HCFA Implements Anesthesia Supervision Rule Change, Endangering Lives of Thousands of Seniors Undergoing Surgery
Politics Rule as 11th Hour Move by Clinton Administration Ignores Science
PARK RIDGE, Ill., Jan. 18 /PRNewswire/ -- Today the American Society of Anesthesiologists is calling on President-Elect George W. Bush to reverse a grievous and dangerous 11th-hour decision by the Clinton Administration that places every Medicare and Medicaid patient having surgery at increased risk of injury or death. The medical organization, representing 36,000 physician members nationwide, charged that the rule change made by the U.S. Health Care Financing Administration (HCFA) will jeopardize the lives of seniors who undergo surgery by eliminating the requirement for a doctor to supervise if a nurse gives the anesthesia. This requirement has been in effect continuously for the 35 years since the Medicare program was created. "This action taken by the Clinton administration, with only two days remaining before leaving office, is an affront to everyone in this country -- but in particular to our most vulnerable patients, senior citizens -- who look to our federal government to establish minimum standards for keeping patients safe," said Neil Swissman, M.D., president of the American Society of Anesthesiologists. "Instead, the safety net that has protected millions of seniors over the years has been dropped right before the Administration leaves town. "It is simply incomprehensible that the Administration could be so callous," he said. Dr. Swissman said the American Society of Anesthesiologists will explore every possible avenue to have this issue redressed, including legal or legislative action or possible intervention by the incoming president. "The Bush campaign stood on a strong platform of protecting Medicare benefits, and this outrageous action from the outgoing president is a mistake that Governor Bush has within his power to fix." Why the HCFA requirement for physician supervision of nurse anesthetists would be targeted for removal from the Medicare/Medicaid conditions of participations for hospitals and ambulatory centers has been questioned by members of the public and health care community throughout the three-year battle, Dr. Swissman noted. Yet HCFA and the Administration disregarded their concerns, he said. Dr. Swissman explained that independent researchers, every major surgical association, all 50 state medical societies and the American Medical Association have supported retaining the rule. During this past year alone, the public decried the proposed rule change by sending more than 75,000 faxes and e-mails to Congress and the White House, and newspapers across the country published editorials supporting patient safety over politics. In Congress, more than 140 senators and representatives supported bills calling for research that would assure safety. "There is a basic but critical misconception that has clouded this issue from the beginning," Dr. Swissman said. The practice of anesthesiology is NOT just administering anesthetic agents. It requires continuous medical judgment before the surgery to diagnose the patient and determine the best anesthetics to use, during surgery when split-second decisions are made and even after surgery when recovery of the patient and their pain treatment are critical. Nurses are not doctors and should not be expected to make those decisions," Dr. Swissman said. Furthermore, there is no scientific research to support the rule change and, in fact, there are studies that call such action into question as it regards the safety of patients having anesthesia. Last summer, University of Pennsylvania researchers published a paper that reviewed the care of 235,000 Medicare patients and determined that there were 25 needless deaths per 10,000 cases when an anesthesiologist was not involved in the care. "Instead of heeding the warning flags, HCFA chose to disregard the research rather than taking it to the next logical step," Dr. Swissman said. "To make it worse, HCFA still has offered absolutely no scientific evidence of its own that this change will maintain the current level of safety." According to HCFA's press release on the new rule, the decision was based on its "commitment to decrease regulatory burden by deferring to state licensing laws regulating professional health care practice." All decisions relating to the supervision of nurse anesthetists will now take place at the state level. Some states require medical direction by an anesthesiologist while others maintain few or no standards at all. "Yet Medicare is a federal program," Dr. Swissman said. "There should be one minimum federal standard of care so that seniors are not placed in medical jeopardy based on a patchwork of different regulations that currently exist throughout the country. For 35 years, no senior, whether in a small town or a big city, ever had to worry if a doctor would be involved in their anesthesia based solely on the state in which they were hospitalized. Now they will." As recently as 1992, HCFA looked at this proposed rule change and said the anesthesia care of Medicare patients was too risky to leave to unsupervised nurse providers. "Nothing has changed in the training of nurse anesthetists that somehow qualifies them now to assume the medical responsibility of patients," Dr. Swissman said. "How can HCFA take a diametrically opposed position today when the only new scientific evidence suggests that doctors should supervise anesthesia nurses?" The government also takes the position that anesthesia has become so safe that less qualified personnel can administer it. "This misses the point completely," Dr. Swissman said. "Anesthesia is safer today than ever before BECAUSE of the involvement of physicians. The safety figures that HCFA has quoted were based on studies in which an anesthesiologist was involved in every single case!" Anesthesia nurses have two years of technical training (versus the 12 years of medical training of physicians), Dr. Swissman noted, and this cannot prepare them for medical emergencies that inevitably arise during surgery. The American Society of Anesthesiologists is reviewing all available options to turn the tide on this ill-conceived plan to experiment with patients' lives, Dr. Swissman said. The rule, published today in the Federal Register, will not become effective for at least 60 days. Furthermore, the society will fight every step of the way to maintain strong state standards in lieu of national guidelines. "We thought that through our educational efforts about what really is involved with the anesthesia care of patients today, HCFA and the White House would set aside politics for the benefit of Medicare patients in this country," Dr. Swissman said. "What we didn't count on was the Clinton Administration's allegiance that sides with the economic interests of nurses over the safety of seniors. And we didn't count on the determination of the Clinton Administration and its staff to leave this kind of legacy to seniors as a parting, potentially lethal, gift as they leave office." Founded in 1905, the American Society of Anesthesiologists is a scientific and educational association of anesthesiologists and other scientists that was organized to advance the practice of anesthesiology and to improve the quality of care of the anesthetized patient. It is the largest organization of anesthesiologists in the world.
SOURCE American Society of Anesthesiologists
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