Taken from the Denver Post:
Putting Surgery Patients at Risk
By Daniel Janik
The Denver Post
POSTED: 09/09/2010 01:00:00 AM MDT
There’s no relationship more intense than the one I have with my patients right before they undergo surgery. I carefully evaluate the patient to make sure they’re fit for anesthesia, then I render them unconscious, taking away their ability to breathe on their own. I’m humbled every time by the magnitude of the task. Patients ask if I will be taking care of them, and I assure them that yes, as their anesthesiologist, I will be responsible for them in surgery and recovery.
But Gov. Bill Ritter is about to change that, and not for the better.
Ritter is on the verge of signing a letter that would remove the requirement for a physician to supervise the administration of anesthesia. Instead, he wants to shift that responsibility from doctors to nurses.
I’m gravely concerned about what this means for the health of our state. Physicians who administer anesthesia have at least eight years of medical education; nurses only have a fraction of that. Anesthesia nurses are not prepared to diagnose and treat medical problems that can arise during surgery.
In a letter dated July 29, Ritter informed the state’s medical boards and associations of his plans to change Colorado‘s policy regarding the administration of anesthesia, stating, “I am also of the opinion that opting-out of the federal supervision rules for anesthesia services in rural areas could help ensure their affordability and accessibility, without sacrificing the quality of care patients receive.”
While that may be Ritter’s “opinion,” there is no sound evidence that such a drastic policy change would, in fact, save money without risking lives. When contemplating changes to medical care, decisions should be based on the presence of sound evidence of benefit to patients. Anything else is an experiment.
In the letter, Ritter asked the various boards and associations to answer whether they believe “opting-out of the physician supervision requirement is in the best interest of Colorado residents” — which federal law requires he attest.
As a resident of Colorado and an anesthesiologist, I would argue that saving the lives of Coloradans from otherwise preventable deaths is in their best interest.
I’ve spoken with my colleagues across the country and heard horror stories of what can happen without a doctor in charge. A patient going in for simple surgery, only to have the anesthesia go awry, can end up with a tracheotomy hole in their neck for the rest of their life, or even worse. Every patient deserves the best possible medical care, and that means having a doctor at the head of the table.
Anesthesiology has come a long way from drops of ether on a cloth. Anesthesia-related deaths have dramatically decreased over the past three decades, largely due to advances in techniques and drugs, sophisticated devices for monitoring, better and longer training for anesthesiologists, and dedicated research into patient safety by anesthesiologists. In the early 1980s, approximately two deaths occurred per 10,000 anesthetics; now there is only one death per 200,000 to 300,000 anesthetics.
During medical school and residency, anesthesiologists study every medical specialty we touch: internal medicine, surgery, neurology, pediatrics, and the list goes on. Anesthesia nurses do not receive that education. This is not to say that nurses are not a critical part of the anesthesia team. I am a firm believer that two sets of hands and eyes are always better than one. But a physician must be in charge.
We don’t know the full consequences of these actions, and it seems as though Gov. Ritter is experimenting with Coloradans’ lives. Is this a risk we are willing to take?
Daniel Janik, M.D., is president of the Colorado Society of Anesthesiologists
- Follow-Up: Anesthesiologists, Nurse Anesthetists and Evidence (blogs.wsj.com)