Do you know who is handling you? Patients often do not realize that experts treating them are not physicians. Here is the situation I realized in my practice defending hospitals, doctors, nurses, including CRNA. Hypothetically, the patient enters an outpatient routine of anesthesia-sedated routine. An anesthesiologist MD can briefly greet patients, ask some history, and conduct short tests. This is done after another expert, especially CRNA. The certified nurse's anesthesiologist and / or nurse took medical history from the patient. As MD insists that this was done by nurses and / or CRNA, we do not do substantive and in-depth work without taking history or testing. He exists to calm the patient, once sedated it leaves control and supervision to the CRNA from the operating theater. The patient does not know what this is going on and they are not worried by the MD. If something goes wrong during surgery in anesthesia, CRNA can take discretion to take care of the patient and can give more anesthesia without seeking MD permission. They are not educated a lot and are not allowed to practice in this hypothetical way to prescribe anesthetics without the supervision of MD (at least in Michigan) by law. What will happen from time to time? Non-MD practitioners should make no mistakes that should be done and will injure patients permanently.
Another example is a doctor assistant (PA) who periodically treats patients with ER. Patient assumes that the order and treatment doctor is a doctor and does not know to investigate further. He is not aware that the doctor's assistant has not been treated. I am not aware that the doctor's assistant has not been treated. Specifically, I can not see the doctor's assistant being supervised again gently by the attending physician, after discharge from the patient, until the patient is discharged, and in some cases the patient's chart can be seen. Later it may be too late, as in the hypothetical case where the patient presents back pain to the ER and is examined, treated, and extremely discharged by a doctor's assistant diagnosing back pain. Pain in the back is a symptom of a heart attack, and it turned out that the patient returned home and died of another large heart attack. At the time of deposit, the doctor testified that he did not do anything wrong, the doctor's assistant could make the decision he made, the doctor could not sign off at the chart later. Treat it before his death!
(See MCL 333.16215, MCL 333.17049)
This article is not intended to discuss the laws related to the practice of nursing. This article is posted to let the patient know that they should ask about who is treating the patient. In my deposition experience protecting the practitioner, the patient will testify that they did not know that the processor was not a doctor. A plaintiff lawyer who prosecuted this case will leave the hospital because he failed to treat a therapist such as RN, CRNA, PA, a doctor who oversees them, the director, and did not take the appropriate protocol. These cases were almost fatal, accompanied by someone other than the doctor who missed the diagnosis. However, please be aware that there are rare cases in the practice of medical malpractice defense. Medical malpractice is not a standard, most of the therapists are highly trained and capable.
For information on the differences between CRNA and anesthesiologists, and for details of supervision that may not be required, please visit the following website. http://allnurses.com/pre-crna-inquiry/anesthesiologist- vs-crna-233939.html.
In the above hypothetical situation, the following law applies.
MCL 333.16215 is discussing delegation of acts, missions or functions to licensed individuals or licensed individuals. Director; rule. Immunity; Including third party refunds, or workers compensation benefits.
Sec. 16215.
Subject to the provisions of paragraphs (1) (2) to (6), a licensee who holds a license other than a subfield license in the health specialty area may obtain a certified or unlicensed individual who is certified by education, training or otherwise Tasks, or functions that are within the scope of Licensee's duties and are executed under the supervision of Licensee. Licensee agrees that if actions, duties or functions require continuing practice standards that tolerate the level of education, skills, and jurisdiction required by Licensee under this provision, acts, missions or functions under this section, Do not delegate functions.
(2) Subject to paragraph (1), unless otherwise provided in this paragraph and items (3) and (4), allopathy physician or osteoporosis doctor and licensee, who is a surgeon, Implementation of procedures requiring the use of surgical equipment only for individuals licensed under. Allopathic doctor or osteopathic doctor and licensee who is a surgeon may license the actions, duties or functions described in this subsection to be licensed under this provision if an unlicensed individual is one or more of the following And can be directly supervised by an authorized Allopathic physician or osteopathic physician and surgeon physically present during the performance of the procedure.
(A) A student enrolled in a medical or osteopathic medicine school approved by the University of Michigan Medical School or the University of Michigan Osteopathic Medicine and Surgery Committee.
(B) Students registered in the doctor's assistant training program were approved by the co-physician assistance task force created in part 170.
(3) According to (1), the Allopathic physician or osteoporosis physician and licensee who is a surgeon may delegate the act, mission or function described in (2) to an unlicensed individual under this section I will. One of the following:
(A) Do acupuncture and moxibustion.
Surgically remove bone, skin, blood vessel, cartilage, dura, ligament, tendon, pericardial tissue, or heart valve only from dead individuals for transplantation, implantation, infusion, or other medical or scientific purposes .
(4) In accordance with paragraph (1), Allopathic Doctor or Osteopathic Doctor and Licensee who is a surgeon delegate the acts, duties or functions described in paragraph (2) to individuals not permitted under this section be able to. Directly supervised by an authorized Allopathic physician or osteopathic physician physician and surgeon physically present during the performance of the procedure and representatives of such procedures are prohibited by the Board or its health facilities or agents and its delegations Or unlimited actions, duties or functions are specifically authorized by that health facility or agency to be delegated and executed by one of the following unlicensed individuals:
(A) a surgeon who meets the qualification established by a health facility or agency that is employed or contracted;
(B) a surgical first assistant that meets the qualification established by a health facility or agency that is employed or contracted.
(5) The Council shall, when the Board determines that the composition of the delegation poses a risk to health, safety, or welfare, to the individual who is not authorized or licensed to delegate specific acts, duties or functions Prohibition or restriction rule can be promulgated by the patient or the public
(6) The Council is subject to a more stringent supervision of acts, duties, and functions delegated under this section to promote safe and effective practices, which is not licensed You can promulgate rules that govern the categories and types of individuals.
(7) Individuals engaged in acts, duties, or duties delegated pursuant to this section shall not violate the part that regulates the scope of practice of that profession.
(8) In the amendment that added this section, a service provided by an individual authorized to execute these services under (4), a new or additional third party refund or forced labor There is no need for compensatory benefit for the person.
CRNA is an anesthesiologist of certified registered nurse. CRNA is a nurse. According to MCL 333.17212, a nurse can prescribe only a starter dose of medicine and control substance can not be prescribed. MCL 333.17212 Registered professional nurse; ordering, receipt, or distribution of free starter medications:
Sec. 17212.
(1) In addition to the acts, missions and functions delegated under paragraphs 16215, 17745, 17745a or 17745b, the supervising physician shall notify the registered professional nurse, the additional starter drug Regulated substances specified by order, receipt, Article 7 or federal law. When mandated regulation, receipt, or distribution of complementary starter dosage medication is performed, both the registered nurse's name and supervisor's name are used, recorded, receipts , Or dispensing. As used in this subsection, "complementary starting dose" means the term defined in section 17745.
(2) It is permitted to distribute supplementary first-dose medicines to registered specialist nurses to pharmaceutical manufacturers or wholesalers, as in the terms defined in Article 177, this It is the intention of Congress to enact the term. )), Section 503 (d), Chapter 675, Chapter 52 of Federal Food, Drugs and Beauty Act. 1051, 21 USC 353.
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