Expert: JM Starkman, MD - 11/29/2009

Question
Please excuse my hostility, but I'm mad as hell.  I had surgery on the west coast and had no problem getting an anesthesiologist to do the case. I do not want an AA or CRNA doing my anesthesia. I recently moved to the east coast (PA) and unfortunately need more surgery; I have been unable to find any place (hospital or surgicenter) that will provide an anesthesiologist 1:1.  Every place says that an anesthesiologist may or may not be available and if they are, that person will probably be supervising multiple cases.  This is dangerous and I don't want any part of nurse (CRNA) administered anesthesia.  The local university hospital even said that I might get a SRNA in addition to a CRNA, and that I have no choice if I come there for surgery.  The pain in my arm was so bad that i tried to have surgery with a CRNA "supervised" by an anesthesiologist; the anesthesiologist promised minimal or no sedation and a block only, but when the CRNA took over she gave me large doses of diprivan (which I told them I didn't want) before we even got to the OR and the result was awful.  The "supervising" anesthesiologist was in another room and the CRNA was running (poorly) the show. Fortunately the surgeon heard my withdrawl of my consent and we cancelled the case.  When the anesthesiologist finally arrived, he told the CRNA "she doesn't get sedation"...I could not get out of there fast enough.  Here is my question:  it's obvious that anesthesia in PA is practiced not my physicians, but by nurses and this is what I am stuck with.  I need joint surgery asap on my arm and leg, the surgeon says it can be done with a Bier Block without sedation (I don't trust them with sedation for good reason)..My question is: is I write "I'm not consenting to general anesthesia or sedation, I am consenting to a Bier Block with lidocaine only" on the consent, will this prevent them from doing anything else?  If the block doesn't work, they can abort the procedure.  I'm not a whiner, I have a graduate degre in pharmacology and have always trusted my providers (until now).  I don't expect miracles and don't care how much it hurts, I just need to have the surgery and want to restrict what the anesthesia "team" can do.  Having to do this makes me angry; but it's obvious that anesthesia here in PA has slipped from the domain of physicians into a system run by nurses who are in way over their heads.  Thanks, sorry for the anger, but I'm in a lot of pain and frustrated by this sad state of affairs.

Answer
I really have no standing to apologize for the lousy treatment you are getting from people who have the nerve to call themselves doctors, but for what it's worth:  I'm sorry this is how you are being treated by physicians who got into medical school proclaiming to be mindful and interested in people and their health.

Indicating what you're planning on writing on your consent OUGHT to accomplish what you wish, but it seems rather clear that the anesthesiologists and their "team" don't care too much about YOU.........so they might just ignore it.  In that case, I've always maintained that that would constitute a battery on their part-----but you're not looking for a legal fight, you just want your arm fixed.

By the way, have you talked to the chief-of-staff and the hospital CEO about this?  How about the Pennsylvania Department of Profession regulation?  Doctors have NO BUSINESS treating patients like this.