To The Editor
The article “MD-Office Safety Regs Stalled in New Jersey” published in the Winter 1996-97 issue of APSF Newsletter presented a one-sided and inaccurate portrayal of the regulatory situation in New Jersey. The Task Force assembled by the Board of Medical Examiners and asked to review proposed regulations was comprised of physicians of various specialties as well as three Certified Registered Nurse Anesthetists. Yet only the opinion of one member, an anesthesiologist, was voiced in the Newsletter article. Having participated in that Task Force, we would like an equal opportunity to comment and, we believe, correct some inaccuracies.
A number of task force members (the plastic surgeon, the radiologist, and the CRNAs) as well as public officials (a Deputy Attorney General and a state senator) were referred to, often with negative comments. Rather than offering an objective account of the situation, the APSF Newsletter appears to have provided a unilateral advocacy forum to one interested party.
We would like to clarify the position of the New Jersey Association of Nurse Anesthetists (NJANA) concerning the proposed office regulations. NJANA strongly supports and substantially contributed to the portion of the proposed regulations which mandates appropriate monitoring, maintenance of equipment, licensure of providers, and availability of ACLS trained personnel, as well as other standards which have been demonstrated to improve patient safety. However NJANA has always opposed the unnecessary restriction of CRNA practice. Requirements for supervision of CRNAs by anesthesiologists cannot be shown to improve patient outcome, nor can requirements that physicians working with CRNAs obtain additional credentials and maintain CEUs in anesthesia. Such restrictions are merely deterrents to the utilization of CRNAs in office practice.
The article misrepresented the nature of mishaps in physician offices in New Jersey. Although the author knows, as we do, that these incidents are rare and involve both anesthesiologists and CRNAs proportionately, he chose only to cite cases in which anesthesia was administered by CRNAs. The circumstances of each particular case and the level of care rendered, not whether the provider was an a CRNA or an anesthesiologist, have the greatest effect on outcome. Nurse anesthetists and anesthesiologists together should strive for the safest possible practice environment. One means of achieving this goal is by promoting effective safety standards such as monitoring and equipment requirements, not by adopting unnecessary restrictions concerning CRNAs.
NJANA has long been a staunch supporter of patient safety and a proponent of the highest standard of anesthesia care. We believe that all providers should be held to this same high standard and that regulations should be outcome driven and based upon scientific data, not prejudicially restrictive of any provider group.
Margaret Burgoyne, CRNA President, NJANA
Clare Golden, CRNA Past President, NJANA
(Editor’s Note: As previously indicated, the APSF Newsletter welcomes contributions concerning anesthesia patient safety from authors with any relevant viewpoint. Readers with experiences, observations, or opinions specifically about the patient safety implications of delivering anesthesia care in a physician’s office are encouraged to submit their articles or letters.)