OPINION - Guest writer

Safety jeopardized

Anesthesia bill imperils patients

Arkansans want physician anesthesiologists to administer their anesthesia or respond to an emergency during surgery (86 percent, according to a research report published Feb. 19). However, the Legislature is considering a bill, SB184/HB1283, that will dismantle the anesthesia care team model in our state and allow nurses to administer anesthesia without physician supervision. SB184/HB1283 will jeopardize the safety of patients who need anesthesia care.

Recent guidelines established by the World Health Organization state "wherever and whenever possible, anesthesia should be provided, led, or overseen by an anesthesiologist." Unfortunately, the standard of care in Arkansas is already less than the rest of the U.S.

This proposal will remove physician supervision from anesthesia care in Arkansas and would effectively allow nurse anesthetists to practice with zero oversight by a physician, which goes against what people need.

Despite advances in medicine and patient safety, surgery and anesthesia are inherently dangerous. Physician anesthesiologists are highly skilled medical experts who have the education and training to make critical decisions when seconds count.

There are no cost savings for patients to make this change. Allowing nurses to administer anesthesia without supervision doesn't save money. Medicare, Medicaid and most third-party insurers pay the same exact fees for anesthesia whether it is administered by a nurse anesthetist or physician anesthesiologist.

Physicians have up to 14 years of post-graduate medical education and residency training. For physician anesthesiologists, this includes 12,000-16,000 hours of clinical training, nearly seven times more training than nurse anesthetists.

I was an RN before I decided to attend medical school. I experienced the vast difference between a nursing and medical education firsthand. As a nurse we are trained that when things go wrong, turn to the physician. We are not taught to be an end-of-the-line decision-maker, nor are we equipped to make those decisions and judgment calls.

Those decisions are made by doctors, because that is what doctors are trained to do.

Current laws in 45 states and the District of Columbia require physician involvement for anesthesia care, and the Veterans Administration chose to maintain its physician-led team-based model of care in 2017. The VA's Quality Enhancement Research Initiative could not discern "whether more complex surgeries can be safely managed by CRNAs, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal."

Physician supervision of anesthesia ensures patients receive safe, high-quality care. They deserve no less. Contact your representative and stop the state from lowering the standard of care in Arkansas. It provides no benefit, will not lower health-care costs and can mean the difference between life and death.


Heather Carter Whaley, M.D., lives in Little Rock.

Editorial on 03/28/2019