Physicians Victorious!!

Alpha_Male · Jul 5, 2005

New Jersey Supreme Court Unanimously Upholds Office-Based Surgery Regulations

The New Jersey Supreme Court affirmed the Appellate Division's decision and held that the office-based surgery regulations challenged by the New Jersey Association of Nurse Anesthetists were within the Board of Medical Examiners' delegated authority. The Court agreed with the Appellate Division's holding that the administration of anesthesia is the practice of medicine and that the regulations fall squarely within the Board's core jurisdiction, the licensing and qualifications of physicians, and how they perform their professional services. It also agreed that while the regulations have an indirect impact on the CRNAs' profession, the BME is not regulating the nursing profession, but rather the physicians who offer anesthesia in an office setting.

Recognizing the unique nature of the office setting, the Court held that the "wealth of testimony adduced at the public hearings on the regulations supported the need for enhanced education and oversight." This decision upheld the requirement that a qualified physician must supervise a nurse anesthetist who administers and monitors general or regional anesthesia. The regulations specify how many hours of continuing medical education in anesthesia the supervising physician must have completed. Lastly, the Court recognized the value of having an anesthesiologist involved in the delivery of anesthesia care. It is "fundamentally reasonable that additional education and training would enable anesthesiologists administering or overseeing anesthesia to better protect patients and to respond when complications occur."

rn29306 · Jul 5, 2005

Nice double post, both in anesthesia and the clinician forums. I see you are trying to incite a rebuttal since you specifically posted a notice that APRNs will read. So here goes:

1. If CRNAs are so dangerous, then why did the 14th state just opt out of physician supervision? Gov Jim Doyle informed the Center for Medicare and Medicaid Services in Washington, D.C. that Wisonscin is opting out of the federal supervision requirement for CRNAs.....effective immediately. In the four years that the states have been opting out of the supervision requirement, there have not been any reports of anesthesia patient deaths or injuries related to the removal of physician supervision of CRNAs...

2. You should really read "Surgical Mortality and Type of Anesthesia Provider" by Dr. Michael Pine, board certified cardiologist widely recognized for his expertise in analyzing clinical data to evaluate healthcare outcomes. In a study of 404,194 Medicare cases from 1995 - 1197. (404,194 - Sample size big enough for ya?)
Please feel free to Google or Yahoo! the study but I'll print the significant findings here:
- 34 deaths per 10,000 cases with CRNA + MDA
- 45 deaths per 10,000 cases with MDA alone
Dr. Pine had an intresting take on the 7 patient deficit when CRNAs did cases alone. And I quote Dr. Pine "the AANA could claim that MDAs not be permitted to administer anesthesia unless a CRNA is present to prevent excess mortality associated with physicians attempting to engage in the practice of nursing. However, unlike the ASA, the AANA has enough respect for its audience to avoid making such unwarranted claims."
He added that his study's data supports the conclusion that even when there are 2 anesthesia providers working together, substitution of a MDA for a CRNA does nothing to lower the mortality rate.
Enter the not-so-happy ASA, rightly so that another physician outed them, publically, and issue a statement that makes no statistical sense that challenged the findings of Dr. Pine. Dr. Pine's rebuttal to the A$A: The ASA suggested that his study supports "the conclusion that 'anesthesiologists improve patient outcomes' is evidence of either woeful ignorance of the basics of data analysis or a cynical contempt for the intelligence of the intended audience". How embarrassing from one MD to another group of MDs.

3. Florida HB629/SB1452
On 12/21/04 the Florida Supreme Court issued an order denying the Florida Board of Medicine's petition for review in the Department of Health/Florida Board of Medicine vs Victor Ortiz case. The Supreme Court's order states that no motion for a rehearing will be allowed.
Further findings of the court:
- The court pointed out that patient safety was not an issue. ..."there was no evidence to indicate any significant difference in patient outcomes whether anesthesia was delivered by CRNA or MDA.
- The court found that APRNs are RNs for purposes of the statute that precludes the Board of Medicine from prohibiting any service provided by a registered nurse under the direct supervision of a physician.
- The court upheld that the Board of Medicine cannot directly or indirectly take action that restricts the practice of nurses.
- The Florida Board of Medicine filed for a motion for rehearing, which the court denied.

