Editor’s note: In the December issue, Dr. Miguel Figueroa’s letter to the Editor questioned Dr. Zauder’s statement that an anesthetized patient should never be left unattended and presented a hypothetical case of a sudden PACU emergency requiring intervention by an anesthesiologist.
Dr. Zauder responds:
Provocative as ever, Doctor Figueroa raises a major moral, ethical and legal issue. I am amazed that this renowned semanticist has allowed h4nself to fall into such a trap. He is providing Monitored Anesthesia Care. The patient is “slightly sedated but awake and perfectly calm even trying to talk whenever she is allowed”. Both Doctor Jenne and I were emphatic about not leaving an anesthetized patient. Is a slightly sedated but awake patient anesthetized? I think not. Doctor Figueroa’s action, then, was appropriate.
Suppose the scenario is changed just a bit. Jenne refuses to have her cataract extracted under local anesthesia. Figueroa administers a general anesthetic. The recovery room calls to say Zauder having been extubated “was experiencing some respiratory obstructions. Figueroa rushes to the PARR. Jenne’s anesthesia lightens. She “bucks” on the tube and extrudes vitreous. Belli is retained and charges abandonment. What is the defense? There is none!
Change the scenario once again. Figueroa elects to remain with Jenne. Zander is brain damaged. His family retains Spence who consults the ICAHO He learns about SA 1.18A which states. “a licensed independent practitioner qualified in resuscitative techniques is present or immediately available until all patients operated on each day have been evaluated and discharged”. Spence institutes suit charging the facility and all who work therein have faded to adhere to the recommendations of the ICAHO. His case revolves about the definition of “immediately available’ He contends that one who is providing anesthetic care is not immediately available to care for another patient.
Howard L. Zauder, M.D., Ph.D. Albuquerque, N.M.