Ohio House Bill 191 - Would eliminate MD supervision of CRNAs

[repititionition]

House Bill 191 - Summary | The Ohio Legislature

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[zizzer]

I'm doing my residency in Ohio. How can I most effectively start creating a riot about this?

 

[FollowTheMoney]

At this point, CRNAs need to be able to practice independently in all 50 states to demonstrate the increase in mortality rate that would accompany it. Unfortunately, patients will have to die in order to prove to hospitals, surgeons, insurance companies, and the government the necessity of having an anesthesiologist present for surgery. These mid level providers are so ignorant that they don't even realize the vast gap in knowledge base that they are lacking to truly be able to take care of patients. They want the independence and money of a physician without the knowledge base or the work involved to get there. Everyone wants to "play doctor", what else is new.

 

[Tuohy]

You can start here-this is the sponsor of the bill-
http://www.ohiohouse.gov/anne-gonzales

 

[Man o War]

At this point, CRNAs need to be able to practice independently in all 50 states to demonstrate the increase in mortality rate that would accompany it. Unfortunately, patients will have to die in order to prove to hospitals, surgeons, insurance companies, and the government the necessity of having an anesthesiologist present for surgery. These mid level providers are so ignorant that they don't even realize the vast gap in knowledge base that they are lacking to truly be able to take care of patients. They want the independence and money of a physician without the knowledge base or the work involved to get there. Everyone wants to "play doctor", what else is new.

+1

 

[acidbase1]

So is this just for Ohio? Obviously if it passes there other states will follow suit but this only applies to Ohio correct?

 

[DrCommonSense]

At this point, CRNAs need to be able to practice independently in all 50 states to demonstrate the increase in mortality rate that would accompany it. Unfortunately, patients will have to die in order to prove to hospitals, surgeons, insurance companies, and the government the necessity of having an anesthesiologist present for surgery. These mid level providers are so ignorant that they don't even realize the vast gap in knowledge base that they are lacking to truly be able to take care of patients. They want the independence and money of a physician without the knowledge base or the work involved to get there. Everyone wants to "play doctor", what else is new.

Why are you so confident they will have much higher mortality rates in most ASA 1-3 patients that are coming in for routine cases?

CRNAs will target the 95% of B+B cases plus OB that will cause an oversupply of anesthesia care and drop salaries.

Unless you are superspecialized at some academic center, this will be an issue going forward for anesthesiologists.

The old timers opened the door to this stuff by selling out the younger crew.

Should've only used AAs and NEVER CRNAs since AAs are UNDER MEDICINE. However, I worry its too late.

 

[T-burglar]

At this point, CRNAs need to be able to practice independently in all 50 states to demonstrate the increase in mortality rate that would accompany it. Unfortunately, patients will have to die in order to prove to hospitals, surgeons, insurance companies, and the government the necessity of having an anesthesiologist present for surgery. These mid level providers are so ignorant that they don't even realize the vast gap in knowledge base that they are lacking to truly be able to take care of patients. They want the independence and money of a physician without the knowledge base or the work involved to get there. Everyone wants to "play doctor", what else is new.

Yeah this gets repeated a lot bro but I'd actually be surprised if the increase in morbidity was large. I bet it would be small enough to go unnoticed. And general anesthesia for community hospital level cases will only get safer and safer. To be clear, I do feel that I see cases of major mismanagement from CRNAs, but they're not common. And even when they do happen, usually the patient lives just fine. You also have to admit that you've seen major mismanagement from physicians as well.

There's a perception problem in our specialty that can't be fixed. Anesthesia is seen as something a nurse can do, whether you want to believe it or not. The only escape is subspecialty training where your job is NOT percieved as something a nurse can do. ICU / Peds / Cardiac. I'm finishing cardiac and good surgeons want consultant level echocardiographers in their cases.

