this is from the ASA site:
DOCTORS FIGHT FOR SENIORS' RIGHTS TO KEEP SAFEST ANESTHESIA CARE AVAILABLE
WASHINGTON, D.C., March 22, 2000 -- In an effort to halt a Medicare proposal that would eliminate a critical Medicare benefit for all seniors and will likely even endanger their lives, hundreds of physicians converged on Capitol Hill today to urge members of Congress to intervene in what has become a bureaucratic quagmire with Medicare's regulatory agency.
The physician members of the American Society of Anesthesiologists are turning to their representatives and senators to block a Health Care Financing Administration (HCFA) proposal that would remove ANY physician supervision of anesthesia. The ramifications are that nurses, often with less than two years of technical training, could be the sole providers of anesthesia to the nation's oldest and potentially sickest segment of the population.
Senator Jon Kyl, R-AZ, told the doctors in Washington, D.C., on Tuesday that he will now join the other co-sponsors of the Safe Seniors Assurance Study Act of 1999 (S. 818/ H.R. 632), because it appears that HCFA has not sufficiently reviewed current data or conducted new studies to ensure that seniors will be safe if the requirement for physician supervision of nurse anesthetists is removed.
"It is obvious now that all concern for patient safety has been lost to bureaucracy," said Ronald A. MacKenzie, D.O., president of the national physician group of more than 35,000 members. "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.
"If HCFA goes ahead and removes this safeguard, seniors stand to lose not only a critical Medicare benefit, but even more frightening, people will die. Is that the evidence that HCFA needs?" Dr. MacKenzie asked.
While he agrees that patient safety in this country has improved over the last few decades, from 1 in 10,000 deaths to less than 1 in 250,000 deaths, Dr. MacKenzie notes that this safety level was only achieved WITH THE INVOLVEMENT OF ANESTHESIOLOGISTS. In fact, a recent scientific study of more than 65,000 Medicare patients in 219 hospitals in Pennsylvania revealed that there was a 28-percent higher rate of deaths and a 21-percent lower chance to rescue seniors who have complications after receiving anesthesia from a nurse anesthetist who is not supervised by an anesthesiologist.
"These are frightening figures," Dr. MacKenzie said. "We could turn back the patient-safety clock to the 1960s when ether was still being used. Yet when we met Monday with HCFA's Administrator [Nancy-Ann Min DeParle], I was told the Pennsylvania study is not relevant to HCFA's decision. How can the increased risk of seniors dying NOT be relevant?"
HCFA claims that its proposal would not affect care but only defer the scope-of-practice issue to the states. Dr. MacKenzie notes, however, that Medicare is a national program, and as such, needs to set national minimum standards. The current physician supervision requirement has been in effect since the Medicare program was established in 1966.
"This is about people, not government," Dr. MacKenzie said. "It's about patients' rights, not states' rights, the right of Medicare beneficiaries in every state to the best available medical care during anesthesia. If HCFA's proposal is approved, Medicare patients would be subject to potentially 50 different levels of anesthesia care in this country, not only where they live but where they may travel as well." All Medicare patients, even those living in rural areas, are now assured of the same level of care because physician supervision is all that is required, and surgeons would continue to be available for supervision in those areas, Dr. MacKenzie said.
Furthermore, this proposal will not save any money for the government, hospitals or patients, Dr. MacKenzie added. "It costs the government the same if a nurse anesthetist is supervised by a physician or not." In fact, studies show that costs are actually lower when anesthesiologists are involved because of the reduced need for additional medical consultations and preoperative tests, he said.
Dr. MacKenzie said members of the American Society of Anesthesiologists will do everything in their power to continue to advocate for their patients, now not only in the operating room, but before every appropriate agency and congressional committee in Congress to seek a resolution that keeps seniors safe.
"HCFA does not need to do anything but leave the long-standing and safe standards in place for Medicare patients. Seniors would then be assured that they will continue to receive good quality medical care. Only if a scientific study proves that unsupervised nurse anesthetists are just as safe should this sensible patient safety rule be changed," Dr. MacKenzie said.
Founded in 1905, the American Society of Anesthesiologists is a scientific and educational association of anesthesiologists 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 with more than 35,000 members.