Nurse anesthetist regulation scrapped
The Bush administration has cancelled — for at least six months — implementation of a last-minute Clinton administration approval of a regulation that would have allowed nurse anesthetists to administer anesthesia to Medicare and Medicaid patients without physician involvement. The Department of Health and Human Services (HHS) says it will introduce a proposal to:
1. allow state governors to apply for a waiver of the supervision rule provided it is consistent with state law and following consultation with the state’s medical and nursing boards;
2. consider a prospective patient outcomes study to compare different anesthesia practices by state.
As has been the case throughout the lengthy debate over this proposal, anesthesiologists and nurse anesthetists argued publicly about the HHS decision and its impact on patients and health care providers.
Neil Swissman, MD, president of the American Society of Anesthesiologists in Park Ridge, IL, says physicians are "absolutely confident that when the new rule from the Bush administration takes effect, and when the scientific facts are known to the individual governors, they will do what is best for the people of their states — retain the supervision requirement for their senior citizens."
But the American Association of Nurse Anesthetists (AANA), also in Park Ridge, IL, says the department’s proposals for the future support the principle of state regulation of anesthesia providers that the association has backed. Larry Hornsby, AANA president, points out that while his group has always said individual states should be allowed to decide whether to require physician supervision of certified registered nurse anesthetists based on each state’s particular needs, "it should be completely unacceptable to the American public that another delay has occurred thanks to the nurse-bashing tactics of physician anesthesiologists."
On the issue of a prospective study, Mr. Hornsby says the AANA "has never been opposed to a post-supervision rule study of anesthesia care. We feel our safety record speaks for itself."
Mr. Hornsby says that 29 states currently do not require physician supervision of nurse anesthetists in their medical or nurse practice acts or board of medicine or nursing rules and regulations. If the issue becomes a matter for governors to decide, he says, "people simply will have to be on the lookout for the nurse-bashing tactics of physician groups, and dismiss them as nothing more than hurtful rhetoric. Poll after poll has shown that nurses are the most trusted health care providers. We believe governors will wisely recognize nurse anesthesia is safe anesthesia, and that removing a bureaucratic federal supervision requirement for nurse anesthetists does not mean removing the surgeon, OB/GYN, podiatrist, or dentist from the patient’s care."
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