Pennsylvania regulations permit a nurse anesthetist to administer anesthesia when the nurse anesthetist is supervised by an anesthesiologist or an operating surgeon. While surgeons may supervise a nurse anesthetist without a physician anesthesiologist, “In the interests of patient safety and quality of care, the American Society of Anesthesiologists (ASA) believes that all patients deserve the involvement of a physician anesthesiologist in their perioperative care.”
If non-anesthesiologists are the physician to supervise a nurse anesthetist, the ASA cautions that “Careful consideration is required whenever a non-anesthesiologist physician will be the only physician available, as in some small hospitals, freestanding surgery centers, and offices. In the event of an emergency, lack of immediate support from other physicians trained in the management of critical events may reduce the likelihood of successful resuscitation.”
A supervising anesthesiologist protects patient safety, because “All types of anesthesia carry risks. Non-anesthesiologist physicians lack the expertise that uniquely qualifies and enables physician anesthesiologists to manage the challenging airway and other complications that could occur during the perioperative period.” 
Anesthesia complications may arise from improper anesthesia care before, during, or after surgery. Patients administered anesthesia at small hospitals, freestanding surgical centers, and other medical offices without appropriate supervision can suffer serious complications or may even die. Patients in those circumstances may have a medical malpractice claim. Attorneys at Del Sole Cavanaugh Stroyd LLC have successfully obtained verdicts against health care providers for medical malpractice in these circumstances.
-  See. e.g., 49 Pa. Code § 21.17.
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