Daily Archives: April 7, 2009

Anesthesiology, Assistants, Business of Medicine, Healthcare, Healthcare Professionals, Healthcare Services, Regulation

Texas Bills Filed To Regulate Anesthesiologist Assistants

Bills to license Anesthesiologist Assistants (AAs), highly trained anesthesia care providers, have been introduced in the Texas legislature. Though AAs have been providing anesthesia in Texas operating rooms for the past 11 years, they believe it’s time to ask legislators to give the AA profession the regulatory protection enjoyed by other health care providers.

“We aren’t trying to change the way AAs practice at all, but we believe that it makes sense to have oversight of the people taking care of us when we need medical care,” says Paul McHorse, a certified Anesthesiologist Assistant (AA-C), and President of the Texas Academy of Anesthesiologist Assistants. “AAs have always practiced within nationally accepted guidelines, but we believe that critical care areas should be regulated, and that certainly includes anesthesia. It’s just a matter of good public policy.”

SB 1794 by State Senator Carlos Uresti (D-San Antonio) and HB 3376 by State Representative John Davis (R-Houston) were filed on Wednesday, March 11th and are identical. If passed, the legislation would require that AAs be regulated and licensed by the Texas Medical Board in order to practice in the state. AAs already practice in Texas, but are not regulated by the state.

The first Anesthesiologist Assistants joined the anesthesia work force almost 40 years ago, at the same time as the more widely known Physician Assistants (PAs). “The big difference between PAs and AAs is that PA training is designed to cover needs in many medical specialties, and AA training focuses exclusively on the specialty of anesthesia,” explains Deb Lawson, AA-C, President of the American Academy of Anesthesiologist Assistants. “Good anesthesia care calls for a very high degree of training and education, and our profession was designed with that in mind from the beginning.”

Like PAs working as physician extenders, AAs work exclusively with anesthesiologists. According to Mr. McHorse, “most anesthetics in the US are given by more than one anesthesia provider working as a team; with a qualified anesthetist like an AA in the room at all times, the anesthesiologist may direct more than one case at the same time, being available for those patients that need more attention. The advantage is that all of the patients have the benefit of an anesthesiologist’s expertise. The reason this ‘Anesthesia Care Team’ model is so widely practiced is that it has been shown to maximize both safety and economy, and results in significantly fewer anesthesia complications. AAs are dedicated to these goals.”

Support is strong among those who work with AAs. “It is my experience and opinion as a neurosurgeon that Anesthesiologist Assistants are qualified and competent anesthesia providers,” says Dr. Peter Shedden, who works with AAs at Memorial Hermann The Woodlands Hospital. “Since AAs work closely with anesthesiologists, this unique relationship allows superior care in the increasingly higher acuity procedures characteristic of modern medicine. In my opinion, Anesthesiologist Assistants (AA) provide accurate, efficient and qualified care for patients and are pivotal for patients receiving a safe surgical experience.”

“The AA profession’s excellent track record of safety explains why interest in hiring AAs is at an all time high, and why the numbers of new employers and programs are growing,” says Ms. Lawson. “Other medical specialties have long had non-physician providers from both allied health and nursing, and anesthesia needs the same advantage. The shortage of anesthesia providers is well-known, and allied health professions have an added advantage: by not limiting their students to nursing experience, they don’t worsen the critical nursing shortage.”

“Our students enter training with the same background as students entering medical school,” says Joe Rifici, AA-C, M.Ed., and Program Director of the Master of Science in Anesthesia Program at Case Western Reserve University in Cleveland, Ohio. “They spend the next two years learning the science, skills and art of anesthesia practice, from simple to very intense cases, in subspecialties such as cardiac, neuro, obstetrics and pediatrics. The gold standards of AA training include affiliation with a medical school and AA students always being paired with an experienced anesthesia provider, which maximizes both the educational experience and patient safety. Everyone benefits, and as everyone who has worked with AAs can attest, it’s an educational model that works.”

If AAs can already practice in Texas, why go to the trouble to push for licensing? Says Mr. McHorse, “Other states are seeking to utilize AAs as providers, and they will look to states like Texas, where AAs are established and have proven themselves, for guidance. Texas AAs would be proud to help establish a public policy precedent, and promote Texas as a leader in AA regulatory affairs.”

Via EPR Network
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Wrongful Convictions Of Physicians By Department Of Health (NYSDOH) Linked To Patient Mortality

The proliferation of wrongful convictions in New York State prompted the NYS Bar Association to create a Blue Ribbon task force to study its systemic, procedural and statutory causes, and to propose solutions. Indeed, a report by the Innocence Project found New York State to be the national leader, outpacing all other states in its rate of wrongful convictions. The Blue Ribbon findings, embodied in a document entitled “ Final Report of the New York State Bar Association’s Task Force on Wrongful Convictions” was unanimously endorsed by the Association’s House of Delegates on April 4.

The findings of the Task Force provide a disturbing commentary on flagrant errors by the New York State judicial system, leading to convictions of innocent individuals. In over 50% of cases, the failures of government practices – such as misconduct by prosecutors – were to blame for the wrongful convictions.

Wrongful convictions do not solely implicate the New York State criminal justice system. They are reportedly rife in the legal practices of the NYS Department of Health (NYSDOH), known for ignoring due process and abusing power in its disciplinary actions against physicians. Several bills aiming to redress these inequities were all vetoed. Reported among many of these due process violations is the denying of witnesses for phy sicians’ defense, the use of tainted judges, and the coaching of plaintiffs by prosecutors to lie – indeed, “winning” cases is vital for their career advancement. Especially targeted in these malicious prosecutions are physicians practicing complementary medicine. One physician who wished to remain anonymous for fear of retribution remarked, “Convicting doctors is a cinch: just don’t allow them any witnesses; then the Department is free to make up whatever it wants.”

The tragedy of wrongful convictions in matters of health care affects far more than physicians. The plight of patients suddenly obliged to forgo the continuity of their medical care by the forcible removal of their long term physicians via the challenging of their license is illustrated in press and Internet releases entitled, “Patient Mortality Linked to Judicial Errors.” Noted are certain fragile patients who, “vulnerable, sick, alone, frightened and suddenly deprived of their main lifeline (their physician), became acutely demoralized, refused referrals to other doctors or failed to bond with them, eventually giving up their will to live and neglecting their medical needs.” One physician reported the untimely deaths of 7 patients, including one from suicide, the rapid decline of 8 Alzheimer’s and the relapses of 12 psychiatric patients leading to their serial hospitalizations.”

In response, petitions have now been forwarded to agencies concerned with patient20welfare, calling for independent impact studies on state-ordered patient abandonment. Agencies contacted include the U.S. Health and Human Services Administration (HHS) and the Centers for Medicare and Medicaid. The petition has also been sent to Health Commissioner Richard F. Daines, NYSDOH.

This landmark study, of major interest to medical, psychiatric and medico-legal communities and the public at large, would aim to show that abruptly severing medical and psychiatric services by state agencies has serious and sometimes fatal consequences for patients – especially patients who are disadvantaged, infirm, chronically ill or psychiatrically disabled. It would also suggest remedial action. Indeed, if state agencies assume the power of terminating the basic care to patients provided for by their physicians, they presumably also should accept the responsibility for adequately supporting said patients through crisis, by providing them with life-saving continuity of care.

Via EPR Network
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