 

[Man o War]

Yeah this gets repeated a lot bro but I'd actually be surprised if the increase in morbidity was large. I bet it would be small enough to go unnoticed. And general anesthesia for community hospital level cases will only get safer and safer. To be clear, I do feel that I see cases of major mismanagement from CRNAs, but they're not common. And even when they do happen, usually the patient lives just fine. You also have to admit that you've seen major mismanagement from physicians as well.

There's a perception problem in our specialty that can't be fixed. Anesthesia is seen as something a nurse can do, whether you want to believe it or not. The only escape is subspecialty training where your job is NOT percieved as something a nurse can do. ICU / Peds / Cardiac. I'm finishing cardiac and good surgeons want consultant level echocardiographers in their cases.

Not my experience at all. My litmus test is would I feel comfortable going under with no MD supervision with the best CRNA I ever worked with.
Nope.
Most of them don't do CVLs or any lines at all. Many of them don't do nerve blocks. Lots of missed airways. Poor crisis management when stuff goes bad....and stuff does go bad in perfectly healthy, young patients. All this happened often enough that it scares me to death to think about being transported to a hospital with no anesthesiologists.
Sure there are bad docs. Not nearly as numerous as mediocre or bad CRNAs. No contest.

 

[supermario21]

Being that I live in OH, want to do residency in OH, and practice in OH, I find this concerning. The silver lining is that this bill has been introduced several times in previous house sessions and never seen even a committee vote.

 

[ryanjmy]

Yeah this gets repeated a lot bro but I'd actually be surprised if the increase in morbidity was large. I bet it would be small enough to go unnoticed. And general anesthesia for community hospital level cases will only get safer and safer. To be clear, I do feel that I see cases of major mismanagement from CRNAs, but they're not common. And even when they do happen, usually the patient lives just fine. You also have to admit that you've seen major mismanagement from physicians as well.

There's a perception problem in our specialty that can't be fixed. Anesthesia is seen as something a nurse can do, whether you want to believe it or not. The only escape is subspecialty training where your job is NOT percieved as something a nurse can do. ICU / Peds / Cardiac. I'm finishing cardiac and good surgeons want consultant level echocardiographers in their cases.

I doubt the mortality would be different because most hospitals doing the hard cases would retain mds. I have no doubt if a state excluded anesthesiologists from practicing in that state you would see a sky rocket in anesthesia related m&m.

Also medium and large size community hospitals are doing sick pts. Often times these pts are neglected on the floor more so than the large academic centers. An anesthesiologist is needed both as a gate keeper and in the or/pacu managing these pts. The guys training me used to say private pactice cases would be easier than acedemic cases. They were wrong.

 

[anbuitachi]

Not sure if mortality will be higher, but morbidity probably will since they can just call help whenever something goes wrong and get bailed out by physicians probably

 

[acidbase1]

Bottom line, donate regularly to ASAPAC

 

[FollowTheMoney]

Just message these congressmen and senators directly and say "I hope if you or a loved one ever needs life saving surgery, an anesthesiologist is nowhere to be found." I am certain that if they read it, it will hit home.

 

[deleted171991]

Not my experience at all. My litmus test is would I feel comfortable going under with no MD supervision with the best CRNA I ever worked with.
Nope.
Most of them don't do CVLs or any lines at all. Many of them don't do nerve blocks. Lots of missed airways. Poor crisis management when stuff goes bad....and stuff does go bad in perfectly healthy, young patients. All this happened often enough that it scares me to death to think about being transported to a hospital with no anesthesiologists.
Sure there are bad docs. Not nearly as numerous as mediocre or bad CRNAs. No contest.

Most patients have no idea that anesthesiologists are physicians. Or they think that CRNAs are doctors, too. Most have zero comprehension of the ACT model, of who does what and why.

 

[deleted171991]

I recently lost a contract at an east coast multispecialty orthopedic hospital where I was the medical director for 3 years, ran the preop clinic, and took care of business... not once over the course of the three years I was in charge did any patient have a significant issue intraop/post op. The surgeon owners wanted to employee crnas with direction by 1-2 physicians. I was privy to whom they hired as crnas and when I refused to staff them, the owners "fired" me and let the crnas run solo there until a physician could be found to direct them... in the course of 3 months running solo crnas, one patient died intraop, one died post op, the 3rd had a lengthy ICU stay. Speaks volumes to me.

