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Archive May 2017 XVIII, No. 5

Medical Malpractice: 5 Tips to Avoid Anesthesia Lawsuits

Your best defense is to operate within the boundaries of good sense.

William Landess

William Landess


malpractice suit LIFE-CHANGING Going through a malpractice suit has caused many clinicians to consider careers outside of medicine.

A majority of anesthesia providers will face a lawsuit during their careers, but most claims are preventable. As I often remind our younger staffers, don't step beyond the boundaries of good sense. Adhering to these 5 rules of thumb is a good place to start.

1Stay true to the basics. Most anesthesia-related malpractice cases probably could have been avoided by adhering to the basic principles. For example, never using supplemental oxygen near an ignition source, as we saw in the case of an elderly patient's face igniting at an Oregon surgery center ( It's often production pressure that causes errors. Some facilities are all too willing to take shortcuts: not taking time outs or letting the surgeon steamroll you because you're afraid to make him wait until it's safe to proceed. In anesthesiology, speed kills. Unless there's a situation involving loss of airway or arterial bleeding, slow it down.

2Don't normalize deviant behavior. A facility's profitability depends on its ability to maintain a strong case volume. That's all well and good — until a dollar amount is placed above patient safety. If a patient comes in with a BMI of 55 who's clearly not appropriate for an outpatient setting and you say, "Okay, let's do this," you may be putting the patient, the facility and yourself in jeopardy.

Most ambulatory facilities will not take patients with a BMI above 40, which I think is the safest approach. Some have gone as high as 50, which is on the razor's edge. Someone with a BMI of 55 might have a perfectly fine airway, but they still have a BMI of 55 and all the potential complications that come with it.

3Build relationships based on mutual respect. Some surgeons will adopt the attitude of, "This is my patient," and they believe that whatever they say goes. But as an anesthesia provider, it's your patient, too, and you have a duty and a responsibility to that patient. You must have the confidence to know the difference between keeping the peace with an overeager surgeon and veering into territory that could endanger the patient. After all, if there's an injury, and your action or inaction is determined to be the proximate cause, it's your license on the line.

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