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New Anesthesia Provider May Threaten Operating Room Safety

Legislation would Lower the Standard of Care by Allowing Inexperienced and Less Educated Anesthesiologist Assistants to Deliver Anesthesia to Maryland Patients

ANNAPOLIS, Md., Feb. 24 /PRNewswire-USNewswire/ -- The Maryland Association of Nurse Anesthetists (MANA), whose members are Certified Registered Nurse Anesthetists (CRNAs), today announced their opposition to Senate Bill 798 and House Bill 1161. These troubling bills would license anesthesiologist assistants (AAs) to practice in Maryland and would drastically alter the anesthesia delivery model currently utilized in the state. AAs, who are less qualified than anesthesiologists and CRNAs, currently are licensed or certified to practice in only 10 states and cannot practice in the U.S. Military. The bills are being supported by Johns Hopkins Hospital.

"The passage of this legislation would radically change the model of anesthesia delivery and would be extremely detrimental to the quality of care in operating rooms and create unnecessary risk for Maryland patients. Maryland is a world leader in health care and lowering the standards for anesthesia providers must be rejected," said Ron Seligman, CRNA, MS, President of MANA. "Anesthesia is 95% routine care and 5% crisis management when patients have unanticipated adverse responses to anesthesia and surgery. I would think Maryland legislators would want the highest skilled practitioners handling their loved one's cases and not an AA that has no prior healthcare experience and could have been working on Wall Street just two years prior."

Patient Safety

This legislation is alarming because AAs do not need to have any prior health care experience or a health care related degree for admission to a two-year anesthesiologist assistant program.

On the other hand, a CRNA must be a registered nurse, have a four-year nursing degree, and have at least one year of critical care nursing experience prior to admission to a graduate-level nurse anesthesia educational program.

Over the years, numerous studies have concluded that CRNAs provide safe anesthesia care; however, no studies have been done to determine the safety record of AAs. Nurse anesthetists have been rendering quality anesthesia care for more than a century.

Medicare rules specify that AAs must practice under the medical direction of an anesthesiologist but an anesthesiologist may run four concurrent operations while directly supervising AAs. Consequently, the anesthesiologist may not be directly in the room with the AA and may be circulating to assist or supervise other surgical suites. When that is the case, patients are left in the care of the lesser-educated and lesser-trained AAs.

Fiscally Irresponsible

During these difficult economic times it makes no sense to engage in new, duplicative spending. It would be more cost efficient to expand the existing University of Maryland nurse anesthesia program rather than develop a costly new program for AAs. Further, the cost of establishing a licensing/regulatory body will far exceed any potential benefit from recruiting a limited number of AAs. Under this legislation the Board of Medicine would need to take on additional costs to regulate AAs. Regulations will need to be created as well as enforcement procedures.

No Savings To Patients

Since the services of AAs and CRNAs are reimbursed at the same rates, patients would pay the same amount for less qualified AAs.

Not Needed

The University of Maryland School of Nursing has said it is capable of and willing to expand its proven nurse anesthesia program to meet any perceived workforce shortages. The University of Maryland Nurse Anesthetist program started in 2004 and graduated its first class in December 2006. To date 62 nurses have graduated from the program and 90 percent of those have stayed in the Maryland area for employment as CRNAs. There are 450 CRNAs practicing in Maryland, and by 2015 the University of Maryland will have graduated approximately 210 nurse anesthetists, almost half of the total CRNA membership in Maryland.

"The University of Maryland's nurse anesthesia program is well equipped to meet the needs of Maryland's operating rooms into the next decade. We have been in negotiations with Johns Hopkins Hospitals and hope to meet their anesthesia workforce needs in the coming years," said Lou Heindel, DNP, CRNA, and Director of the University's Nurse Anesthesia Program.

There are 109 accredited Nurse Anesthesia programs nationally including the University of Maryland. The first AA school accreditation standards were approved in 1987 and more than two decades later only five schools have been accredited to train AAs. Additionally, CRNAs are the predominant anesthesia providers in the U.S. Military and Veterans Affairs health care system. AAs are not recognized providers in the Military, while nurse anesthetists have been providing anesthesia care to soldiers on the front lines since the Civil War.


CRNAs are the sole anesthesia providers in more than two thirds of all rural hospitals. (Source: American Association of Nurse Anesthetists). SB 798 and HB 1161 would decrease the number of operating rooms available to educate nurse anesthesia students because AAs are not allowed to train or supervise student nurse anesthetists.

In addition, this legislation could create a shortage of anesthesia providers in rural areas. Unlike CRNAs, AAs simply cannot meet the need of rural hospitals because they are required to be directly supervised by an anesthesiologist at all times. Because anesthesiologists typically shun working in rural communities, and because rural facilities cannot afford to employ both anesthesiologists and their highly-paid assistants who cannot work independently, AAs are not the answer to the workforce shortages and patient access to care issues affecting rural America.

    Dan Ronayne (202) 870-4902

SOURCE Maryland Association of Nurse Anesthetists
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