I bet nothing happened to the hospital or the owners. Except for a nice profit.

Especially in the age of capped malpractice damages, hospitals can play this Russian roulette with very little downside when compared to the upside. In the end, it's all about the money.

 

[DrCommonSense]

I recently lost a contract at an east coast multispecialty orthopedic hospital where I was the medical director for 3 years, ran the preop clinic, and took care of business... not once over the course of the three years I was in charge did any patient have a significant issue intraop/post op. The surgeon owners wanted to employee crnas with direction by 1-2 physicians. I was privy to whom they hired as crnas and when I refused to staff them, the owners "fired" me and let the crnas run solo there until a physician could be found to direct them... in the course of 3 months running solo crnas, one patient died intraop, one died post op, the 3rd had a lengthy ICU stay. Speaks volumes to me.

Doesn't change anything unless there are big lawsuits that affect their malpractice insurance.

Has this happened or will it happen? Doubtful.

If they make a bigger profit by getting rid of you, they don't care about the "outcomes" unless it affects their insurance bottom line costs.

Just the way it works.

 

[DaTruMD]

lol, these CRNAs never give up

 

[epidural man]

I wish CRNA's were independent and then MD's would refuse to work in hospitals that employed CRNA's. Then hospitals and surgi-centers would advertise that they had all MD's.

Then I wish patients would make the decisions for us about which was better.

 

[d9sccr]

I wish CRNA's were independent and then MD's would refuse to work in hospitals that employed CRNA's. Then hospitals and surgi-centers would advertise that they had all MD's.

Then I wish patients would make the decisions for us about which was better.

I recently took an MD/DO-only position. You'd be amazed by how many people looked at me like I'm crazy, both attendings and even some of my fellow classmates.

 

[deleted126335]

I recently took an MD/DO-only position. You'd be amazed by how many people looked at me like I'm crazy, both attendings and even some of my fellow classmates.

most likely your income and lifestyle will be lower, but you mental health will be higher.

 

[linkin06]

I wish CRNA's were independent and then MD's would refuse to work in hospitals that employed CRNA's. Then hospitals and surgi-centers would advertise that they had all MD's.

Then I wish patients would make the decisions for us about which was better.

That was the angle my mentor who was in anesthesia for decades told me when I was deciding. He said the debates been going on forever. One hospital could easily advertise their anesthetics are done by Doctors vs Nurses. Which hospital will people want to choose?

I just saw a billboard for a Peds ER that "is the first pediatric ER in Houston to display waiting times in waiting room!"

If that's a selling point, I would hope most laity would understand the choice of Doctor vs nurse for anesthetic. But then again, I've been very surprised before

 

[facted]

I recently lost a contract at an east coast multispecialty orthopedic hospital where I was the medical director for 3 years, ran the preop clinic, and took care of business... not once over the course of the three years I was in charge did any patient have a significant issue intraop/post op. The surgeon owners wanted to employee crnas with direction by 1-2 physicians. I was privy to whom they hired as crnas and when I refused to staff them, the owners "fired" me and let the crnas run solo there until a physician could be found to direct them... in the course of 3 months running solo crnas, one patient died intraop, one died post op, the 3rd had a lengthy ICU stay. Speaks volumes to me.

Did they hire you back or they stuck with the crnas?

 

[Consigliere]

I recently took an MD/DO-only position. You'd be amazed by how many people looked at me like I'm crazy, both attendings and even some of my fellow classmates.

Just wait until you're rotting away during a 4 hour Mediport insertion, all the while being subjected to inane OR conversation and you'll begin to understand those looks.

 

[d9sccr]

most likely your income and lifestyle will be lower, but you mental health will be higher.

