Sunday, October 20, 2013

Anesthesiologists' Last Stand?

Last week, Rep. Andy Harris, M.D., the only anesthesiologist serving in Congress, sent a letter to the California Society of Anesthesiologists apologizing for not being able to attend the ASA conference in San Francisco due to the government shut down at the time. In it, he also addressed the issue of the insidious changes that are occurring at the VA Administration in regards to increasing the scope of practice of CRNA's that are being considered at VA hospitals. I have copied the letter in its entirety below.

To those of you who are attending the ASA meeting in San Francisco - I am sorry I have to remain in Washington this week and won't be able to attend as I had planned.

I did want to update you on a very important issue to anesthesiologists addressed here in Washington last week.

The Department of Veteran Affairs recently developed a new draft of the VA Nursing Handbook which dramatically expands scope of practice for nurses. This change would require nurses to practice independently. Currently, the VA facilities operate under the applicable state scope of practice laws.

Last week, I requested to sit in on a hearing of the Veteran Affairs Committee's Health subcommittee where the VA Principal Deputy Undersecretary for Health Dr. Robert Jesse was testifying. I directly confronted Dr. Jesse about these dramatic changes to the nursing handbook. You can watch the exchange by clicking here (or copy and paste this link into your web browser).

The main focus of the over two hour hearing was on the skyrocketing use of prescription painkillers to treat veterans. Those who testified discussed how the VA is failing to adequately treat the pain our soldiers are returning from battle with and failing to prevent our soldiers from becoming addicted to painkillers. The drafted dramatic scope of practice expansion for nurses would only make this problem worse as those with little to no training in pain management would be in charge of treating these wounded warriors. Those who sacrificed for our country deserve better.

During the questioning, Dr. Jesse committed to me that before any changes to the Nursing Handbook are finalized, the VA will have a comment period and will listen to the concerns of the ASA, AAFP, and AMA. I will continue to make sure our concerns are addressed. In addition, the VA Health subcommittee's chairman, Dr. Benishek, and Democratic ranking member Ms. Brownley have written to the VA and expressed concerns about these changes.

If you have any concerns or need to reach me, please feel free to email me at

Andy Harris, M.D.

The danger here, of course, is that the federal government will lead the charge in allowing CRNA's to practice without the supervision of a physician.  Right now, each VA hospital lets the nurse anesthetist practice according to the laws of the state that it resides in, whether the state has allowed CRNA's to opt out of physician supervision or not. If the federal government decides that all VA hospitals in every state should let CRNA's practice without supervision, then the chances are that this will open the door for more states to opt out.

The threat posed by this seemingly minor rules change in the VA Nursing Handbook should not be underestimated. Don't our veterans, the ones who have sacrificed their lives to protect the interests of our country, deserve to have the best anesthesia providers available to them? Do we really want the heroic men and women of our armed forces to be treated by somebody who is just counting down the clock to their 2:00 PM quitting time so they can hustle to their cars ahead of the secretarial and janitorial staff?

If you understand the grave risks the Veterans Administration is posing to anesthesiologists, don't hesitate to contact your state anesthesiology society and your local congressional representative ASAP. Giving money to the ASAPAC or your state society PAC wouldn't hurt either. Congress shouldn't hear only one side of the story from the politically powerful AANA. We need to do everything in our power to prevent these changes from happening at VA Hospitals. If this isn't stopped, it will be a slippery slope to universal control of operating rooms by CRNA's.

What happens when anesthesiologists abdicate their proper role as the patient's safety advocate in the operating room? Read here to find out.


  1. "War" and "Last Stands".....this is what you are all reduced to? Pathetic. Too bad you were all shut out of combat anesthesia when the Army designed the "Forward Surgical Team" (Google it)....combat anesthesia care is the best it has ever been, in spite of you. You know nothing of "War" and "Last Stands"....we've been doing all the fighting for you. Too bad you all don't play well with others.
    US Army LTC CRNA

  2. LTC? You don't do any clinical care. There is no time to get that Fit Rep all spruced up. Don't play so tough. If we model anything off Military Medicine we are in a world of hurt

  3. Evidenced-based arguments, please. Until studies suggest that CRNAs are not as good as MDAs, then you need to STFU. Too bad all studies suggest otherwise. Your pissed off that you went to medical school to do what an Advanced Practice Nurse can do--just as safely, with the same outcomes. And don't go bad mouthing an ARMY CRNA, they practice independently under some pretty dire circumstances--quit being an ass.

    1. This reply embodies all that is wrong with expansion of CRNA responsibility. A CRNA, apparently with a straight face, can actually invoke resentment and regret by the doctor for his advanced training and clinical superiority over nurses.
      I for one am not "pissed off" that I went to medical school and residency only to find that CRNAs with inferior training are seeing their clinical portfolios expand. I simply see economics and politics getting in the way of common sense. Just wait until operative surgeons tire of CRNA freeloading on their insurance. Let my CRNA take my recert exam and pay my malpractice premium and we'll talk.

    2. You know what? Next time I'm at the dentist's office I'll let the hygienist do my root canal! it's cheaper and the dentist is always available during the beginning and end and all relevant portions in between!