ATLANTA, Ga. (CBS46) – The coronavirus crisis is reigniting a battle over who should be allowed to manage anesthesia care for veterans and their families inside the country’s largest integrated health system – the Veterans Health Administration (VHA).

Dr. Richard Stone, the VHA Executive in charge of the VA, issued a directive April 21, recommending VA facilities across the country allow CRNAs, Certified Registered Nurse Anesthetists, to “practice and operate within the full scope of their license, registration, or certification.” Practically speaking, that means nurse anesthetists would be able to care for patients in the same way as a physician anesthesiologist, and without their supervision. That includes administering anesthesia before and during surgeries as well as pain management.

This is already the standard of care at VA facilities in 18 states, according to Stone’s memo. However, the Georgia Board of Nursing's Nurse Practice Act says that CRNAs can provide anesthesia as long as it is "administered under the direction and responsibility of a duly licensed physician."

With the pandemic putting additional strain on healthcare providers and resources, Stone encourages VA administrators in other states to work on expanding CRNA responsibilities during the COVID-19 National Health Emergency.

Julius Hamilton, vice-president of the Georgia Society of Anesthesiologists, says he can’t think of one good reason for anyone to bypass physician anesthesiologists.

“Advanced practice nurses were allowed to practice independently in every field except anesthesiology in the VA medical system and unfortunately a memo within the last two weeks completely undid that. No public comment, no input from legislators, no input from the chief of anesthesiology, just a unilateral decision to allow nurse anesthetists to practice independently,” added Hamilton, who says his care will be compromised for veterans, including his father.

The American Association of Nurse Anesthetists (AANA) has been pushing for years to give CRNAs at all VA facilities full practice authority. The organization argues CNRAs meet the same standard of care as their supervising doctors, they outnumber physician anesthesiologists inside VA facilities and can therefore increase access to care for veterans.

“So, we actually predate anesthesiologists,” said Dr. Randy Moore, CEO of the AANA.

The organization’s website says nurses first administered anesthesia to soldiers during the Civil War.

“To be perfectly candid,” says Moore, “This is about physician anesthesiologists not wanting to give up control.” Also a veteran, Moore calls this a case of politics over patient care.

“And the politics of it, for me, are especially concerning because we’re talking about veterans and access to care, and here we are playing political games with people’s lives," he said.

The Atlanta VA tells CBS46 they have made no changes in the way they administer anesthesia to patients for surgery.

Copyright 2020 WGCL-TV (Meredith Corporation). All rights reserved.

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(18) comments

Welcome to the turf war

Looks like 18 states have already done this. Are we seeing an increase in deaths or other complications there?

If not, then what are we talking about here?

And yes, what about the military using solo CRNAs? I have NEVER heard Anesthesiologists demanding that our troops in the field deserve a doctor. Makes you wonder..

gosnold

The headline of the article is misleading from the start. "VA allows nurse to administer anesthesia without an anesthesiologist present".

rimo127

Every patient deserves a Doctor. A CRNA is a nurse-- i respect them and their place in medicine. they are absolutely essential and I mean no harm. There aren't DOA's and CRNA's-- Don't place the training and education of a doctor and a nurse on the same level when they are eons apart. There are Doctors, and there are nurses. An anesthesiologist refers to the doctor.

Nurses can perform simple cases to save money and because there simply aren't enough anesthesiologists to have a ratio of 1:1 doctor to patient. But nurses are out of their depth in complex cases and need to recognize that a doctor is a different profession entirely. They take on real responsibility and complex cases for a reason-- they have been trained for years to do so.

Everybody wants to be a doctor but nobody wants to go to med school.

Historyismystory

It’s rather ironic that the origin of anesthesia provision by nurses during the Civil War foreshadowed the current debate of using ‘nurses’ to deliver anesthesia in the VA system. The legitimacy (Chalmers, et al. v Nelson, et al. [Calif.] 1934) of Certified Registered Nurse Anesthetists providing anesthesia was assured by surgeons maintaining that nurses provided the best anesthesia care for their patients. All this happened when reimbursement for anesthesia was very small. Now that providing anesthesia commands a bigger price tag, it’s important that a physician provides it.

Dollfacebex

So because you’re sleeping with a physician anesthesiologist, this is the nonsense you choose to post? You sound like a trump supporter. At least do your research rather than touting nonsense. How embarrassing. Your ancestors didn’t die for this. You meant to write CERTIFIED REGISTERED NURSE ANESTHETIST in your article title. You should be fired.

