Doctor groups in Colorado are up in arms this week after Gov. Bill Ritter's decision to opt out of a federal Medicare rule by allowing qualified nurses at rural hospitals throughout the state to administer anesthesia without a doctor present. Both the Colorado Society of Anesthesiologists and the Colorado Medical Society are suing the state in an attempt to reverse what CSA spokesperson Dr. Randall Clark calls "an unnecessary lowering of the standard of care in hospitals," reports the Denver Post.
Ritter says his decision was made with patient safety in mind, specifically for patients in rural areas who have limited access to high-quality care. Colorado becomes the 16th state to opt out of the rule since 2001, when states were first given the option.
In a letter to Ritter last month, when he still was weighing the decision of whether or not to opt out, CSA president Dr. Daniel J. Janik argued that--contrary to Ritter's ultimate reasoning behind the decision--patient safety was put in jeopardy.
"Quality of care will be imperiled," Janik wrote. "Outcomes research conducted...found 25 to 60 more deaths per 10,000 anesthetics when physicians were not involved....Patients [also] want physician involvement in their anesthesia care. A 2001 national survey of 1,004 consumers found that 77 percent of Medicare patients opposed allowing anesthesia nurses to administer anesthesia without medical supervision."
In an editorial written in the Detroit Free Press this week, Dr. Kenneth Elmassian, president of the Michigan Society of Anesthesiologists, made a similar argument for hospitals nationwide. His letter came in response to an opinion piece written in the Baltimore Sun last week by dean of the Duke School of Nursing Catherine L. Gilliss, who wrote that anesthesia is being unnecessarily duplicated in far too many situations.
"Today, postgraduate education and clinical training in the specialty of anesthesia is remarkably similar for both [doctors and nurses], occurring in the same settings. As a result, both groups can independently provide an equivalent level of safe and effective anesthesia care," Gilliss wrote.
"While we all recognize that nurses are competent professionals, they simply do not have the advanced medical education and training to manage the complete needs of patients, especially those undergoing an anesthetic," Elmassian retorted.
To learn more:
- read this Denver Post article
- here's a press release on Gov. Ritter's decision
- here's Gov. Ritter's letter to CMS chief Donald Berwick
- check out the CSA's website
- here's CSA's earlier letter to Gov. Ritter
- read Gilliss's commentary in the Baltimore Sun
- check out Elmassian's response in the Detroit Free Press