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Evaluating the Patient

Until the operation begins, the anesthesiologist has the right and the duty to refuse to participate in the surgery if the risks of anesthesia outweigh the benefits of the surgery. Once the operation begins, the anesthesiologist still retains the duty to ask that the surgery be stopped, but there is little that can be done if the surgeon refuses. The anesthesiologist cannot abandon the patient once the operation has begun.

The surgeon is entitled to rely on the anesthesiologist's expertise in determining if the patient is a candidate for anesthesia. Surgeons should demand that the anesthesiologist interview and examine the patient before the patient has been premedicated for surgery. The increasingly common practice of skipping the independent anesthesia evaluation is legally indefensible. The surgeon should make sure that the anesthesia note is written before the surgery begins.

Surgeons should also be careful that an anesthesiologist performs the preanesthesia evaluation. A surgeon may not legally rely on a nurse's evaluation of a patient's medical condition; if the patient is not a candidate for anesthesia, the surgeon will be liable unless the determination of fitness was made by a properly qualified physician. If the CRNA evaluating the patient is ostensibly supervised by an anesthesiologist, then the anesthesiologist must countersign the anesthesia note before surgery.

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