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The only radical wayThe treatment of achalasia cardia is surgical treatment.

Does the case suck for RNs? The article leaves me the impression the case is about nurse practitioners or nurse anesthetists, and the clearest assertion that bedside nurses are affected by the decision only comes from a bedside nurse who is…a nurse practitioner student. So I suspect a component of fear-mongering by nurse practitioners to get the whole profession on their side. I dunno, maybe somebody with more familiarity with the legal specifics of the case can comment.

It's the same as if I accidentally hit someone while driving my car. You'd have to be a psychopath to be annoyed at a person filing against your insurance. I WANT that person to get refunded, and would expect the same if roles were reversed.

Midlevel providers almost always have “collaborative practice agreements” with a physician, depending on state law and institutional requirements and preference of the midlevel provider. These collaborative practice agreements confer considerable medico-legal exposure to physicians who participate in them, as they would be the ones to be sued.

When I work as an RN, it's full chaos mode, where it is literally not possible to fulfil everything that's ordered and still meet protocols for CVA/STEMI/Sepsis/etc and keep people who are determined to throw themselves on the floor off of it. That failure is squarely on admin's shoulders, but frontline workers (RNs, MDs) are the ones who are liable for the patients who fall through cracks in the system.

CONNETTE EX REL. GULLATTE V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 2022-NCSC-95 Opinion of the Court I. Factual and Procedural Background ¶ 2 On 11 September 2010, an emergency room visit for an upper respiratory infection revealed that three-year-old Amaya Gullatte was tachycardic, prompting Amaya’s pediatrician to refer the child to a cardiologist. The cardiologist’s examination of Amaya disclosed that the youngster was plagued by the heart disease known as cardiomyopathy, an affliction which enlarges the heart and makes it difficult for the heart to pump blood correctly. The cardiologist recommended the performance of an “ablation procedure” on Amaya’s heart in order to address the disorder. The child was admitted to a Carolinas Medical Center facility on 20 October 2010, where an anesthetics team consisting of anesthesiologist James M. Doyle, M.D. and Certified Registered Nurse Anesthetist (CRNA) Gus C. VanSoestbergen utilized a mask to administer the anesthetic sevoflurane to Amaya prior to the surgical procedure. Shortly after she was induced with the sevoflurane, Amaya went into cardiac arrest. Although the introduction of resuscitation drugs and the performance of cardiopulmonary resuscitation (CPR) by Dr. Doyle was able to revive Amaya, still the approximately thirteen minutes of oxygen deprivation which was experienced by the child resulted in the onset of permanent brain damage, cerebral palsy, and profound developmental delay. Plaintiff Edward Connette, as Amaya’s guardian ad litem, and plaintiff Andrea Hopper, as Amaya’s mother, filed a lawsuit against Dr. Doyle, CRNA VanSoestbergen, the Charlotte-Mecklenburg Hospital Authority, and two additional physicians who treated Amaya.

Starter Comment: According to the lawsuit, Rojas's blood pressure dropped while his doctor was supervising four certified registered nurse anesthetists, or CRNAs, all with patients at the same time. "As a result it is our position while that may be good business for Anesthesia Partners, it is not good medicine, because there is no way an anesthesiologist can supervise that many CRNAs at one time," said Steckler. "I think patients need to be apprised up front that they have a choice to get an anesthesiologist who has 4 years of medical school, 3 years of training and board certified”.

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Is this not standard practice everywhere? I work in a busy PACU where patients are told that the anesthesiologist will be there for induction but is supervising multiple rooms. We run 8-10 rooms at a time and normally have 3-4 anesthesiologists at a time. The only time one of our Drs spends an extended time in the room is if it’s something like an open heart, crani, or a vats. But there is always either an AA or CRNA.

Yeah this story doesn't make sense. Could run this guy at a MAP in the 40-50s and he'd probably be fine. Of course with paper charting who knows what really happened. Maybe the CRNA neglected to ventilate the patient for an extended period and fudged the documentation. Run of the mill hypotension doesn't make sense.

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Without explaining how the hypotension was managed it’s a over simplification that doesn’t explain the poor outcome. Very unfortunate situation that the hospital created the dangerous circumstances for this mismanagement to occur.

Okay so maybe I'm a sweet summer child, but doesn't the monitor scream at everyone in the room when the patient's anything drops too low? And aren't BPs usually scheduled for every 5 minutes while under anesthesia? And wouldn't they have become hypercapnic and their hypoxic, which would, again, make all of the alarms go off?


It's actually one of the most common Medicare audits that are done because it's an easy denial if malnutrition affected reimbursement. I don't work in denials but coding leads/educators tell this to coding professionals all the time. As I mentioned in another comment the reason is not so much "easy increase in reimbursement" (because it's more like easy audit target) and more of "the patient met established criteria for the diagnosis, would you agree or not?" Most of the time it comes from a dietician stating they meet criteria for a certain severity of malnutrition and then a physician not closing the loop on whether it's actually there or not.

Maybe it’s my location but my favorite question to ask when getting a history and need to know about diet is “when’s the last time you ate a vegetable? What was it?” If they say something potato related say that potatoes don’t count (often “potatoes” means “fries” and it’s mostly a starch anyways), also beware of the people who say lettuce but leave out that they mean the few pieces of lettuce on their burger or in their taco. You’ll get some wild answers. That and the fact that a balanced diet should have a variety of fruits/veggies, I wouldn’t be surprised if a large amount of people are technically malnourished. Luckily I take a daily multivitamin so my crap diet is fine

A few years back there was a study out of MA (Springfield, I think, which is a shit hole if anybody wants to know) that tested everyone coming in who had easy bruising, easy bleeding, loose teeth, etc. Tested serum vitamin C. Thirty percent had scurvy but since none of us knows what scurvy looks like it is routinely missed.

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