Anesthesia-related lawsuits in Maryland: CRNA and anesthesiologist claims

Fifty-two anesthesia-related claims filed with the Maryland Office of Health Claims Arbitration from January 1990 through February 1994 were analyzed in terms of patient care variables, types of anesthesia, surgical categories, legal causes of action, and patient outcomes to determine whether differences existed in the rate of filing of cases provided by CRNAs and anesthesiologists. In Maryland, all claims against a healthcare provider in excess of $20,000 must be filed with the Office of Health Claims Arbitration. During the study period, 70% of the claims were filed against anesthesiologists, 17% were against nurse anesthetists, and 13% named both the anesthesiologist and the nurse anesthetist. Claimants ranged from 13 to 78 years of age; the mean age was 45 years. Slightly more than half of the claims (54%) were on behalf of women. The majority of the claims originated in community hospitals (73%) and medical teaching centers (23%). The remainder of claims (4%) originated in military hospitals, medical offices, and surgicenters. Study findings indicated that general anesthesia accounted for two thirds of the claims, followed by regional anesthesia care (23%), local anesthesia (3.8%), and monitored anesthesia care (2%). Gynecological, neurosurgical, and orthopedic surgeries accounted for more than half of the claims. Two thirds of all claims alleged failure to attend to changes in the perioperative status of the patient. This included inadequate monitoring of the patient's position and failure to respond to changes in cardiopulmonary status. The second most prevalent cause of action concerned problems securing or maintaining a safe airway. Death was the most frequent adverse outcome (21.2%). Airway trauma (15.4%), nerve damage (15.4%), and brain damage (7.7%) were also cited as adverse outcomes.