History and studies have shown it does not take a MD to deliver anesthesia. Seriously, I have great respect for MDAs and the path he or she has chosen. But like anything in life, there is competition and the CRNA vs MDA discussion is certainly not left out of this fact of life. If MDA are so superior, then where's the data? Do you honestly think that the government or public would tolerate unsafe populations of anesthesia providers? That silence you hear is a very loud NO. Imagine if a CRNA did a study of 400,000+ individuals and found more deaths when CRNAs were involved with anesthetic cases....The ASA would be up in arms trying to ban CRNAs. What really happened is that a physician found CRNAs to be statistically safer than MDAs. Sucks to be sold out by your own kind, a population (MDs in general) that traditionally sticks together better than JB Weld compound. And then to be called on the carpet for making a ******* response....OUCH. The answer is that it comes down to money and the A$A or the AANA is no different.

Congrats on your recent victory. We'll have to see how this settles out in court. A precedent has been set that the Boards of Medicine "cannot directly or indirectly take action that restrics the practice of nurses". Don't think this won't be challenged.

rn29306 · Jul 7, 2005

What's up alpha? Are you just a one shot chump that won't respond?

Alpha_Male · Jul 7, 2005

rn29306 said:
What's up alpha? Are you just a one shot chump that won't respond?

I don't have time to waste responding to some disgruntled nurses attempt at justifiying their own existence. Suffice it to say that NJ has done the right thing and I am glad I practice here. 🙂

rn29306 · Jul 7, 2005

So then, why the post in the clinician forum? Trolly Trolly Trolly.

There is no "attempting" to justify my existence, we are a long-establisted entity.

You cannot discredit what was in my post so you just turn the other cheek. Very nice.

Alpha_Male · Jul 7, 2005

rn29306 said:
So then, why the post in the clinician forum? Trolly Trolly Trolly.

There is no "attempting" to justify my existence, we are a long-establisted entity.

You cannot discredit what was in my post so you just turn the other cheek. Very nice.

Dude.......whatever. Stop trying to engage me in an argument. Here's the bottom line: as an MDA I will always tell you what cases to do, have ultimate authority on how you do them, when you'll have a break, when you'll get lunch, and when you go home. I'm the doctor, you're the nurse, that's life!

Sheesh 🙄

rn29306 · Jul 7, 2005

Alpha_Male said:
Dude.......whatever. Stop trying to engage me in an argument. Here's the bottom line: as an MDA I will always tell you what cases to do, have ultimate authority on how you do them, when you'll have a break, when you'll get lunch, and when you go home. I'm the doctor, you're the nurse, that's life!

Sheesh 🙄

There is no law in any 50 states, except for NJ's most recent decision, that says a MDA must "supervise" a CRNA. I don't have to work with asses like you. And you know how "supervision" is in a teaching hospital. You show up on induction while CRNA intubates, poke head in OR with coffee in hand "when you get a chance", stand at bedside while CRNA extubates and then bitch about how much money you don't make. If the above is how you practice, then you are a tool and will be a lonely ahole of a MDA.
You come in here trying to throw weight around in a clinician forum and this is what you result to...You already posted in the anesthesia forum so why here if not to just try and stir up people for no reason. You can't even argue about legitimate issues without resorting to a chest beating "I'm the MDA" attitude. Other than you piss-poor attitude, you have no substantial data to support your existence.
I'll drop this issue, but realize you can't make a productive argument with a student CRNA. You came in here to piss people off, then don't hang around for the discussion afterwards. Congrats on playing the leading role of the arrogant SOB thundercat young MD.

bell412 · Jul 7, 2005

Alpha Male it must be hard for you to do a job that nurses can do?

mx_599 · Jul 7, 2005

Alpha_Male said:
I don't have time to waste responding to some disgruntled nurses attempt at justifiying their own existence. Suffice it to say that NJ has done the right thing and I am glad I practice here. 🙂

Don't worry Alpha, this same nurse has belittled me in another thread.

