Two issues face the citizens of the Commonwealth of Pennsylvania with respect to healthcare. Patients who require surgical or interventional procedures must have physician-led anesthesia care. In the first example, Pennsylvania’s citizens at large are directly affected. The second issue specifically affects our veterans who require anesthesia care in Veterans Affairs (VA) hospitals in the commonwealth.
I’ll start with the surgical issue.
House Bill 1277, sponsored by Rep. Jim Christiana (R- Beaver), has been languishing in the House Professional Licensure Committee. This bill proposes to place into statute what is already in regulation overseen by in the State Board of Medicine. By making this requirement law, rather than more easily modified regulation, the citizens of the commonwealth will be assured that a physician is in charge of anesthesia care for hospitalized patients.
The bill specifies that anesthesia care in a hospital shall be provided by a physician or “a nurse anesthetist authorized by the State Board of Nursing to provide anesthesia care and who is under the supervision of either of the following … an anesthesiologist or … the operating physician …”
HB 1277 enjoys overwhelming bipartisan support. I urge the House Professional Licensure Committee to move this bill out of committee and to the floor of the House.
The citizens of the commonwealth want the best healthcare possible. This bill will assure that each citizen will have a physician anesthesiologist overseeing their care. Some who object to this bill argue that mandatory physician supervision reduces access to anesthesia care in a hospital. The truth is that greater than 97 percent of hospitals in Pennsylvania already have physician anesthesiologists in charge of their care. Access to care is not an issue. Ninety-five percent of Pennsylvanians say it’s important to them that physicians supervise nurses administering anesthesia or responding to emergencies during surgery – that IS an issue.
The education of physician anesthesiologists and certified nurse anesthetists (CRNAs) cannot be considered equal with respect to years of training and experience.
Physician anesthesiologists complete a much longer educational process prior to going into practice. They have, at minimum, a four-year undergraduate degree, four years of medical school, a year of internship and a minimum of three years of anesthesiology residency. Many have subspecialty training in specific areas such as pediatric anesthesiology, intensive care, obstetrical anesthesiology, cardiac anesthesiology or pain medicine.
CRNAs have a four-year undergraduate degree and a combined 27-month master’s degree program that includes their clinical training, as well. Few extend their training to a new Doctorate of Nursing Practice.
There is no doubt that CRNAs play an important role on the patient care team. However, the Pennsylvania Society of Anesthesiologists believes that the citizens of Pennsylvania should get the best and most educated care. All hospitalized patients undergoing anesthesia should have a physician anesthesiologist in charge.
With regard to the VA Hospital issue: The Veteran’s Administration Nursing Handbook is currently undergoing revision. There is pressure from some quarters to have independent (meaning not supervised by a physician) care provided by certified registered nurse practitioners to fill the large gap of patient care needs with respect to primary care.
This proposal unfortunately has crossed into the realm of anesthesia care for veterans. Veterans often have complex medical issues stemming from combat injuries and older age. Their surgical and interventional procedures requiring anesthesia services must have physician-led care.
During a recent hearing on the FY 2017 VA budget held by the House Appropriations Committee’s Subcommittee on Military Construction and Veterans Affairs, U.S. Rep. David Jolly (R-Florida) asked VA Secretary Robert McDonald and Under Secretary of Health David Shulkin M.D. about proposals for anesthesia care in the Veteran’s Administration. They answered quite simply, “We believe that the current system is serving veterans adequately and safely.” The implication of that statement is obvious; there is no access to care or safety issue that requires independent certified nurse anesthesia care.
The importance of physician-led anesthesia care within the VA system also was discussed at a joint hearing of the House and Senate Veterans’ Affairs Committees. Written testimony prepared for the committees by the National Guard Association of the United States and the Association of the United States Navy conveyed the two groups’ concerns about patient safety if the physician-led care was abandoned.
The National Guard Association wrote: “The risks and complications associated with the administration of anesthesia during surgeries should not be reduced when serving an aging and injured veteran population.” The Association of the Navy added: “… our nation’s veterans deserve the highest level of medical attention, and this proposed shortfall in care is unacceptable.” The AMVETS organization also was supportive of physician-led anesthesia care.
What can you do about this issue for our veterans? The answer is quite simple. Go to www.SafeVAcare.org and complete the online form. Call your congressman and U.S. senators. Call your local Veterans Administration Office. Write to every news organization. Let them know that our veterans deserve the highest and most knowledgeable anesthesia care. Insist that physician-led anesthesia care be retained!