EmbarrassedforBobeth

Wow. I am embarrassed for the reporter for being so misinformed and brainwashed by her husband (a physician anesthesiologist). I can’t believe a news outlet would allow such corruption by allowing her to publish such a biased article. She obviously doesn’t mind posting trash, as a sock puppet for her husband.

JSanderson1120

Nurses have been administering anesthesia without an anesthesiologist since the civil war. Mayo Clinic's first Nurse Anesthetist, Alice Magaw, was the sole anesthetist for both Dr. Charles and William Mayo from 1893 to 1900. She administered 14,000 anesthetics without a single anesthesia-related death. Nurses all over the country administer anesthesia on a daily basis and are the sole anesthesia providers in rural areas...and for half the cost and with the same research-proven outcomes. Anesthesiologists do not "supervise" Nurse Anesthetists on battle fields and in combat zones. This is another example of Fake News, anti-CRNA propaganda.

JSanderson1120

Nurses have been administering anesthesia without an anesthesiologist since the civil war. Mayo Clinic's first Nurse Anesthetist, Alice Magaw was the sole anesthetist for both Dr. Charles and William Mayo from 1893 to 1900. She administered 14,000 anesthetics without a single anesthesia-related death. Nurses all over the country administer anesthesia on a daily basis and are the sole anesthesia providers in rural area...and for half the cost and with the same research proven outcomes. Anesthesiologists do not supervise a Nurse Anesrbetists on battle fields and in combat zones. This is another example of Fake News, anti-CRNA propaganda.

Jon

I feel it is important for the author/reporter that prepared this story to understand that they were played or manipulated in a very major way. So many distortions of fact and misrepresentations that it would be hard to call them anything but deliberate lies to serve an agenda. Firstly, there is absolutely No DIFFERENCE IN THE STANDARD OF CARE between a physician anesthesiologists and a nurse anesthesiologists or anesthetist. My wife and I are both independently practicing CRNAs providing anesthesia care to to the very highest acuity patients undergoing very complex surgical procedures. In addition I am a retired CRNA from the Dept. Of Veterans and in that setting was always completely independent of any physician anesthesiologist. In fact I rarely saw one unless they happen to be visiting from Washington D.C. Thanks much.

Stephanie

This story comes across as one-sided, clearly biased, and editorial in nature. I would recommend to the reporter to reach out to Nurse Anesthetists for comment to gain a balanced insight on the issues at hand. Not having first hand information on how a system works, one can easily be swayed towards one opposing side.

I would have zero problems having a nurse anesthetist provide anesthesia to any one of my veteran family members as an independent practitioner. There is zero proof of poorer patient outcomes or patients receiving substandard care if nurse Anesthetists have full practice authority, therefore operating under the guise of patient safety has no merit.

EldridgeS

The VA has always had independent CRNAs. There are several VA facilities that are CRNA only practices and every military hospital only has independent CRNA practices. Furthermore, nearly every military hospital has VA treatment agreements that allow VA patients to be treated on base. The normal course is that the sickest VA surgical patients are treated on military bases by independent CRNAs already. The rest of this rhetoric is just politics from medical PACs. The research speaks for itself independent CRNAs are just as safe as our physician anesthesiologist colleagues.

Spalmerton

I will disagree with our poorly informed surgeon and present the more up to date evidence below:

http://www.healthaffairs.org/doi/full/10.1377/hlthaff.2008.0966

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010357.pub2/abstract;jsessionid=B8D9CAC782B9EC65DAD59C8BDA956CB1.f01t02

http://journals.lww.com/lww-medicalcare/Abstract/publishahead/Scope_of_Practice_Laws_and_Anesthesia.98905.aspx

Unfortunately, most of our surgical colleagues are misinformed by their physician anesthesiologist friends and don't bother to consult their Nurse Anesthesiologist coworkers. There is no significant difference in risk whether a nurse or physician anesthesiologist cares for you.

NoahReese

This is irresponsible reporting. This is an editorial, not a balanced piece of journalism. CBS46 Atlanta should be ashamed. This is about money and nothing else. Giving Nurse Anesthesiologists/Nurse Anesthetists/CRNAs full practice authority expands the capabilities of every VA facility and delivers the same high quality anesthesia services to our veterans at a MUCH more efficient cost.

1. Bobath Yates, the author, is married to a physician anesthesiologist, so of course this is her position.

2. The only interviews/quotes were physician anesthesiologists’ organizations. No quotes from the opposing view, Nurse Anesthesiologists’ organizations.

