A proposed rule allowing nurse
anesthetists to administer anesthesia to Medicare patients without physician
supervision is now expected to become final this June. But anesthesiologists,
citing potential threats to patient safety, remain up in arms over the change.
Nancy-Ann Min DeParle, administrator of the Health Care Financing
Administration (HCFA), recently confirmed in a letter to Sen. Arlen Specter
(R-PA) that the administration intends to finalize the regulation by June.
Spearheading opposition to the rule is the American Society of
Anesthesiologists (ASA), which last week urged Congress once again to intervene
in the matter. The ASA cites University of Pennsylvania research showing a
higher death rate in cases in which an anesthesiologist was not involved in
supervising the nurse anesthetist.
"It is obvious now that all concern for patient safety has been lost to
bureaucracy," contends Dr. Ronald A. MacKensie, president of the 35,000 member
ASA. "HCFA is saying that it has made this proposal based on reasoning that
anesthesia is 'relatively safe' now and that there is no evidence to compare the
differences between anesthesiologists' care and nurses' care. That reasoning is
dangerously flawed."
As Reuters Health has reported, HCFA's December 1997 proposal called for
deleting the requirement that certified registered nurse anesthetists administer
anesthesia only under the supervision of an operating practitioner or
anesthesiologist. The change, HCFA said, would "allow greater flexibility to
hospitals and practitioners" and "give deference to state scope of practice
law."
Twenty-nine states now allow nurse anesthetists to provide anesthesia
without a doctor's supervision.
The American Association of Nurse Anesthetists (AANA), a chief proponent of
the change, last week reiterated its support. "HCFA's decision supports what the
American Association of Nurse Anesthetists has been saying all along -- that
certified registered nurse anesthetists provide safe, high-quality anesthesia
care," according to AANA President Jan Stewart.
In an interview with Reuters Health, Stewart questioned the applicability of
the study cited by the anesthesiologists as evidence of poorer outcomes and said
that she believes the real issue is one of "control."
