To the Editor.—The editorial "Who Is Captain of the Anesthesia Ship?"1 in the Archives purports to describe legal aspects of a surgeon working with an anesthesiologist or a certified registered nurse anesthetist (CRNA). As counsel to the American Association of Nurse Anesthetists, I have read a great majority of the cases in this area, and they do not agree with what Dr Modell wrote.
It is not the status of the administrator of anesthesia that determines whether the surgeon will be held liable but the degree of control that the surgeon exercises over the administrator, CRNA, or anesthesiologist. What differences there are in the cases result from the interpretation of the facts relevant to control in each case.
For example, Dr Modell indicates that when an "anesthesiologist personally administers anesthesia... clearly, only the anesthesiologist should be held responsible for the quality of anesthetic care." There are, however, cases
BLUMENREICH GA. 'Captain of the Anesthesia Ship': Does It Make a Difference?. Arch Surg. 1987;122(9):1088-1089. doi:10.1001/archsurg.1987.01400210126024