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

Jan 18, 2001, 00:00 ET from American Society of Anesthesiologists

    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
     "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