To The Editor:
Many readers of the APSF Newsletter would be aware of the New South Wales Anaesthesia Mortality Study, which has just completed its 40th year of reviewing deaths in association with anaesthesia.
For the benefit of those yet to visit Australia, New South Wales (NSW) is our most populous State (approximately 6.5 million), and its capital, Sydney, our biggest and brightest city.
After reading the Newsletter devoted to safety in Office-Based Anesthesia (OBA), our Committee thought it might be useful to describe the relevant regulatory framework existing in NSW.
General anaesthesia may only be administered here in premises which have been licensed under the Private Hospitals Act, which lays down strict requirements for equipment and staffing. Essentially these differ very little from the licensing rules for Day Surgery facilities, so that the “office” would have to be a very elaborate one indeed to qualify. A breach of this Act by any practitioner could result in deregistration (revocation of licensure) for unprofessional conduct.
Combined with the statutory duty to report all deaths occurring within 24 hours of anaesthesia or sedation for a procedure to a Coroner, the barrier to inappropriate practices in anaesthesia or sedation/endoscopy is quite formidable. So strongly is this true that the Committee classified its last death in a dental surgery as long ago as in 1986, in a case in which the operator was the sole professional person present. To some extent, the present regulations were triggered by this catastrophe.
We would agree with your correspondents on the need for tight regulation of OBA and equally strong or similar controls for “sedation” by non- anesthesiologists. The NSW laws define sedation as being a state in which the patient is still capable of responding intelligibly to a verbal message – anything less responsive than that condition is considered to be general anaesthesia, and is subject to the same strictures which govern that more involved status.
PS: Full text of the above legislation can be provided if desired (requests to: firstname.lastname@example.org)
Professor Ross Holland
NSW Special Committee Investigating Deaths Under Anaesthesia
Camperdown, NSW, Australia