News
Medicare Payment Relief, Teaching Rules Reforms Become Law
Congress Overrides President’s Veto July 15
Anesthesiologist Assistants Fact Sheet
General information about Anesthesiologist Assistants
Call for Rosalie McDonald Award Nominations
Rosalie C. McDonald
GANA is asking for your nominations for a CRNA to receive the 2008 Rosalie McDonald Award. Your nomination must be submitted by August 15th to the GANA office. Nominations can be submitted by mail, fax or email to GANA, 1832 Highway 54 W. Fayetteville, GA 30214; facsimile: 770.632.1625; or ganaoffice@bellsouth.net.
Rosalie McDonald spearheaded the GANA in 1938. She was the first GANA President and the 6th AANA President. Be proud of your profession. Honor a fellow CRNA by nominating him or her for their contribution to our profession. The honoree will be presented with the award at the GANA Annual Meeting this year in Stone Mountain on October 3-5.
State Government Affairs - AANA NewsBulletin, March 2008
State Government Affairs Update
Mitchell Tobin, JD
Jana Conover, BA
Barbara Anderson, JD
Bruce Allain, JD
This column includes information regarding the Louisiana trial court declaration that interventional pain management is solely the practice of medicine, and the graduate degree grandfathering deadline in Colorado.
Louisiana Trial Court Declares Interventional Pain Management is Solely the Practice of Medicine
In early January 2008, the Louisiana District Court, Judge Janice Clark, issued a judgment in favor of an anesthesiologist pain management group (Spine Diagnostics Center of Baton Rouge), and against the Louisiana State Board of Nursing (LSBN) and an individual CRNA who had performed chronic pain management procedures. The lawsuit was prompted by a LSBN favorable advisory opinion regarding CRNA pain management services. Both the Louisiana Association of Nurse Anesthetists and the Louisiana Society of Anesthesiologists intervened in the case as interested parties.
The court’s judgment is devoid of any rationale, analysis, or background facts. In addition, it uses terms that do not have universal or widely understood definitions, such as “interventional pain management,” which may cause uncertainty regarding the reach of the court’s ruling.
The court’s declaratory judgment states:
- “1. The statement [advisory opinion] issued by the LSBN substantively expands the scope of practice for CRNAs into an area where they have not traditionally practiced, i.e., chronic or interventional pain management.
- 2. The practice of interventional pain, management is not within a CRNAs [sic] scope of practice.
- 3. The practice of interventional pain management is solely the practice of medicine.
- 4. The opinion issued by the LSBN is an effort to substantively expand CRNA scope of practice and is an improper attempt at rule making.”
Additionally, Judge Clark’s judgment provides for a permanent injunction prohibiting the LSBN from enforcing the statement (advisory opinion) and a permanent injunction prohibiting the CRNA defendant from “performing chronic interventional pain procedures in connection with the LSBN statement.” The judgment further requires the LSBN to remove the advisory opinion from its website and to post the judgment on its website and publish it in the LSBN publication, The Examiner.
The LSBN advisory opinion that is the subject of the permanent injunction reads, in pertinent part, as follows:
- [I]t is within the scope of practice for the CRNA to perform procedures under the direction and supervision of the physician involving the injection of local anesthetics, steroids, and analgesics for pain management purposes, peripheral nerve blocks, epidural injections, and spinal facet joint injections when the CRNA can document education, training ,and experience in performing such procedures and has the knowledge, skills, and abilities to safely perform the procedures based on an order from the physician.
The LSBN and Louisiana Association of Nurse Anesthetists are appealing the case to the Louisiana Court of Appeals. The AANA will continue to assist in any way possible and understands the extremely serious implications of this judgment, with which the AANA strongly disagrees. It is the AANA’s position that management of both acute and chronic pain is within the professional scope of practice of CRNAs and is not exclusively the “practice of medicine.” (See AANA Position Statement 2.11, Position Statement on Pain Management, at www.aana.com > Resources > Practice Documents; Scope and Standards for Nurse Anesthesia Practice at www.aana.com > Resources > Practice Documents.)
It is important to keep in mind that this judgment affects CRNAs practicing in Louisiana only. This decision, which is extreme in its implications for access to quality, cost-effective CRNA care, is not a national precedent. Courts in other states would not necessarily reach a similar conclusion in similar circumstances.
Louisiana is the only state in the nation to rule that “interventional” pain management is not within CRNA scope of practice. For additional background, please see the State Government Affairs columns in the March, May and August 2007 editions of the AANA NewsBulletin. We will continue to keep you apprised of significant developments in the Louisiana case.
Colorado Graduate Degree Grandfathering Deadline
A Colorado law enacted in the late 1990s imposes a grandfathering deadline of July 1, 2008 for CRNAs who do not possess graduate degrees. The law grandfathers CRNAs without graduate degrees who are included in the state’s “advanced practice registry” by June 30, 2008. (CRNAs are a type of advanced practice nurse [APN] in Colorado.)
CRNAs who are currently included in the APN registry in Colorado, or who become registered by June 30, 2008, and who continue to renew the registration, will continue to be grandfathered in the state. CRNAs without graduate degrees, or who allow the Colorado registration to lapse, after June 30, 2008, would presumably no longer be grandfathered. CRNAs who are currently practicing in other states, and who do not have a graduate degree, should consider whether they may want to practice in Colorado at some time in the future. CRNAs who may want to practice in Colorado, and who do not have a graduate degree, must obtain APN registration in Colorado prior to July 1, 2008. (Please note that applicants not currently licensed in Colorado must obtain both a registered nurse license and an APN registration.) Application forms can be found on the Colorado Department of Regulatory Agencies, Board of Nursing, website at http://www.dora.state.co.us/Nursing/licensing/RN.htm. Applications are also available by telephone at (303) 894-2430. CRNAs interested in applying should begin the process as soon as possible.
