Overwhelming Number of Veterans and Citizens Urge VA to Uphold Physician-Led Anesthesia Care to Protect Veterans Lives

CHICAGO – The American Society of Anesthesiologists (ASA) is gratified by the overwhelming concern from Veterans, their families, the medical community and concerned citizens about a rule from the U.S. Department of Veterans Affairs (VA) that would remove physician supervision from anesthesia care in VA.  More than 10,000 comments were submitted, including more than 3,000 from Veterans and their family members, in support of maintaining safe, high-quality physician anesthesiologist-delivered or physician-led anesthesia care for our nation’s Veterans, out of the 13,000 comments submitted overall.

ASA opposes any weakening of protections that ensure VA patients have a highly trained physician anesthesiologist involved in their anesthesia care. Veterans should never receive a lower standard of anesthesia care than the general public. Previously, in 2017, Veterans’ right to this standard of care was reaffirmed after an exhaustive, multi-year review that garnered a record-breaking more than 200,000 comments, including 25,000 from Veterans and their families. 

“Removing physician anesthesiologists from Veterans' care and replacing them with nurses lowers the standard of care and jeopardizes Veterans’ lives,” said ASA President Beverly K. Philip, M.D., FACA, FASA. “Our nation’s Veterans have earned and deserve the safest, highest-quality anesthesia care. They are often sicker and have multiple medical conditions that put them at greater risk for complications, and VA must continue to ensure the involvement of a physician anesthesiologist in Veterans’ care.” 

In April, VA’s Executive in Charge, Richard Stone, M.D., and the VA’s Office of Nursing Services issued a memo encouraging VA facilities to replace physician anesthesiologists with nurses in VA facilities. The efforts to change anesthesia care models is strongly opposed by more than 350 of VA’s own frontline anesthesiologist experts who urged VA to rescind the “Stone Memo” by invoking VA’s “Stop the Line” patient safety initiative – an initiative through which any VA employee can notify VA leadership of any risk to Veterans’ health.

In a formal comment letter, ASA objected to the unnecessary and inappropriate efforts of VA to make changes to care delivery in VA without appropriate stakeholder engagement.  ASA raised specific concerns about changes to anesthesia care models.

Independent research supports the importance of the involvement of physicians in Veteran’s anesthesia care. VA’s own Quality Enhancement Research Initiative (QUERI) specifically raised questions about the safety of replacing physician anesthesiologists with nurses noting it 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.” [emphasis added]

Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training to specialize in anesthesia care and pain control, with the necessary knowledge to understand and treat the entire human body. By comparison, nurse anesthetists have about half the education and up to 2,500 hours of clinical training.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS 
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. 

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook, follow ASALifeline on Twitter.

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