Medical Malpractice – Who is Treating You?

Do you know who is treating you? Patients are often unaware that the professional treating them is not a physician. Here is a situation of which I became enlightened to in my practice defending hospitals, physicians and nurses. Hypothetically speaking: Patient goes to the hospital for a routine outpatient procedure under which they are to be sedated with anesthesia. The anesthesiologist M.D. (MDA) greets the patient briefly and asks some history and may perform a short examination. This takes place after another professional, likely a Certified Registered Nurse Anesthetist (CRNA) and/or a nurse has taken a history from the patient. The MDA may not do a real thorough job taking the history or performing an examination because he assumes this has been done by the nurse and/or CRNA. He is present to sedate the patient and once sedated, leaves the operating room giving control over to the CRNA. The patient may have no idea that this is taking place and that they are not being cared for by the MDA. If something goes wrong during the surgery with the anesthesia, the CRNA is allowed to use discretion to take care of the patient and may give more anesthesia without speaking with the supervising MDA. What sometimes happens? The non-MD practitioner may make a mistake which should not have been made and which injures the patient forever.

Another example involves physician assistants (PAs) who routinely treat patients in the ER. The patient may make assumptions that the person giving the orders and treatment is a physician and does not know to inquire further. He may be unaware that he is not being treated by a physician assistant and if he is, he may be unaware of the importance of the distinction. Specifically, he may not be aware that the physician assistant is again loosely supervised by the physician in charge who may or may not look at the patient’s chart until after, and in some cases, well after, the patient has been discharged. Then, it may be too late as for example, in a hypothetical case in which the patient presents to the ER for back pain, gets examined, treated, and ultimately discharged by a physician assistant who diagnoses back strain. Turns out, the back pain was a symptom of a heart attack and the patient goes home and dies of another massive heart attack. At deposition, the physician may testify that he did nothing wrong and it was no breach to allow the physician assistant to make the decisions he did and for the physician to sign off on the chart days later, having never been aware of the patient or the treatment prior to his death.
(See MCL 333.16215, MCL 333.17049)

This article is posted to inform patients that they should inquire about who is treating them. In my deposition experience defending treaters, the patient would testify that they did not know that the treater was not a physician. The plaintiff attorney prosecuting the case would go after the treater who could have been a RN, CRNA or PA for example, the physicians supervising them, and the hospital for failing to supervise and have proper protocols in place. These were cases involving missed diagnoses by someone other than the doctor, which were nearly fatal. Please know however that in the practice of medical malpractice defense, we see the rare cases. Medical malpractice is not the norm.

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