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The End of the Crisis

Several events in the mid-1980s changed the course of anesthesia practice. The first was a direct selective effect of dramatically higher insurance rates. These higher rates, combined with a requirement that part-time practitioners pay full rates, forced many marginal physicians out of anesthesia practice. The second event was the development of cheap, easy-to-use monitors for oxygen tension in the blood and end-tidal carbon dioxide. The inseparable role of oximetry and capnography in reducing anesthesia claims highlights the interdependence of medical practice and technical innovation. The most important factor was that the higher rates motivated anesthesia professional societies to propose basic standards of practice. These standards reflected the consensus of most certified anesthesiologists that someone should stay with the patient and that patient ventilation should be continually monitored.

It is impossible to sort out the contributions of each of these events to the reduction of medical malpractice awards against anesthesiologists. It is clear that these awards have declined, resulting in lowered insurance premiums for anesthesiologists. What is particularly problematic is that it is not possible to prove that anesthesia deaths and injuries have declined. While anecdotal evidence indicates that deaths have decreased, there is no reliable statistical evidence to support this belief. It is possible that staying with the patient and using proper monitoring has merely made it more difficult to prove anesthesia negligence. The presumption that an anesthesia death in a healthy patient must be due to negligence is destroyed if the patient was properly monitored. The plaintiff is left with the often impossible task of proving what really happened.

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