term “Doctor”. I look less at a piece of paper with a stated “MD” and more at the statistical evidence. I much rather have a CRNA with likely a decade of medical experience than a 2nd year resident. But ultimately access to anesthesia care is limited and the US population is growing older/unhealthier. Without CRNAs the health care system would crumble, leaving hundreds of thousands without access to procedures. So you can’t make these broad arguments that do not help in any shape or form. But you are entitled to your opinion, which does not offer a solution. If CRNAs were as unprepared and lacked knowledge as you say, half of the country would not opt out for medical supervision and allow them to be independent providers at the state level. Majority of rural sites are managed by CRNAs and provide access to individuals without a hospital within hundreds of miles. So you making patients fear due to the thought of job security is much more harmful than anything.

[@infectdiseaseepidemiology2599]

Multiple outcome studies demonstrate that for routine and lower risk surgeries, there is absolutely no difference btw CRNAs and anesthesiologists. Clearly, in this case, the CRNA should have contacted the attending ASAP after hypotension developed.

[@andresgarces10]

Managed to get out of Venezuela to live in a better placer and then this happens to him. Really sad

[@ArmoredGauntlet]

I am in nursing school for my BSN. And all three hospitals that I work in use electronic charting exclusively. I would decline employment from any nursing facility that uses paper charts.

[@one4blondes]

Wow, eye opening, very informative, thank you

[@IAMsangoku]

Did I hear him say at 7:46 that “CRNA’s are doing that”: go a block to get coffee? Putting other professionals down 😮😱🙄

[@calletanocruz6920]

By having paper charts you don’t run the risk of losing your patient information if the system where to go down. That could mean life and death. Don’t get me wrong having them digitally is always faster and at you finger tips. Even better would be to have both paper and digital charts. You never know what could happen and should always be prepared for any and all. But that’s just my point of view. I would 1000 times rather have a hard copy and not risk losing my digital information. But having both is always better.

[@surgerystudio7654]

Same! I miss paper charting, and I’ve had records get completely deleted so to be so dependent on these computers not failing is not wise.

[@davidvarner4089]

I have had 2 nurse anesthetists. No issue. Now MDs use CRNA. They pay the CRNA a small amount in salary. The MDs get the big bucks. Pure greed

[@cheryllawrence2743]

Why don’t the Hospitals give us the option??? I’ve had too many surgeries n I need total knee replacement on right knee. I’ve been dealing with it. When n if I have it done, you best believe I’ll have these questions when I talk with anesthesiologist. Thank you. I love the information you pass on

[@etamlous]

This is the future of healthcare in America that is here to stay forever. A for profit system with ever eroding professional ethics and with ever eroding rigorous training in all fields of healthcare. Healthcare expenses keep skyrocketing, patients go into bankruptcies while they receive inadequate care. I would not let RNs or PAs with any subspecialty to take care of my pets let alone administer anesthesia on me or trust them to diagnose and manage conditions without supervision. If anyone believes that physicians and RNs follow state laws to the letter and don’t cut corners for profits, I have a bridge to sell you. I work in healthcare administration side and see the ugly reality every day.

[@m8trxd]

How do we know a blood clot didn’t get dislodged and cause the brain injury, which could have caused the hypotension

[@barb8335]

Good video Dr. C Valuable information

[@lnanesthesia3366]

The loss of any life is tragic and condolences to the family and those involved. It should be said that CRNAs are not educated, trained and hired to be replacements for physician anesthesiologist. There is a place for both these professions within and outside of the OR. CRNAs are highly-trained clinicians who are also human. Equally they or ANY other healthcare professional can make mistakes, or lapse in judgement because no one is perfect. This story has been made out that all CRNAs are not adequate, knowledge or skilled providers and that’s not the case. There’s always bad apples, but that doesn’t mean the tree is ruined.

[@SK-mr6ov]

That’s a stupid argument, the point is try and minimize this stuff from happening by having the most qualified individuals do cases. “Bad apples” isn’t the case here. It’s lack of Knowledge

[@lnanesthesia3366]

I want you to go look up malpractice or neglect cases for anesthesiologist even with more education issues, mistakes and problems arise nonetheless. There are bad apples. I appreciate your comment.

[@judithwyman7654]

I live in area where several Baylor Hospitals. My friends and I all have had complications. My complications were serious with mistakes. I now use Seton.

[@dawnbarchett8026]

Your concluding statement contradicted your initial Google search about the training of CRNAs. Your Google research correctly found that this requires 1 year of RN ICU experience and a 3 year CRNA program. Yet, at the end, you said that this CRNA in this case "may have been a nurse with one year of training." Why did you say this? Are you attempting to imply that this person in the case was not a CRNA? Or cast more doubt on their abilities? And therefore, by implication, all CRNAs? Please let me also put forth that applicants to CRNA programs must also possess a bachelor's in nursing, which takes a minimum of four years to complete. Please discuss the whole story if you are going to discuss the physician qualifications by years of education and experience. It was nice that you mentioned that you work with several "solid" CRNAs, but your actual opinion about CRNAs was revealed at the end.

[@DrCellini]

It’s called an error.

[@Snoopy_dogg123]

Nurses should stick to nursing. If you wanted to administer anaesthesia, you should have been a doctor. You cant put patient's lives at danger just because you think you deserve to be more involved in the medical side of practice than you are supposed to. This system of RN's in the US is built to fail.

[@Emoney131]

@@Snoopy_dogg123 you have no idea what you are talking about. literally none

[@edwardherrera846]

@@Snoopy_dogg123 say that to the 60k CRNAs who provide 60% of all anesthesia in the US. Most likely did the anesthesia for you or your family safely. Always easy to bash when you don’t know what you’re talking about.

