Since the thread is WTF Florida thought this article may be appropriate:
Anesthesia proposal in state House goes too far
Here’s a statement that should concern anyone who is serious about patient safety in our state: “Florida House of Representatives proposal PCB 14-01 would allow nurse anesthetists to administer anesthesia – in all cases – independently and without any supervision of a physician.”
This proposed legislation would fundamentally alter the safest clinically proven model of anesthesia care in America and one that Floridians have the most confidence in. The bill represents a sharp departure from a wellrecognized nationwide standard of physicianled anesthesia that would not just make Florida a national outlier, it would significantly decrease the level of safety for Florida’s patients while doing nothing to control costs.
To be unmistakably clear, the bill would allow nurse anesthetists to do in Florida what they can currently do in only three other states (Utah, New Hampshire and Montana): conduct or administer an anesthetic independently and with zero physician involvement or oversight.
Ironically, this dramatic move flies in the face of the study presented and paid for by the nurse anesthetist lobby, one that shows the safest way to clinically put someone to sleep is with a team led by a physician. Nurses, educated with half the classroom education and one-seventh the clinical training of physician anesthesiologists, would be given complete and full autonomy in all areas of providing anesthesia services.
Advocates claim that this is an access to care issue. While Florida does indeed have a pending shortage of some types of physicians, it is vital to note that this shortfall is mostly in the area of primary care. Coincidentally, we are also projected to have a very serious shortage of nurses. According to the Florida Center for Nursing, Florida in 2025 will need 50,000 more nurses than it will have on hand. No such deficit exists in the area of anesthesiology, and Florida law has this well covered by already permitting nurse anesthetists to practice to the full scope of their training under nonanesthesiologist physicians.
Nurse anesthetists are respected members of the anesthesia care team and I work with them daily in my practice. They are extremely competent and highly skilled individuals who can handle many situations and circumstances related to anesthesia care. But when it comes to complex medical decision-making required in certain types of surgical procedures or unexpected emergencies that may arise during even simple cases, physicians leading the anesthesia care team can make all of the difference in achieving better outcomes. Additionally, there are specialized areas of anesthesia where the advanced training of medical doctors is crucial.
Finally, it is important to note that in an era of health care cost consciousness, physician- led anesthesia teams cost no more than if a single person were providing that care – regardless of that person’s training. When it comes to anesthesia, the vast majority of insurers, including Medicare, pay for the anesthesia service provided and not based on who provides it. Anesthesiologists save additional dollars by effectively making patient triage decisions, preventing complications, increasing patient rescue rates, and limiting the need for additional doctors to be involved. The physician, therefore, adds a tremendous amount of value to the safety of anesthesia without costing the system any additional expense.
Florida has a timetested, efficient, costaware, accessible system for providing safe anesthesia care to our families and friends. Lacking a demonstrable and compelling reason to change this successful formula, the Florida Legislature ought to err on the side of safety and caution and retain the physician supervision requirement over anesthetists.
Dr. Jay Epstein is president of the Florida Society of Anesthesiologists.