Do you know who treats you? Patients often do not know that their treatment is not a doctor. Here is a situation in which I became enlightened in my practice, defending hospitals, doctors and nurses, including CRNAs. Hypothetically speaking: the patient goes into a normal outpatient procedure, in which they calm down with the help of anesthesia. Anesthesiologist MD briefly greets the patient and asks for a story and can conduct a short examination. This happens after another professional, especially CRNA. A certified nurse anesthetist and / or nurse took the patient’s story. MD does not really do thorough work with history or exam because he claims that it was done by a nurse and / or CRNA. He is present to calm the patient and after he calms down, leaves the operating room, providing control and monitoring of KRINA. The patient has no idea that this is happening and that they do not care about MD. If something goes wrong during anesthesia surgery, CRNA is allowed to use discretion to take care of the patient and can give more anesthesia without asking permission from the MD. They do not have such an education and are not allowed by law (at least in Michigan) to practice in this hypothetical manner, prescribing narcotic drugs without supervision of the MD. What happens sometimes? A non-physician practitioner makes a mistake that should not have been made and which harms the patient forever.
Another example is the physician assistants (PAs) who regularly treat patients in the ER. The patient makes the assumption that the person giving the orders and treatment is a doctor and does not know to find out further. He does not realize that a medical assistant is not being treated for him, and if he is, he does not know what it means. In particular, he does not know that the doctor’s assistant is again freely controlled by the doctor, who may or may not look at the patient’s chart until after him, and in some cases, after the patient has been discharged. It may then be too late, for example, in the hypothetical case where the patient presents the ER for back pain, receives an examination, treatment, and is extremely discharged by a physician assistant who diagnoses reverse deformation. It turns out that back pain was a symptom of a heart attack, and the patient goes home and dies from another massive heart attack. When precipitating, the doctor will testify that he did not do anything wrong, and there were no breakthroughs so that the assistant doctor could make the decisions that he made and so that the doctor could subscribe to the schedule later, not knowing about the patient or before his death!
(See MCL 333.16215, MCL 333.17049)
This article is not intended to discuss laws relating to the practice of nursing. This article is published to inform patients about what they need to ask about who treats them. In my depositing experience protecting practitioners, the patient testified that they did not know that Palatr was not a doctor. The lawyer of the complainant pursuing the case will go after the traitor, which could be RN, CRNA or PA, for example, the doctors who supervise them, and the hospital for failing to control and have proper protocols. In these cases, there were cases of missed diagnoses by someone other than the doctor who were almost fatal. Please know, however, that in the practice of medical protection against negligence we see rare cases. Medical negligence is not the norm, and most cleaners are highly qualified and competent.
If you want to learn more about the difference between a CRNA and an anesthesiologist and about any supervision that may or may not be necessary, visit the following website: http://allnurses.com/pre-crna-inquiry/anesthesiologist- vs-crna-233939 .html.
In the hypothetical situation described above, the following laws apply:
MCL 333.16215 discusses the delegation of actions, tasks, or functions to a licensed or unlicensed person; supervision; regulations; immunity; third party reimbursement or employee compensation.
Sec. 16215.
(1) In accordance with subsections (2) to (6), a licensee who has a license other than a license for the underground medical profession can delegate a licensed or unlicensed person who otherwise qualifies as education, training or experience in performing the chosen action or task. or functions where actions, tasks or functions fall within the scope of the profession of the licensee and will be carried out under the control of the licensee. The licensee shall not delegate an action, task or function in accordance with this section if the action, task or function in accordance with the standards of acceptable and continuous practice requires the level of education, qualification and jurisdiction required by the licensee in accordance with this article.
(2) In accordance with subsection (1), and except as provided for in this subsection and subsections (3) and (4), a licensee who is an allopathic doctor or osteopathic doctor and surgeon delegates an action, task, or function that includes performing a procedure that requires the use of surgical instruments only for a person who is licensed in accordance with this article. A licensee who is an allopathic doctor or osteopathic doctor and surgeon may delegate an action, task, or function described in this subsection to an individual who is not licensed under this article, if an unlicensed person has 1 or more of the following conditions, and The procedure is directly controlled by a licensed allopathic doctor or an osteopathic doctor and surgeon physically present during the procedure:
(a) A student studying at a school of medicine or osteopathic medicine approved by the Michigan Council of Medicine or the Michigan Council of Osteopathic Medicine and Surgery.
(b) A student enrolled in the program of a physician assistant, approved by an assistant assistant special doctor who was created under part 170.
(3) In accordance with subsection (1), a licensee who is an allopathic doctor or osteopathic doctor and surgeon may delegate an action, task or function described in subsection (2) to an individual who is not licensed in accordance with this article, and which 1 of the following:
(a) Performing acupuncture.
(b) Surgical removal of only bone, skin, blood vessels, cartilage, dura mater, ligaments, tendons, pericardial tissue, or heart valves only from a deceased person for transplantation, implantation, infusion, injection, or other medical or scientific purposes.
(4) In accordance with subsection (1), a licensor who is an allopathic doctor or osteopath and surgeon may delegate an action, task, or function described in subsection (2) to an individual who is not licensed under this article if the procedure directly controlled by a licensed allopathic doctor or osteopathic doctor and surgeon who is physically present during the procedure, the delegation of such a procedure is not prohibited or is not otherwise limited to advice or a medical institution or agency, and the delegation of this action, task or function is specifically authorized by this medical institution or agency, which must be delegated and performed by any of the following unlicensed persons:
(a) A surgical technologist who meets the qualifications established by the medical institution or agency with which he or she works or under contract.
(b) A surgical first assistant who meets the qualifications established by the medical institution or agency with which he or she works or under contract.
(5) The board may promulgate rules to further prohibit or otherwise restrict the delegation of specific actions, tasks, or functions to a licensed or unlicensed person, if the board determines that the constitutions of a delegation may pose a risk to the health, safety or welfare of the patient or the public.
(6) In order to promote safe and competent practice, the council may promulgate rules defining the conditions under which, as well as the categories and types of licensed and unlicensed persons, which may require closer monitoring of the activities, tasks and functions delegated in accordance with this section.
(7) A person who performs the activities, tasks, or functions delegated in accordance with this section does not violate the part that regulates the practice of this profession.
(8) The amended act, which added this subsection, does not require new or additional third party compensation or employee compensation benefits for services rendered by the person authorized to perform these services in accordance with subsection (4).
CRNA is a certified medical anesthetist. KRINA - the nurse. According to MCL 333.17212, nurses can only prescribe starter medications and uncontrolled substances. MCL 333.17212 Registered Professional Nurse; Order, receive or distribute free products for beginners:
Sec. 17212.
(1) In addition to the activities, tasks, and functions delegated to sections 16215, 17745, 17745a, or 17745b, the supervising physician may submit in writing to a registered occupational nurse an order, receipt, and issuance of free drugs for refueling a starter, except as defined in the article 7 or federal law. When compulsory regulation, acceptance or delivery of free medication of the dispenser occurs, both the name of the registered professional nurse and the name of the supervising doctor must be used, recorded or otherwise indicated in connection with each order, receipt or issue. As used in this subsection, “free starter dose” means this term as defined in section 17745.
(2) The purpose of the legislature in resolving this section is to allow the pharmaceutical manufacturer or wholesale distributor as these terms are defined in section 177 to distribute additional starter medications to a registered professional nurse, as described in subsection (1))), in accordance with section 503 (d) of the Federal Law on Food, Drugs and Cosmetics, Chapter 675, 52 Stat. 1051, 21 USC 353.