[@bluethunder9102]

@@Snoopy_dogg123 Wow you’re ignorant 😂

[@Nightowl80]

Hmmm, I wonder if there were other doctors and nurses in that particular surgery. They all were covering up something?

[@shannonobrien9922]

How truly devastating!!!! THIS is why there is SO much redundancy built into Healthcare!!!!!!! So cases such as this didn't happen! I'm truly surprised bcuz Baylor is normally SUCH a good hospital

[@eduardodiaz9354]

I work at a level 1 trauma center with 1300 beds and anesthesia uses paper chart now that I see your video I understand why the use paper charts to hide vitals

[@cwavt8849]

On the last video I was in disagreement with your views. But, in this, I am in total agreement. And, living in Texas, you have opened my eyes on a very serious subject that affects me. Thank you, Sir

[@datboikevin]

srna here, just want to fill in some facts, it's 2 years of nursing school, minimum of 1 year of icu experience, average srna have 3 years of icu experience, crna school is 3 years

[@cmozoo]

Patients should be fully informed whether an anesthesiologist or CRNA will be doing the anesthesia.

[@csc1641]

I had 2 surgeries in 24 hours. Scary to have to go under twice back-to-back.

[@NateLeone]

Just a couple points to correct in your video. This case was done a few years ago, likely before they moved to electronic record keeping in the OR. Many facilities still use paper charting in the OR. Also, it's highly unlikely the nurse anesthetist left the room of the patient unattended. I'm all for physician only anesthesia but highly doubt that the nurse left the OR, they were most likely just getting a break. Finally, we don't routinely use neuromonitoring (cerebral oximetry, SSEPs, MEPs, BIS) for cases that do not require them nor have I ever heard of a hospital requiring every case to use them. Neuromonitoring has a small scope of use and I doubt it would've changed the outcome.

[@aladin1216]

Thank you. He is talking about a topic he knows very little about.

[@TisOnlyAScratch]

I'm not in the medical profession at all but I just imagine myself being the shoes of this CRNA (any medical professional really). I cannot believe CRNA waltzed away without a care in the world for 12 minutes for any reason without having some to take over temporarily. I would be too high strung to make sure my patient didn't die or get injured because it would eat me up inside that I was the reason that someone else got hurt. I imagine if this attitude wasn't in that person's mind, there sould be the fear of getting in trouble or sued if something happened and it was that person's fault.

[@DDTipsy]

There seems to be lot of missing information in this case.. Q1. How did the BP fell ? Was it due to effect of Anaesthesia drugs or due to the uncontrolled surgical bleeding or due to inability of the lone nurse Anesthetist to quickly provide lot of fluids, blood and BP raising medications all at the same time, in sufficient amount and quickly, so that the BP could have been maintained. Q2. Where that CRNA had gone for 12 mins ? Was it for a break ? or was it for calling help or arranging resuscitative equipment? I have seen leg surgeries. Sometimes they bleed like hell. And even if it is a small surgery , one has to be fully prepared for the worst. All iv lines, fluids, drugs, blood bags and other equipment for resuscitation as well as extra human help should be available before starting the case. If it goes alright, then its fine, but in 1out of 1000 cases, things can go south. And when it starts slipping, then it is impossible to control. It takes lot of experience of thousands of cases to handle such situations. I fully empathize with the patient, but it is not clear with the information given, that was it due to negligence or was the situation too difficult to handle..

[@karinakotsur527]

Thank you for educating us on these medical situations. It's very important to be aware.

[@saramoran3961]

Sadly we are seeing more instances in which care of patients is getting turned over to someone with less training because of cost. Most of these professionals can handle routine cases. The problem occurs when something happens and it’s no longer routine. That person does not have the additional training to come up with anything past plan c or d whereas the physician does. We are seeing many medical professionals leaving the field, due to various reasons, and this is going to affect patient care.

[@AlanZablocki]

It is malpractice if a CRNA or anesthesiologist left the OR with an anesthetized patient without another replacing them. I doubt that happened.

[@anniesshenanigans3815]

2024 and we still shuffle a lot of paper.. and our PACS system is at least 20 years old!! We still have to burn CDs!! Who has CD drives in their computers?? The scheduling system is well over 20 years old. We have to SCAN our hand written documents. It's crazy.

[@sarahchristine546]

When a bad outcome happens under the care of an anesthesiologist then the case is about that individual anesthesiologist and the case (which it should be). When the exact same thing happens under the care of a CRNA somehow it becomes political and about the profession rather than the individual. I don’t think this was an unbiased , thorough or medically informative video.

[@haroldpierre1726]

I hesitate to comment on this because as an anesthesiologist, I know there is much more to this case than has been reported in the news. This case is very suspicious for incompetence. Brain activity doesn't need to be monitored for anesthesia to be safe. I would bet that 99.99999% of anesthesia administered worldwide are provided without monitoring the brain. However, hypotension should have a cause and anoxic brain injury could be due to an esophageal intubation. If the CRNA left without coverage, then that a BIG issue. But that the covering person signs in and signs out. CRNAs are quite capable and this outcome can not be blamed on CRNAs. We are missing information!! I've received care from CRNAs and have no problem receiving care from a CRNA. By the way, at the majority of hospitals, patients DO NOT have a choice of receiving care from CRNAs or anesthesiologists.

[@cynthiajohns0n442]

My question is, did she administer the medications before or after her 12 minute absence?