That's actually incorrect. Granted I'm moving to another state, my income will be more than my peers staying here and supervising. It was an easy decision for me

 

[deleted162650]

Just wait until you're rotting away during a 4 hour Mediport insertion, all the while being subjected to inane OR conversation and you'll begin to understand those looks.

Dude, you're all over the place. One minute you can't stand sitting your own cases. Then you change your mind and tell us how "exhilarating" it is to do your own cases again. Now your back to dogging it. Make up your mind man. 😕

 

[Consigliere]

Dude, you're all over the place. One minute you can't stand sitting your own cases. Then you change your mind and tell us how "exhilarating" it is to do your own cases again. Now your back to dogging it. Make up your mind man. 😕

Meh. There's pros and cons to either scenario. I go back and forth.

 

[Mman]

Just message these congressmen and senators directly and say "I hope if you or a loved one ever needs life saving surgery, an anesthesiologist is nowhere to be found." I am certain that if they read it, it will hit home.

LOL

Your username is quite ironic in relating to this topic. You want to know what they care about? Money. You can explain things factually as much as you want and then they will go back to their CRNA lobby and thank them for the $100K check they received as a campaign contribution.

This same stupid stuff gets brought in my state about every 2-3 years. Every year it ultimately gets shot down but not without massive information (and $$$) campaigns by physicians to "educate" the legislators. There are state representatives in probably every state in the country that are bought and paid for by CRNAs that have a major mission to introduce these bills as often as they can. It will literally never stop. It's like a cockroach.

 

[acidbase1]

^^^^ that is the unfortunate truth. It's a money game so donate to ASAPC often. Honestly, the established guys who've been working for >15-20 years should be donating the 5k max

 

[dhb]

How such blatant corruption is allowed is mind blowing.
In political terms campaign money = wallet.

 

[FollowTheMoney]

Medical malpractice attorneys should be going to town on these nurses in every state. For them it has to be a lay up to find gross malpractice by mid level providers and get the plaintiffs to sue for millions. The only issue I could see is that they have no way of knowing that it occurred from the records without being informed. If physicians paired up with medical malpractice attorneys to get them the all the cases of malpractice by CRNAs and went after them hard in every state it would make hospitals, anesthesia groups, and insurance companies think twice before exposing themselves to a major lawsuit. The litigation against them needs to get ramped up and unfortunately the average person has no idea half the time that malpractice was committed. If you don't make hospitals, etc. responsible for their unethical practice models and hiring practices there is no reason to have an anesthesiologist around. Why wouldn't they save money if they can get away with malpractice without being held accountable? They don't give a **** about outcomes or the patient, they care about the bottom line. In order for them to take you seriously, you need to hurt them where it matters... like I don't know... maybe with an onslaught of legitimate lawsuits against CRNAs.

 

[Psai]

Medical malpractice attorneys should be going to town on these nurses in every state. For them it has to be a lay up to find gross malpractice by mid level providers and get the plaintiffs to sue for millions. The only issue I could see is that they have no way of knowing that it occurred from the records without being informed. If physicians paired up with medical malpractice attorneys to get them the all the cases of malpractice by CRNAs and went after them hard in every state it would make hospitals, anesthesia groups, and insurance companies think twice before exposing themselves to a major lawsuit. The litigation against them needs to get ramped up and unfortunately the average person has no idea half the time that malpractice was committed. If you don't make hospitals, etc. responsible for their unethical practice models and hiring practices there is no reason to have an anesthesiologist around. Why wouldn't they save money if they can get away with malpractice without being held accountable? They don't give a **** about outcomes or the patient, they care about the bottom line. In order for them to take you seriously, you need to hurt them where it matters... like I don't know... maybe with an onslaught of legitimate lawsuits against CRNAs.

Sounds silly. Plus nurses have way more time to think up frivolous lawsuits than doctors do if this kind of thing were to happen.

 

[deleted171991]

Nurses are not as rich as doctors, and their malpractice insurance coverage limits are much lower, hence not juicy targets.