3. Nurse Practioners have already been given full practice authority at VAs. Guess who’s next? We are, Nurse Anesthesiologists. Why? It expands your capabilities and makes your costs MUCH more efficient.

4. Nurse Anesthesiologists already administer >60% of all US anesthetics. In rural areas, we administer 100% with NO physician anesthesiologists present.

5. When I’m in Afghanistan, Uncle Sam trusts Nurse Anesthesiologists to save Delta Force and Special Forces operators, Seal operators, Rangers, Infantry, Fighting partners, civilians and everyone else. Why? Because the Army gives us full practice authority to expand the Army’s capabilities and make the delivery of anesthesia care more efficient.

6. Nurse Anesthesiologists/Nurse Anesthetists/CRNAs existed 50 years before physician anesthesiologists even began training.

7. Physicians have been quoted repeatedly in multiple medical journals stating there is no difference in the outcomes or safety between Nurse Anesthesiologists vs Physician Anesthesiologists.

knajan

Pretty convenient your husband is an anesthesiologist. Why else would you post this nonsense? CRNAs provide most of the anesthesia administered in the US. Supervision by an anesthesiologist is NOT required in many states. Journalism with complete bias is nothing more than garbage.

Tommeltj

What a tempest in a teapot. Nurse anesthetists already give anesthesia "without an anesthesiologist present" in much of the world, including the United States and in the military, and have done so for over a hundred years. There is no difference in standard of care, and no research consensus that outcomes are any different. I appreciate why physician anesthesiologists might be bothered by this, but being bothered isn't a reason to use resources poorly.

wsatl

Respectfully, as a surgeon, I have to adamantly disagree. There is good published data in ortho at least that patients do better with a physician anesthesiologist supervising (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303976/) or providing the anesthesia care by themselves. Anecdotally, I love the CRNAs I work with, but often find many quickly hitting their limits and calling in docs for help (as they should!). I really worry about the ego of someone doing something so dangerous being sure they are "the same" when they have 1/3-1/2 the training of an MD who did a residency.

This is a shame for our veterans, some of our most medically frail patients, who deserve a choice. Where is the public outcry?

Anesthesia4Veterans

With all do respect sir, I like to compare the ASA and many physician anesthesiologists to Donald Trump. Just because you state something enough times, does not make it a true statement. Please have your facts straight before you post on a public forum.

The study you posted shows retrospective data compiled and 'analyzed' by 2 physician anesthesiologists along with some biostatisticians. Please have both parties associated with data reporting and analyzing to truly view this data as 'fair' and nonbias. Large corporations do this all the time to sway their point of view, as do medical professionals. Furthermore, you see a 1.1% increase from 2.9% to 4.0% regarding dispositions physician anesthesiologist vs CRNA. The data they collected includes 4x as much data from physician anesthesiologists vs CRNA and you find this to be valuable and reliable. Furthermore, you see a significant increase in disposition from 2.9% to 14% in nonanesthesia providers. That to me seems like a big deal? So what you're saying is that it matters to you that you have 2.9% disposition rate and your surgeon colleague has a 4% disposition rate...conclusion being that your surgeon colleague should not operate as that 1% difference seems justifiable to you, despite having 4x fewer cases in comparison. Hmm.....something seems fishy.

Next point. 'Hitting their limits'? Interesting point of view. I tend to find my surgeon's 'hitting their limits' and calling in for another point of view, phone a friend, whatever you want to call it. In the anesthesia care team model 'you' work around, CRNAs get grilled legally for not 'calling the physician anesthesiologist' when you surgeons are losing 1L of EBL for what supposed to be a 'straight forward' procedure. So yeah, in ACT models, CRNAs better call their 'colleagues' which often doesn't seem to matter in the courtroom as physician anesthesiologists go running back to their holes when sh*t hits the fan. Let's make one thing clear...the only team in a ACT model is me, myself, and I. One of the most ridiculous terms the ASA came up with so they can 'justify' their jobs.

Honestly, this post could go on for days regarding your misinformed, and apparently bias opinion, but enjoy your yachts and 1mil homes with your physician anesthesiologist friends while your shamed veteran patients can barely get a Doc visit, let alone have access to safe, affordable, reliable anesthesia services.

pmedic336

[thumbup]

I was going to reply to this surgeon as well, but after reading your reply...nothing more need be said. Mic drop! Boom!

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