Colorado Anesthesiologists Say Governor's Errors Will Harm Patient Care

DENVER -- A number of Colorado physicians are cautioning patients that imminent action by Gov. Bill Owens could dramatically alter the quality of health care in Colorado. At the same time, doctors are asking Owens to fully explain why he is removing an important safety net that has meant safe anesthesia care for senior citizens for almost 40 years.

Owens recently notified the Colorado Board of Medical Examiners that he intends to exempt the state of Colorado from federal Medicare rules that currently require a physician to oversee the anesthesia care of Medicare patients when they are having surgery. This exemption from federal rules is an option if a governor determines that an opt out is consistent with state law and in the best interests of a state's citizens.

Last week, in a 5-to-4 vote, the Colorado State Board of Medical Examiners voted to recommend opting out to the governor. Three board members were absent and one member abstained at the time of the vote.

According to Colorado Society of Anesthesiologists (CSA) spokesperson Randall M. Clark, MD, requests by CSA for the governor to "put patients first" have gone unanswered. "The governor is not only ignoring anesthesiologists and the many other physicians and physician groups who are opposed to the opt out, he is ignoring Colorado's sickest and most vulnerable patients," he said. "If Gov. Owens does opt out, Colorado's Medicare and Medicaid patients could undergo surgery in hospitals and ambulatory surgical centers without the benefit of a doctor's oversight of their anesthesia care."

According to CSA, Owens has precipitated three significant errors that will alter how medicine is practiced in Colorado and hamper the quality of care patients receive. The governor's first mistake was to ignore what many physicians consider sound medical care. "Based on what we saw presented at the Board of Medical Examiners, some rural hospitals and their surrogates have completely misrepresented the supervision issue," Clark said. "Some rural hospitals have blamed their many problems on the long-standing and common sense requirement of physician supervision, and that is just not the case. A physician's involvement is particularly needed during the preparation of the anesthesia plan and during the most critical parts of surgery, specifically, the administration of anesthesia and the patient's recovery from its effects. Physicians need to become more responsible -- not less responsible -- for each patient's care."

CSA is pointing out that the governor's second mistake was in misunderstanding the distribution of surgical and other medical procedures within Colorado. Many rural hospitals in the state perform far fewer than 1,000 surgeries in a year, compared to individual front-range hospitals that can have 20,000 procedures per year or more. "Governor Owens seems intent on lowering the standards all across the state in the hope of relieving a very small number of rural hospitals of their supervision needs," Clark said.

Clark says Owens' third error is that he failed to adhere to Medicare's rule stating that an opt out must be in the best interests of the state's citizens and it must be consistent with state law. "By both of these standards, the Governor's proposed action is deeply flawed," Clark said. "Available scientific data prove that the safest care a patient will receive is when an anesthesiologist is involved, as is already done in 90 to 95 percent of the anesthetics in this country. Never has any data shown that independently practicing nurses are providing care equal to that of a physician," he said.

Next, Colorado's long-standing hospital regulations do require physician supervision of anesthesia nurses, Clark said. "Making the opt out clearly inconsistent with state laws and regulations."

According to Clark, it makes no sense to opt out of the physician supervision requirement at this time. "We are not even three years out from a widely publicized Institute of Medicine report that commended America's anesthesiologists for leading the way in patient safety and patient advocacy. Now, here in Colorado, we have a governor who thinks the time has come to relax our standards. Colorado's anesthesiologists strongly disagree."

Source: Colorado Society of Anesthesiologists