Twenty-nine states have adopted graduate degree requirements for CRNAs that are either currently in effect, or will take effect at a future date. It is important to note, however, that the vast majority of these states will grandfather currently practicing in-state and out-of-state CRNAs without graduate degrees. The only exceptions that we are aware of, other than Colorado, are (effective date in parentheses): Tennessee (effective July 1, 2005) and Illinois (effective Dec. 31, 2006). A 50-state summary of graduate degree requirements for CRNAs, titled “Advanced Education Requirements,” is posted on the AANA’s Web site at www.aana.com under Resources > State Legislative and Regulatory Requirements.
(Opinion Editorial) Public at Risk: Addressing the Syringe Reuse Problem in Healthcare
On behalf of the millions of patients who receive injections for anesthesia, pain management, and other health reasons each year, the American Association of Nurse Anesthetists (AANA) applauds the efforts of the Centers for Disease Control (CDC), Nevada State Department of Health, lawmakers, and the media to finally expose and correct the frightening infection control problem caused by contaminated syringes, needles, and medication vials that was brought into the light by the recent hepatitis C outbreak in Nevada. As the professional association representing more than 37,000 nurse anesthetists who administer 30 million anesthetics each year, the AANA looks forward to working closely with these organizations and other healthcare associations and societies to ensure patient safety across the nation.
It is important for the public to know that most healthcare professionals have their patients' best interests "rather than the bottom line" at heart, and to that end adhere to accepted infection control standards and guidelines when injecting anesthetic drugs or medications. Unfortunately, and for reasons yet to be determined, there are still some healthcare professionals, including nurse anesthetists and physician anesthesiologists, who put their patients in harm's way through poor infection control practices when applying this most basic of medical/nursing skills.
As has been reported in the media, this issue goes beyond provider specialty, title, and credentials. In anesthesia alone, there have been several high-profile cases of improper use of needles/syringes/medication vials over the last six months that put many patients at risk:
- In October 2007, Dr. Kamal Tiwari, an anesthesiologist, was accused of reusing syringes on an unspecified number of patients at a surgery center in Bloomington, Ind. At least two tested positive for hepatitis C.
- In November 2007, reports surfaced out of Long Island, N.Y., that anesthesiologist Harvey Finkelstein, MD, was under investigation by the New York State Department of Health for allegedly reusing syringes to draw up medicine from multi-dose vials and exposing thousands of patients to blood-borne pathogen infection.
- In February 2008, Nevada health officials closed an endoscopy center in Las Vegas after six patients were diagnosed with hepatitis C. The outbreak was traced back to nurse anesthetists allegedly reusing syringes to draw up medicine from single-use vials, thereby contaminating the vials which were then used for multiple patients.
- Also in February 2008, Dr. Scott Young, an anesthesiologist working at a gastrointestinal clinic in Las Vegas, was observed by Nevada health inspectors reusing syringes and potentially contaminated vials of medication on multiple patients. According to the investigation report, "The anesthesiologist was asked what the process was when he went from a used Propofol vial to a new patient. The anesthesiologist stated that he would change the needle and reuse the same syringe."
Simply stated, reusing needles and syringes, and using medication vials in an unsafe and inappropriate manner, is inexcusable and cannot be tolerated. If there are any gray areas with regard to proper usage of needles, syringes and medication vials, then those gray areas must be identified and made black and white. The AANA is committed to working with the CDC and other groups to put an end to such needless, tragic situations as those in Nevada, New York, and Indiana.
It is disappointing that some of our physician colleagues have weighed in on the Nevada situation involving nurse anesthetists by suggesting on websites and talk shows that doctors never reuse syringes or improperly use medication vials and that only nurses and other healthcare providers do. While the evidence in state health department reports and the media clearly indicates that reuse of syringes and improper use of vials are not uncommon practices among anesthesiologists, the AANA believes the focus of our efforts should be on fixing the problem rather than fixing blame.
If we are to solve this problem and regain the public trust, then denial and finger pointing need to stop and healthcare professionals must work together for the public good.
Patients should never have to fear that the injection they received for the purpose of supporting their health or promoting their healing might actually make them sicker due to a dirty needle/syringe or tainted vial of medication. The AANA will work tirelessly with the CDC and other interested organizations to achieve this outcome.
Wanda Wilson, CRNA, PhD
President
American Association of Nurse Anesthetists
Park Ridge, Illinois
AANA Condemns Unsafe Injection Practices
2008 GANA Board of Directors
Your 2008 GANA Officers and Board of Directors: Sharon Twibell, Secretary; Leslie Jeter, Vice President; Matt Kervin, Immediate Past President; Eric Herrold, Director; Brent Dubois, Treasurer; Cheryl McRae-Bergeron, President; Steve Smith, President-Elect; Lisa Stephens, Director; Rose Synsmir, Director; Cecilia Morales, Director; Sao Berkowitz, Director.
Student Registered Nurse Anesthetists in the News
Mr. Jeff Cryder won the “Outstanding Graduate Nurse Anesthetist in Georgia for 2007”. He was noted for his excellence in academics; exemplary clinical practice; leadership capability; potential for future contribution to the practice of nurse anesthesia; contribution to the profession body of knowledge; and his contribution to the GANA/GANAS as a student nurse anesthetist.
