Operating rooms can be risky places these days — and not just for patients. Medical professionals face risks to licensure and their careers when something goes wrong in today’s complex health care arena.
Surgeries often take longer, are more complicated and patients are often sicker than in past years, said Sheree Wolfenden, clinical assistant professor and program director of the nurse anesthesia program at the Mercer University School of Medicine/Medical Center of Central Georgia in Macon.
“Technology is advancing at a rapid rate and we’re called on to provide more care. We worry, 'Are we moving too fast? Are we implementing all the checkpoints and meeting the patients’ needs?’ ” she asked.
Starting a surgical or invasive procedure is a lengthy process. Due to the timeout procedure — or surgery safety checklist — advocated by the World Health Organization, the Center for Medicare and Medicaid Services, and the Joint Commission, as well as the required preprocedural verification, there are many things to check before a procedure can be started.
“Should something go wrong, if something is missed, the clinicians can be liable. Everyone needs to be aware of the legal issues involved in practice,” said Wolfenden, CRNA, JD.
As a nurse anesthetist and a lawyer, she understands the hazards better than most.
Wolfenden never set out to become a lawyer. She graduated from the Grady Memorial Hospital School of Nursing in 1979 and worked as an intensive care nurse while earning a bachelor’s degree from the Medical College of Georgia (now Georgia Health Sciences University) in 1981. She graduated from the Manley Cummins School of Nurse Anesthesia in Alabama in 1983 and began practicing as a CRNA.
"Later, as a chief anesthetist and administrator, I found myself reviewing patient cases for quality control and other reasons," she said.
She was fascinated by the legal aspects of those cases.
“I wanted to know what the law was all about, so as a challenge to myself I studied for and took the LSAT and scored pretty well,” Wolfenden said. “I went to law school at night and practiced [as a nurse anesthetist] during the day. The hours were pretty unbearable.”
After graduating from Atlanta Law School and passing the Georgia Bar exam in 1991, Wolfenden practiced law for a couple of years.
“I worked in medical malpractice and wills and estates, mostly. I never actually made it to trial, but I did a lot of preparation and took a lot of depositions,” she said. “I [eventually] quit my full-time legal job, because I missed clinical practice.”
Today, she practices as a nurse anesthetist two days a week at the Medical Center of Central Georgia, heads Mercer University’s nurse anesthetist program and works part time as an attorney/legal consultant.
She helps clients at medical facilities improve their processes to meet Joint Commission requirements and to avoid legal issues. She also reviews anesthesia medical malpractice cases.
Wolfenden's understanding of the law, as well as her knowledge of clinical practice, nursing standards and the Nurse Practice Act, make her a valuable consultant.
Wolfenden also teaches a course in legal issues to nurse anesthetist students . The class helps them prepare for the legal questions on the national exam but, more importantly, for the situations that can arise in practice, she said.
"We will break down a case and discuss it to see how an error could have been prevented or what problem led to the domino effect of a poor outcome," Wolfenden said.
In one case, a woman lost the use of an arm during a gynecological procedure because no one noticed that it had come loose from a restraining apparatus, and nerves were damaged.
"With robotic surgery in a dark room, it's not uncommon for a nurse anesthetist to need to get under the bed and check things out with a flashlight," Wolfenden said.
Because nurse anesthetists obtain patient history information before surgery to avoid complications due to drug interactions, allergies or co-existing conditions, they must speak up when they see potential risks during a procedure.
“If a doctor orders a drug and you know it could have an adverse reaction, you need to be prepared to question it,” Wolfenden tells her students. “A nurse anesthetist has to be well organized and on top of her game. That means being well-trained from a legal perspective as well as a clinical one.”
She also stresses the importance of communication and documentation to her students.
“Even if it’s your practice to always do something, you can’t prove you did it if you didn’t write it down,” she said. “If something is questioned, no one is going to remember what happened two years from now [in court].”
Nurse anesthetists with law degrees aren’t very common, and Wolfenden is proud of her dual roles.
“It helps me instill more knowledge in my students,” she said. “You can’t go wrong with getting more education.”
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