Manipulation Under Anesthesia Increases Liability Exposure

Shawnee Mission, KS – January 7, 2009 – Preferred Physicians Medical (PPM), industry-leading provider of professional liability insurance for anesthesia practices, announced that it has received several recent inquires from policyholders regarding working with chiropractors to provide sedation for manipulation under anesthesia (MUA). PPM has identified some concerns that our policyholders may want to consider before undertaking such a venture.

The American Society of Anesthesiologists (ASA) published a newsletter in 2005 that addressed this issue. The authors stressed that MUA posed “significant medical liability” issues. Notably, incidents were documented involving neural injuries including myelopathy and cauda equina syndrome after MUA procedures. [Web site: www.asahq.org/Newsletters/2005/01-05/spinalManip01_05.html.]

PPM policyholders should be aware that practicing alongside any non-physician presents higher liability exposure than practicing with another physician. In cases where the anesthesiologist is the only physician present, plaintiff attorneys will typically allege that the anesthesiologist has a greater duty to second guess and/or intervene in the care being provided by non-physicians.

The PPM policyholder may also be asked to do a history and physical prior to the chiropractic procedure on patients who have not been evaluated by a primary care physician. This requires the PPM policyholder to determine that the patient is not only an appropriate candidate for anesthesia, but also a medically appropriate candidate for the chiropractic procedure. Performing a history and physical also exposes the PPM policyholder to an array of failure to diagnose claims that are not part of a normal anesthesia exposure.

Further, chiropractors and other non-physician providers may carry lower malpractice insurance limits than those carried by PPM policyholders. PPM’s experience indicates that when there is a significant disparity in the insurance coverage limits, plaintiff attorneys will distort the allegations to focus more attention on those health care providers with the most insurance coverage available. "Anesthesia groups working with chiropractors should ascertain whether or not chiropractors and other non-physician providers are required to carry the same limits of insurance coverage as physicians in the facility," according to John Morhiser, Underwriting Supervisor. To the extent there is disparity, anesthesia groups are encouraged to work with PPM to address this issue.