Question: “We have a staff person who insists on leaving a patient alone on a ventilator in an OR while he takes breaks. He has been counseled by the department chairman and hospital administrator, but still persists in this action. What should be the next step in dealing with this problem?”
Answer: Dealing with the problem of an anesthesiologist leaving a patient unattended is very straightforward if the Anesthesiology Department/Section has the appropriate Guidelines/Rules/Policies written to cover such action, i.e., adoption of ASA Standards for Basic Intra-operative Monitoring. Ignoring departmental policies or rules should be grounds for disciplinary action within the department or the hospital medical staff. The by-laws of the medical staff should cover disciplinary action at the department level first, and possibly higher level action, such as loss of privileges at the hospital medical staff level.
The first ASA standard requiring the anesthesiologist’s presence in the OR should be a “given” in any department. AD of the above, plus the comments of Drs. Zauder and Jene in the APSF Newsletter of June, 1988 are the ideal situations. There are anesthesiologists practicing in this country who do not fit the idea, i.e., there is no one to relieve the practitioner for even short periods during the day or night. In most practice situations, it is unthinkable that a patient should be left during a case under general anesthesia. However, we must realize that all do not practice in Utopia, and having one anesthesiologist for a small community hospital is better than none.
In conducting a consultation through the ASA On-Site Program, it is evident that situations exist that are not ideal, i.e.-, small, isolated hospitals with one anesthesiologist, or a 200-bed acute care hospital in which four anesthesiologists are “stretched” to cover the OR, OB and emergency schedule. There may be extenuating circumstances, defensible cases in which an anesthesiologist leaves the OR for very short periods and designates a temporary substitute after evaluating the potential risks and benefits.
Through the On-Site Program, it is hoped that ASA may be of assistance to the-se hospitals that are seeking a solution to understaffing.
Answer by Betty P. Stephenson, M.D., Houston, TX who is a member of the ASA Peer Review Committee.