Politics Is Apparently Numb to Medical Risks
If you worry about the danger of anesthesia when you have surgery, you should know that your danger is increasing because of a new federal policy to lower standards for overseeing anesthesia in operating rooms.
Until now, the federal government, through its Medicare health program for seniors, set a standard that every surgery patient must have an anesthesia care team with a nurse anesthetist supervised by a physician trained in anesthesiology. Now, Secretary of Health and Human Services Donna Shalala has announced that the requirement for a supervising doctor would be dropped, leaving nurses on their own.
Shalala’s decision is the culmination of a three-year battle between nurses’ groups and doctors’ groups, with each side hiring lobbyists and dispensing hundreds of thousands of dollars in campaign contributions. There are undertones of feminism in the nurses’ crusade, but the battle is basically over money. Now, the nurse and doctor responsible for anesthesia share the fee paid by Medicare. Once the physician safeguard is dropped, the fee stays the same and the nurse anesthetist pockets the whole fee. The big loser is the patient.
A nurse anesthetist has slightly less than half as many years of formal education and clinical training as a physician anesthesiologist. Though some have college degrees, they have not gone to medical school. That can mean the difference between life and death for a patient in distress.
A study of postoperative deaths related to anesthesia, published in the North Carolina Medical Journal, showed that patients treated by a nurse anesthetist alone had a significantly higher mortality rate than patients treated by an anesthesia care team with a supervising physician trained in anesthesiology. The Stanford Center for Health Care Research analyzed patients undergoing 15 types of surgery and found that those who received their care from a nurse anesthetist alone had an 11% higher-than-expected rate of death or severe illness after surgery. Studies such as these were expressly cited by federal officials in 1992, when they first announced the Medicare requirement that nurse anesthetists be supervised by a physician anesthesiologist. The scientific data behind that requirement have not changed.
Before Dr. Jane Fitch went to medical school, she practiced as a nurse anesthetist in the operating room at Baylor College of Medicine in Houston. “I got frustrated,” she said. “I just didn’t know enough” to tell whether a patient was ready to undergo surgery. She went to medical school, then pursued several required years of postgraduate training in anesthesiology and is now back in the operating room as an anesthesiologist specializing in heart surgery. “There is no comparison,” she said, between what she knew then and what she can do for her patients now.
Although Shalala’s announcement affects only patients on Medicare, it soon will lower the standard for all patients. Historically, Medicare standards have quickly become universal because hospitals are reluctant to enforce one set of rules for elderly patients and another set for those under 65.
The lower standard of supervision for anesthesia is the result of greed-inspired lobbying by one profession against another, with no regard to patient safety. It is not a cost-saving measure because it will not lower anesthesia fees paid by Medicare. It has no justification in the scientific evidence, which consistently shows that removing supervision by a physician anesthesiologist increases the risk to the patient.
When you go in for surgery, having less-trained and educated personnel in charge of your anesthesia cannot possibly be an improvement. It is the one time when only the most-trained, experienced person should be making the decisions. “When you are anesthetizing a patient,” observed Dr. John Neeld Jr., a specialist in the field, “you are dangling them by a thin thread over the abyss.”
