December 17, 2001
Governor Says Doctors No Longer
Needed for Anesthesia Care
Action Ignores Iowans Who Overwhelmingly Disagree
- With the stroke of his pen, Governor Thomas J. Vilsack has ignored medical
experts and overwhelming public opinion by eliminating a decades-old
provision for physicians to supervise the anesthesia care of this state's
Medicare and Medicaid population. Iowa is the first state to take this
Also as a result of his actions, the anesthesia care of patients of all ages
having ambulatory surgery is left virtually unregulated.
"What this means, in effect, is that anesthesia nurses who believe they can
handle any and all surgical cases -- whether giving anesthesia to the frail
80-year-old grandfather having a hernia operation or to the diabetic
4-year-old girl having corrective eye surgery -- do not have to answer to
anyone, even someone with a medical degree," Dirk H. Brom, M.D., President
of the Iowa Society of Anesthesiologists (ISA), said.
"By his hasty actions, Governor Vilsack has blatantly ignored the
recommendations from the highest levels of Iowa medicine, an 8-out-of-10
public opinion poll supporting continued doctor supervision, and state
laws," according to Dr. Brom. "The residents of this state should be
Dr. Brom said the Governor has not released any documentation to support his
decision, which according to Medicare's federal agency, must be "in the best
interest of the residents in the state."
"Without taking the time to look into this matter thoroughly, the Governor
has shown his apparent disregard for the hundreds of thousands of Iowans
having surgery this year," Dr. Brom said. "He has even shunned the advice of
his own experts."
Joining the ISA in strong opposition to this action are the Iowa Board of
Medical Examiners, composed of physicians and other experts appointed by the
governor who advise him on health-care issues, and the Iowa Medical Society,
which represents 4,000 physicians in the state. The no-supervision rule also
has been opposed by the American Medical Association, the American Society
of Anesthesiologists, and other medical and surgical groups.
Last month the Centers for Medicare & Medicaid Services (CMS) reaffirmed its
longstanding policy that anesthesia nurses must be supervised by a
"Although states have the right to govern certain health care matters for
their residents, the federal rules as set by CMS generally serve as the
baseline, or minimum standard of care, for many hospital and ambulatory
surgical center regulations," Dr. Brom said.
"For the past 40 years, patients having surgery in Medicare-approved
facilities could count on that level of care. Effective immediately, they
are no longer guaranteed that patient-safety benefit," Dr. Brom said.
Not only will Medicare and Medicaid beneficiaries be subject to a lesser
level of physician involvement, but there are now no safeguards in place for
ambulatory surgical centers. Because such centers are not currently licensed
in the state, Medicare's minimum standards for quality and safety were often
the only safety net, Dr. Brom said. Without that, "this now affects perhaps
another million Iowans or more," he said.
A statewide survey conducted earlier this month shows that almost eight out
of 10 adults (78 percent) are against removing a doctor's supervision of
their anesthesia care. Dr. Brom said a copy of the complete survey, which
was conducted by an independent surveying firm earlier this month, was sent
to the governor's office last Friday.
"The Governor has, in effect, turned his back on these people, saying that
their concerns are of no matter to him," Dr. Brom said. "We offered to meet
with him to explain how the anesthesia care in the state of Iowa can be
maintained or even improved." The governor's office has yet to schedule such
a meeting, he added.
Refuting anesthesia nurses' claim that residents of Iowa are being denied
access to surgery due to the longstanding supervision requirement, Dr. Brom
notes that the nurses have never produced any data to support such an
"In any hospital where an anesthesiologist is not on staff, it has been the
responsibility of the surgeon or other physician to oversee the medical
care, including the delivery of anesthesia, which is so important to the
safety of every patient before, during and after surgery. That
responsibility has now been transferred -- entirely -- to a nurse," he said.
Any questions about this matter can be directed to the Iowa Society of
Anesthesiologists (515) 223-1401. The public can direct their comments on
this issue to Governor Vilsack via the Internet: < http://www.iowaccess.org/governor/comments/capitol_correspond/index.html
> or mail to: Office of the Governor, Iowa State Capitol, Des Moines, IA