Alpha_Male · Jul 7, 2005

bell412 said:
Alpha Male it must be hard for you to do a job that nurses can do?

Well - not really........ since ANY nurse can do ANY job a physician can do WITH ENOUGH TRAINING. I do enjoy the fact that I can "supervise" 3-4 CRNAs at a time while they help make me about $500k/year. Gotta' love that :laugh:

nev · Jul 7, 2005

Ok Lets calm down here....

bell412 · Jul 7, 2005

Alpha Male your not the brightest light on the block are ya? I do the same job you do. SAME JOB Alpha ol boy. I think deep down Alpha you want to be a nurse. I mean why would you pick a nursing residency.

Alpha_Male · Jul 7, 2005

bell412 said:
Alpha Male your not the brightest light on the block are ya? I do the same job you do. SAME JOB Alpha ol boy. I think deep down Alpha you want to be a nurse. I mean why would you pick a nursing residency.

You may THINK you do the same job as me nurse. But let's face it - I make 5 times more than you do.

Oh well.....life is good! 😍 :laugh:

😍

mx_599 · Jul 7, 2005

rn29306 said:
Nice double post, both in anesthesia and the clinician forums. I see you are trying to incite a rebuttal since you specifically posted a notice that APRNs will read. So here goes:

1. If CRNAs are so dangerous, then why did the 14th state just opt out of physician supervision? Gov Jim Doyle informed the Center for Medicare and Medicaid Services in Washington, D.C. that Wisonscin is opting out of the federal supervision requirement for CRNAs.....effective immediately. In the four years that the states have been opting out of the supervision requirement, there have not been any reports of anesthesia patient deaths or injuries related to the removal of physician supervision of CRNAs...

2. You should really read "Surgical Mortality and Type of Anesthesia Provider" by Dr. Michael Pine, board certified cardiologist widely recognized for his expertise in analyzing clinical data to evaluate healthcare outcomes. In a study of 404,194 Medicare cases from 1995 - 1197. (404,194 - Sample size big enough for ya?)
Please feel free to Google or Yahoo! the study but I'll print the significant findings here:
- 34 deaths per 10,000 cases with CRNA + MDA
- 45 deaths per 10,000 cases with MDA alone
Dr. Pine had an intresting take on the 7 patient deficit when CRNAs did cases alone. And I quote Dr. Pine "the AANA could claim that MDAs not be permitted to administer anesthesia unless a CRNA is present to prevent excess mortality associated with physicians attempting to engage in the practice of nursing. However, unlike the ASA, the AANA has enough respect for its audience to avoid making such unwarranted claims."
He added that his study's data supports the conclusion that even when there are 2 anesthesia providers working together, substitution of a MDA for a CRNA does nothing to lower the mortality rate.
Enter the not-so-happy ASA, rightly so that another physician outed them, publically, and issue a statement that makes no statistical sense that challenged the findings of Dr. Pine. Dr. Pine's rebuttal to the A$A: The ASA suggested that his study supports "the conclusion that 'anesthesiologists improve patient outcomes' is evidence of either woeful ignorance of the basics of data analysis or a cynical contempt for the intelligence of the intended audience". How embarrassing from one MD to another group of MDs.

