A blow to rural health care
October 4, 2010
As a part-time resident of the Roaring Fork Valley I am quite concerned about a decision recently made by Gov. Ritter. On Sept. 27 the governor sent a letter to the Centers for Medicare and Medicaid Services in Baltimore that stated many “rural” hospitals in Colorado are now exempt from the requirement that certified nurse anesthetists be supervised by a physician.
While Aspen Valley Hospital was not one of those hospitals, Valley View Hospital in Glenwood Springs was on the list, as was Vail Valley Medical Center. Quite simply what this means is that the governor has made a decision that in certain hospitals there are different standards of acceptability regarding the delivery of anesthesia services.
A nurse anesthetist is an advanced practice registered nurse who has received special training to administer anesthesia, usually being supervised by an anesthesiologist. Anesthesiologists are physicians who, after medical school, receive an additional four to five years of specialized training during residency. Not only do anesthesiologists function in the operating room but they are trained to medically evaluate patients prior to surgery and to take care of problems that may arise immediately after surgery. In a few small hospitals a nurse anesthetist may be supervised by the surgeon if there is no anesthesiologist.
It is interesting to note that the United States is the only westernized country in the world that allows nurses to administer anesthesia unsupervised. Countries such as Canada, Australia, New Zealand, Japan and Israel, just to name a few, have no nurses administering anesthesia. In some European countries there are a few nurse anesthetists who work under the strict supervision of a physician.
So what’s up with us? Well, it seems that the American Association of Nurse Anesthetists have convinced our government in Washington that unsupervised nurses are just as safe as a physician. They point to the fact that there are no comparative studies to show they are not. The reason there are no studies is that it would be unethical to perform such a study in which some people get a physician and some do not. Can you imagine a patient agreeing to participate in such a study?
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The AANA likes to point out that nurse anesthesia is cheaper and we as a nation would save money, but at what cost to the patients? Nurse anesthetists serve a valuable function in a team approach, not functioning independently. Colorado has joined a list of 14 other states to go this way, and it is simply not in the people’s interest. Our culture today is about shortcuts, but there is no shortcut to being an anesthesiologist. A nurse is not a physician, and anesthesiology is the practice of medicine, not nursing. Just because we have made it safe is no reason to take it for granted.
If you agree please write the governor and tell him that this decision scares you and you believe people in Colorado deserve the same care wherever they are.
Paul Rein, D.O.
president, Virginia Anesthesia and Peroperative Care Specialists