Professional liability crisis

LETTERS TO THE EDITOR J Oral Maxillofac Surg 44:340. 1986

oral and maxillofacial surgery if the surgeon-anesthetistanesthesia team is utilized. This mounting criticism of the surgeon-anesthetist provides an opportunity to contribute additionally to public safety and, quite incidentally, to increase the role of the oral and maxillofacial surgeon in the delivery of anesthesia for ambulatory patients. I suggest to the AAOMS membership that consideration be given to the use of a fully trained anesthetist for outpatient general anesthesia, a person occupied with no other duty and, most importantly, a person qualified by law to administer general anesthetics without supervision. Such a person could be a qualified dentist or physician and, in our practices, would most likely be another oral and maxillofacial surgeon, a person highly skilled in anesthesia for our particular requirements, a virtual extension of the surgeon. My position is strengthened by the study of Co plans and Curson.' Coplans, a British anesthesiologist, reports a mortality rate of I:300,000 related to general anesthesia for general dentistry in British dental offices. Their report also documents a distinctly more favorable mortality rate when qualified dentists rather than anesthesiologists acted as the anesthetists. There is no question that improvement in our training of the anesthesia assistant is called for, and this action may delay legislation banning the anesthesia team, but I would urge that the next great step in anesthesia safety would be to go all the way with the person best qualified to do the job. Failure to take advantage of this opportunity in the public interest will result in eventual restrictive state legislation.

Professional Liability Crisis I enjoyed reading the timely editorial in the November 1985 issue concerning the professional liability crisis. However, I would like to point out that if oral and maxillofacial surgeons had only experienced increases of 100 to 180% in their professional liability rates, it would not be too serious. Even though these rates seem extreme to some, they would really be quite small in comparison with what has been happening in other specialities. However, I am aware of rate increases ranging anywhere from 100% up to 1000% being paid by oral and maxillofacial surgeons, and this is not justified. Unfortunately, it has taken this increase in premiums to make us aware of this growing crisis. I could not agree more that the solution to this problem is goingto be for us to become involved in federal and state legislation. However, this will take a joint effort in both state and local dental and medical societies. This further emphasizes the importance of OMSPAC and other such organizationsfor this is where the ballgame will be won or lost! RONALD B. MARKS, DDS Special Committee on Liability and Tort Reform, AAOMS

THE ANESTHESIA TEAM FOR AMBULATORY PATIENTS

History predicts the future. In 1983 the General Dental Council of the United Kingdom mandated that outpatient general anesthesia be administered by a person other than the operator. In 1985 the American Society of Anesthesiology adopted an official position supporting a separate anesthetist occupied with no other duty. It is becoming increasingly difficult to defend serious morbidity or mortality related to outpatient general anesthesia in

FRANK M. MCCARTHY, MD, DDS Los Angeles, California

Reference 1. Coplans MP, Curson 01: Deaths associated with dentistry. Br Dent 1 153:357, 1982.

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