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The U.S. Department of Veterans Affairs, Office of Nursing Services (ONS) and its allies have launched a new effort to eliminate anesthesiologists from the team-based model of Veterans’ care and to move to a nurse-only model of care for both surgery and critical care services. The effort, centered around a senior VA staff memorandum, would undo a longstanding VA patient safety policy, affirmed in 2017, that provides for anesthesiologist-delivered or anesthesiologist-led team-based care for Veterans.
As a result of its high-risk nature, the most common model of anesthesia care throughout the world is an anesthesiologist personally delivering or working in a physician-led, team-based model with nurse anesthetists to jointly delivery anesthesia care. A nurse-only model of anesthesia is rare.
With 12 to 14 years of education and 14,000 to 16,000 hours of clinical training, anesthesiologists are the most highly trained and skilled anesthesia professionals and serve a critical role in providing safe anesthesia care. Removing highly-trained anesthesiologists from the care of Veterans lowers the standard of care in VA facilities and puts the lives of more than 9 million Veterans at risk.
VA patients generally have poorer health status than the general population. Access to highly educated and skilled anesthesiologists in VA patent care is critical in providing better outcomes for their care. Many Veterans suffer from underlying health conditions such as heart disease, diabetes and high blood pressure, all of which increase patient risk around the surgical experience. Additional risks have been identified for Veterans suffering from health conditions related to exposure to Burn Pits and Agent Orange, including serious respiratory diseases, Parkinson’s Disease and certain cancers. Without physician involvement, especially due to these exposures, VA would be lowering the standard of care for Veterans and putting their health and lives unnecessarily at risk.
Veterans deserve the same level of care that patients receive in the nation’s top quality health care facilities - all of which utilize anesthesiologists alone or working in a team.
In April 2020, Veterans Health Administration, Executive in Charge, Richard Stone, MD, initiated a new effort to eliminate anesthesiologists from the care of VA patients. Dr. Stone partnered with the VA Office of Nursing Services to issue a memorandum “strongly” encouraging VA facilities to change their hospital bylaws to remove anesthesiologists from Veteran care and, in their place, use a nurse-only model of care for Veterans. This action was taken surreptitiously without any consultation with other VA stakeholders, including VA’s own anesthesia experts, the leaders of National Anesthesia Services, the lead anesthesia policy and care protocol organization in VA.
In a presentation before VA nurses, Dr. Stone, a strong advocate for replacing physicians with nurses in VA, stated:
“We are still breaking even some of the legal requirements we’re under that this is a physician-centric only organization. And look, I am a physician, I love my fellow physicians, but I don’t care what degree is after your name. I need leaders that can think, leaders that can be innovative, creative, and agile. And we need to change that, and we will change that.” [Emphasis added] – November 17, 2020 Department of Veterans Affairs APRN Conference.
Veterans have earned the right to access to safe, highest-quality anesthesia care. This was reaffirmed in 2017 after an exhaustive, multi-year rulemaking process that garnered a record-breaking number of comments---more than 200,000 comments from both Veterans, their families, and concerned citizens -- overwhelmingly directing VA to ensure our nation’s Veterans do not receive a lower standard of anesthesia care than the general public. Additionally, VA’s Chiefs of Anesthesia have invoked VA’s “Stop the Line” patient safety program three times in the last year to bring attention to the highest levels of VA Leadership to the concerns this proposal would have on the health and lives of Veterans. In one such memo, the Chiefs pointed out that “Veterans with COVID-19 are among the most complex patients health care providers will encounter in their professional capacity. Eliminating the clinical oversight and involvement by physicians, even temporarily during this critical time, jeopardizes the quality of Veteran health care and unnecessarily puts our Veterans at increased risk.” If made permanent, the “Stone Memo” would reverse the 2017 policy preserving the role of physician anesthesiologists in VA.
ASA organized and has been leading a multipronged campaign – Safe VA Care (SafeVACare.org) - to preserve safe, high-quality physician-led anesthesia care for the nation’s Veterans. Through the Safe VA Care initiative, ASA has worked to inform and mobilize Veterans, their families, the public, policymakers and the medical community to speak out against any effort to lower Veteran’s standard of care.
In a recent formal correspondence, ASA urged VA Secretary Denis McDonough to rescind the “Stone Memo” and has requested a meeting with the Secretary.
VA’s front-line anesthesiologists have also directly raised concerns with the Secretary about the memo and invoked “Stop the Line,” a VA patient safety initiative, urging reversal of the “Stone Memo” policy. The anesthesiologists stated that Dr. Stone’s untested approach “would directly compromise patient safety and limit our ability to provide quality care to Veterans.” The communication was signed by over 300 VA anesthesiologists.
ASA has also organized leading national medical associations, prominent Veterans organizations, and bipartisan Members of Congress to support safe, high quality care at VA.
This page is curated by Amada Cate, Associate Director of Governmental and Political Outreach, and was last updated May 2021.