3. Florida HB629/SB1452
On 12/21/04 the Florida Supreme Court issued an order denying the Florida Board of Medicine's petition for review in the Department of Health/Florida Board of Medicine vs Victor Ortiz case. The Supreme Court's order states that no motion for a rehearing will be allowed.
Further findings of the court:
- The court pointed out that patient safety was not an issue. ..."there was no evidence to indicate any significant difference in patient outcomes whether anesthesia was delivered by CRNA or MDA.
- The court found that APRNs are RNs for purposes of the statute that precludes the Board of Medicine from prohibiting any service provided by a registered nurse under the direct supervision of a physician.
- The court upheld that the Board of Medicine cannot directly or indirectly take action that restricts the practice of nurses.
- The Florida Board of Medicine filed for a motion for rehearing, which the court denied.

History and studies have shown it does not take a MD to deliver anesthesia. Seriously, I have great respect for MDAs and the path he or she has chosen. But like anything in life, there is competition and the CRNA vs MDA discussion is certainly not left out of this fact of life. If MDA are so superior, then where's the data? Do you honestly think that the government or public would tolerate unsafe populations of anesthesia providers? That silence you hear is a very loud NO. Imagine if a CRNA did a study of 400,000+ individuals and found more deaths when CRNAs were involved with anesthetic cases....The ASA would be up in arms trying to ban CRNAs. What really happened is that a physician found CRNAs to be statistically safer than MDAs. Sucks to be sold out by your own kind, a population (MDs in general) that traditionally sticks together better than JB Weld compound. And then to be called on the carpet for making a ******* response....OUCH. The answer is that it comes down to money and the A$A or the AANA is no different.

Congrats on your recent victory. We'll have to see how this settles out in court. A precedent has been set that the Boards of Medicine "cannot directly or indirectly take action that restrics the practice of nurses". Don't think this won't be challenged.

What are you saying?? Gosh...that was long 👎 😴

mx_599 · Jul 7, 2005

Alpha_Male said:
I don't have time to waste responding to some disgruntled nurses attempt at justifiying their own existence. Suffice it to say that NJ has done the right thing and I am glad I practice here. 🙂

😛

mx_599 · Jul 7, 2005

rn29306 said:
So then, why the post in the clinician forum? Trolly Trolly Trolly.

There is no "attempting" to justify my existence, we are a long-establisted entity.

You cannot discredit what was in my post so you just turn the other cheek. Very nice.

He is probably too busy to write a painfully long, boring response like you did.

mx_599 · Jul 7, 2005

Alpha_Male said:
...as an MDA I will always tell you...when you'll have a break, when you'll get lunch, and when you go home. I'm the doctor, you're the nurse, that's life!

hehe 😀

mx_599 · Jul 7, 2005

bell412 said:
Alpha Male it must be hard for you to do a job that nurses can do?

Please...anything nurses can do, physicians could do better 👍

Alpha_Male · Jul 7, 2005

mx_599 said:
Please...anything nurses can do, physicians could do better 👍

And do do better! 👍

mx_599 · Jul 7, 2005

Alpha_Male said:
And do do better! 👍

🙂
The added implication was that there are tasks physicians wouldn't do...but if they did, it would be done better. 😀

bell412 · Jul 7, 2005

I asume when you state you are better that you actually have better patient outcomes? but you don't alpha. So I will use the same words you did. I do your job better alpha. mx_599 you simply don't know what your talking about.

mx_599 · Jul 7, 2005

bell412 said:
mx_599 you simply don't know what your talking about.

I know...I agree, I haven't even started school yet. 😀

snoopy69 · Jul 7, 2005

C'mon Alpha, you know you just posted this thread in the midlevel forum so that you could start an ego battle with everyone here, don't try to deny that. You obviously have to assert your dominance over others to feel better about yourself, hence your name :laugh:

. You are a very sad individual and you give the real competant and caring physicians a bad name. Hmm...I wonder why you chose anesthesia, possibly because it was one of the highest paid specialties? I'm glad you take pleasure out of your huge ego.

mx 599, I find it hilarious that you are talking with such authority since you haven't even started med school yet. I'm sure you'll get a slice of humble pie served to you when you start.

tkim · Jul 7, 2005

closing.

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