To the Editor
One of the big factors affecting patient safety today is the problem of the substance-abuser being allowed to continue to administer anesthetics and to be responsible for patients’ lives. I have been at institutions (hospitals) in my career, where I had become aware that the CRNA was abusing drugs while administering a general anesthetic. Needless to say, the rest of the staff learned what happened and the person, usually a repeater, would be sent off to the rehab place on a little six week vacation, and then returned to the fold. In discussing this situation with peers, most of us felt we would not even let these CRNAS put us to sleep, let alone anyone we loved. You are always aware of your drugs, too, when these people relieve you (that is if you feel comfortable enough to let them). With the repeat abusers also signing your charts, they may involve you in any liability on their parts also. I believe substance abusers in the medical field, who have been in a high position of trust and who have accessibility to narcotics, etc., should go to 0 just like we insist our common folk do after being caught in possession of marijuana or cocaine. I also believe that part of the anesthesia consent should be to inform the patient that the CRNA and/or anesthesiologist was a former substance abuser.
Another situation that I feel needs looking into is the preparation of the patient for colonoscopy and gastroscopy. In many hospitals these days, the patients are given sedation during these procedures, having IV’s started, and being monitored for BP, HR, and oxygen saturation. Yet, these patients who are done as outpatients have no lab work, EKG, or chest film. Not all of these patients are classified ASA 1. The risk is that patients come in who are in poor health and former CABG patients with no labs or EKGs. I feel more needs to be done to address that issue. These procedures are indeed stressful to these patients and proper lab work and at least an EKG would serve as a beneficial guideline to prepare for anything unforeseen happening.
Mary R. Locke, CRNA Dearborn, MI