Letter to the Editor

LETTERS: PATIENTS BEING NEEDLESSLY FRIGHTENED

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To the editor:

Dr. Stephen Stigers' March 21 letter talks about a recent proposal by the Health Care Financing Administration to eliminate the Medicare physician supervision requirement for certified registered nurse anesthetists. It saddens us that patients are being needlessly frightened by his statement, "when the unexpected happens and I, the anesthesiologist, truly mean the difference between a patient's life and death."Should the rule be adopted, little would change in operating rooms across the country in terms of working relationships between CRNAs and anesthesiologists. Most importantly, the quality of care each anesthesia provider brings to the care of our patients will certainly continue.

To give a little background about our education, CRNAs are registered nurses who have completed an advanced practice anesthesia program and successfully passed a national certifying exam. All nurse anesthesia programs are now master's level. The anesthesia program consists of both didactic and clinical education. Patient outcomes vary insignificantly between CRNAs and anesthesiologists.

Regretfully, Dr. Stigers has substituted the issue of quality for the real issue of a desire to control the Medicare flow of money for anesthesia services. HCFA controls Medicare-Medicaid reimbursements. HCFA's proposed rule would defer to the states, stating "we would require that surgical procedures be performed only by practitioners with appropriate clinical priviledges, and that anesthesia be administered only by a licensed practitioner permitted by the state to administer anesthetics," thus giving the state more weight than the federal government in terms of health-care supervision. Missouri already has documented rules and regulations regarding supervision of CRNAs. CRNAs must work with a physician, dentist or podiatrist when administering anesthesia. When CRNAs are administering anesthesia, one of these other professionals are present. In our rural state, it is not possible for an anesthesiologist to be present in all hospitals. Missouri depends on the high-quality care of CRNAs to provide anesthesia services in many hospitals. Without them, many small hospitals would have to close. It is the CRNAs who are willing to work in our small communities in Missouri which often require more on-call hours.

CRNAs will remain, as they are today, totally committed to attend to each and every patient need as they have for the past 100 years. CRNAs provide 70 percent of the anesthesia in America's rural hospitals and ambulatory-care settings and 65 percent of the anesthesia nationwide. Anesthesia is the practice of nursing when a CRNA administers the anesthetic. It is the practice of medicine when an anesthesiologist gives the anesthetic. Rest assured, patients are in good hands when either provider administers the anesthesia.

SUZANNE DUFEK, ANDREW SCHULMANN, STEVE BROOKS, JOE MAYFIELD, LOU ANN MAYFIELD and JOHN EATON

Certified Registered Nurse Anesthetists

Cape Girardeau