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Archive for the ‘Anesthesia News’ Category

16 States That Have Opted Out of Doctor Anesthesia Supervision

08 Nov

In the last post, we discussed the debate over allowing nurse anesthetists to administer anesthesia to patients without a doctor’s supervision. While that debate rages on, let’s take a closer look at the first five states to opt out of the federal requirement for doctor supervision of anesthesia provision:

1. Iowa – In 2001, the Centers for Medicare & Medicaid Services published its rule granting state governors the ability to opt out of the supervision requirement. Less than a month after that news, Iowa became the first state to take them up on the offer. At that time, 91 of 118 Iowa hospitals relied exclusively on Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia care.

2. Nebraska – The second state to opt out of the physician supervision requirement, Nebraska did so in February 2002. Nebraska Governor Mike Johanns sent a letter to CMS saying “it is in the best interest of the State’s citizens to exercise this exemption.”

3. Idaho – In March 2002, the state’s governor, Dirk Kempthorne, told Idahoans that their state would opt out of the physician requirement as a way of benefiting “Idaho’s citizens, rural communities and hospitals.”

4. Minnesota – In April 2002, Minnesota’s outspoken and colorful governor
Governor, Jesse Ventura, informed CMS in April 2002 that his state would opt out of the federal physician supervision requirement, saying his office consulted with medical and nursing boards, the attorney general and various other parties.

5. New Hampshire – Rounding out the first five states to opt out of the federal doctor supervision requirement is New Hampshire. Opting out in June 2002, Governor Jeanne Shaheen claimed that not doing so “may severely limit the ability of rural hospitals to treat emergencies and provide other services that require anesthesia care.”

The most recent state to opt out of the physician supervision requirement is Colorado. Just this past September, Colorado Governor Bill Ritter announced that his state would opt out following the controversial study published in the August 2010 issue of Health Affairs which claimed patients were not harmed when CRNAs provided anesthesia without physician supervision.

The other 10 states to opt of the supervision requirement were New Mexico, Kansas, North Dakota, South Dakota, Washington, Oregon, Alaska, Wisconsin, California, and Colorado.

California’s situation is particularly interesting since both the California Society of Anesthesiologists and California Medical Association filed a motion that sought to have Governor Schwarzenegger’s letter withdrawn. While the motion was denied this month, the CSA and CMA are considering further actions to appeal the ruling.

 

Doctors Fight to Retain Anesthesia Oversight in New Jersey

01 Nov

In New Jersey, there is a dispute going on between doctors and the state’s health department over the fact that the state is now allowing nurse anesthetists to sedate patients in hospitals without having a doctor present. Many doctors are angered by this move.

Currently, the rules require nurse anesthetists to work under direct supervision of an anesthesiologist. However, that is set to change now that the state health department is proposing to let the nurses work unassisted – they just need to be able to reach a doctor if necessary.

According to the rule change it “potentially would allow the anesthesiologist to be out of the office on a golf course” said Roger Moore, an anesthesiologist and previously president of the New Jersey State Society of Anesthesiologists.

On the other side, you have nurse anesthetists who support the change.

“The argument that nurse anesthetists are undereducated is not supported by the data,” said Jamie Eisenberg, president of the New Jersey Association of Nurse Anesthetists Inc.

They cite a study that revealed no signs of complication or risks in 14 states with similar rules allowing nurses to provide anesthesia.

But doctors like Barry Gleimer, president of the Orthopedic Surgeons of New Jersey, have their doubts. He cites personal experience from an arthroscopy procedure he was involved with 10 years ago where he says the nurse anesthetist didn’t notice that the patient had turned blue.

“We’ve all been in the OR, when a nurse anesthetist reaches the end of her ability to treat the patient,” said Dr. Gleimer, an osteopath. “At that point, she hollers for an anesthesiologist to get her out of deep water.”