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.