CLEAR News - Winter 2002

CLEAR News - Winter 2002

Florida Nurse Anesthetists Sue Board of Medicine,
Protesting New Limits on Practice

Four Florida Nurse Anesthetists are suing the state's Board of Medicine, after it introduced a ruling on April 15, 2002 that prevented the administration of anesthesia by nurses during some types of office surgery unless supervised by a physician anesthesiologist. This ruling comes despite the fact that, according to the Florida Association of Nurse Anesthetists, nurse anesthetists had previously administered anesthesia in over 90 per cent of office surgeries.

The April ruling meant that a physician anesthesiologist was required to be present when the deepest form of anesthesia was to be administered, while office surgeons and their staff could administer the milder forms. Susanne Oliver, a nurse anesthetist and board member of the Florida Association of Nurse Anesthetists (FANA), claims "the rule change may be reducing patient safety rather than enhancing it by creating an incentive for surgeons to opt for lighter ... anesthesia." Some physicians groups have also expressed concern at the effect of the ruling, with Chris Nuland, legal counsel of the Florida Society of Plastic Surgeons noting that "Since April 15, physicians have had two choices," either "they can move their level IIIs [the deeper form of anesthesia] to more expensive hospitals or ambulatory surgical centers or use more expensive anesthesiologists in their offices. Second, they can try to do the procedures under a level II [the lighter] anesthesia, increasing patient discomfort. None is an ideal option." Dr. Douglas Dedo, an otolaryngologist from Palm Beach Gardens admits to the latter, saying "I've had to change from doing my surgery under general in the office to doing it under sedation", noting that "it's not as comfortable for the patient or the surgeon."

In late July, nurse anesthetists and those opposing the rule change were granted a reprieve by the board, which issued criteria that physicians and their offices must meet to be considered for a waiver from the April requirement. In practice this means the Board of Medicine will have 90 days to review each waiver request, with a recommendation provided by its surgical-care committee. The board has suggested that those seeking waivers will not have to meet all of the criteria but rather show overall competency to supervise anesthesia. Included in the criteria are board certifications, continuing education requirements, completion of 500 surgeries involving supervision of nurse anesthetists and an absence of reportable "adverse incidents" in the preceding two years. Also to be considered is disciplinary and malpractice history, financial responsibility, education, board certification and hospital staff privileges.

FANA has suggested a series of "urgent reforms" including the requirement that a qualified anesthesia provider should be present for all procedures involving intravenous sedation (i.e. level II and III). They point out that current rules allow a surgeon or registered nurse to provide anesthesia in level II cases, something it feels is a direct risk to patients. The association also notes that currently nurse anesthetists are able to provide anesthesia without the supervision of a physician anesthesiologist in more complex patient cases in hospitals and ambulatory care facilities. It also noted that the Florida Board of Nursing released a statement in 2001saying that it does not consider registered nurses (as opposed to nurse anesthetists) qualified to administer anesthesia and that they should not be asked to do so. Finally, the FANA proposals would have all office surgery reported and stored, in order to provide policymakers with data about the type of surgery performed and anesthesia used. Currently, only "adverse incidents" need be reported, leading to ignorance about the scale of the practice of office surgery.

However, the July compromise has not found favor with the four nurse anesthetists bringing suit against the Board of Medicine. Vicki Digby, Sandra Darling, David Stephen Rogers and Milton Taylor are seeking to eliminate the rule introduced on April 15, and argue in their lawsuit that at its July 20 board meeting, the chairman admitted that it lacked evidence to support the need for physician anesthesiologist supervision of nurses in office surgeries. It adds that the board acknowledged a lack of jurisdiction over nurse anesthetists who are regulated by the Board of Nursing, and that the rule unlawfully limits the scope of practice of nurse anesthetists. Each of the litigants claims damages due to the loss of revenue they say has resulted from the rule change. Defending the decision to file suit rather than wait for legislative change, Milton Taylor said "in my opinion it will take forever to change this ruling through the Legislature," adding "I could see it happening, but it would be a long time down the road. The only alternative was to file a lawsuit."

CLEAR News will monitor events in Florida and provide readers with an update when the situation changes.

Next