Thompson extends decision on anesthesia rule

By Rhonda Rowland
CNN Medical Unit

(CNN) -- The Bush administration moved Thursday to prolong a heated turf battle between doctors and nurses over who should be in charge of anesthesia in the operating room for at least another six months.

Health and Human Services Secretary Tommy Thompson delayed a rule scheduled to take effect Friday that would have allowed nurse anesthetists to administer anesthesia -- without supervision -- to Medicare and Medicaid patients.

The former Wisconsin governor said he was taking the step "to ensure that all Medicare beneficiaries receive the safe, high quality anesthesia services they need."

The delay is to allow consideration of a new HHS proposal that would allow individual governors to overrule the current standard requiring physician supervision of nurse anesthetists. Governors could request waivers to allow certified nurse anesthetists to practice unsupervised after consulting with the State's Boards of Medicine and Nursing.

VIDEO CNN's Rhonda Rowland reports on the debate over who should administer anesthesia (May 16) Play video (QuickTime, Real or Windows Media)   MORE Get more information about where each side stands on the issue:  • American Society of Anesthesiologists  • American Association of Nurse Anesthetists   RESOURCES Read Tommy Thompson's statement about the anesthesia decision   TRANSCRIPT Rhonda Rowland discusses the implications of the anesthesia decision

"States have encountered increasing challenges in providing access to anesthesia services to all their citizens, particularly residents of rural areas or other areas with few anesthesiologists" Thompson said.

The American Society of Anesthesiologists applauded the move.

"I am very pleased and I am pleased for my patients," said the group's president, Dr. Neil Swissman. "This has never been about anesthesiologists or nurse anesthetists, it's been about patient safety."

HHS also is considering whether a study should be undertaken to assess the impact of giving nurse anesthetists greater responsibility in the operating room.

"The secretary and Bush administration have taken a significant step in making these proposals to determine safety and preserve the rights of an individual state if it really believes it's important in their area to seek a waiver," said Swissman.

The American Association of Nurse Anesthetists (AANA) called the decision "a blow to thousands of hospitals" that have been waiting for the rule to take effect.

"It should be completely unacceptable to the American public that another delay has occurred, thanks to the nurse-bashing tactics of physician anesthesiologists," said Larry Hornsby, president of the AANA, in a statement.

Horsnby pointed out that 29 states currently do not require physician supervision of nurse anesthetists, who he said provide two-thirds of the anesthesia care in the United States each year.

"Nurse anesthetists meet the most stringent continuing education and recertification requirements in the field of anesthesia care, and that has paid off in patient safety," added Hornsby.

On his last day in office, President Clinton signed off on a federal government proposal doing away with the decades-old rule requiring doctors to supervise the work of nurse anesthetists when surgery is performed on Medicare and Medicaid patients. The Bush administration put it on temporary hold.

The proposal would not have saved the government money since hospitals are paid the same amount regardless of who administers the anesthesia.

"The population this would affect is primarily elderly patients with a lot of medical problems," said Dr. Robert Brooker, a cardiovascular anesthesiologist who practices in Nevada. "The role of the anesthesiologist may not be apparent to patients. We evaluate them before surgery to be sure they can survive the operation. The nurse anesthetist is not in a position to do that because they don't have the medical training."

Physician anesthesiologists attend four years of medical school followed by four years of training in anesthesiology. Certified nurse anesthetists are now required to be licensed registered nurses with at least two years of graduate training in anesthesiology.

While a number of studies, including an Institute of Medicine report on medical errors, shows anesthesia is largely safe as practiced today, with both specialists working together, there is no scientific evidence that it's safe for nurse anesthetists to practice independently.

About 90 percent of nurse anesthetists are supervised by anesthesiologists. In the other cases, the surgeon may take on the role of supervisor, which is often a necessity in some rural areas where physician anesthesiologists are not available.