Rhonda Rowland: The anesthesia debate

Rhonda Rowland

CNN medical correspondent Rhonda Rowland on the move to prolong the argument between doctors and nurses over who should be in charge of anesthesia in the operating room.

Rhonda Rowland: Hello, everyone! I'll do my best to answer your questions regarding the issue of physician-anesthesiologists and nurse anesthetists and the current supervision requirements for Medicare and Medicaid patients.

CNN Moderator: What was President Clinton's reason for making the change to allow trained nurses to provide anesthesia to Medicare and Medicaid patients?

Rhonda Rowland: On President Clinton's last day in office, he did sign off on a proposal that would allow nurse anesthetists to administer anesthesia without direct physician supervision. This was a proposal that had been pending for three years. We never had direct comment from the Clinton administration regarding their decision.

VIDEO CNN's Rhonda Rowland reports on the debate over who should administer anesthesia (May 16) Play video (QuickTime, Real or Windows Media) MORE Get more information about where each side stands on the issue: • American Society of Anesthesiologists • American Association of Nurse Anesthetists RESOURCES Read Tommy Thompson's statement about the anesthesia decision ALSO Thompson extends decision on anesthesia rule

Question from chat room: Along with informing the public of who's doing their anesthesia, we could ask the public which they would prefer, the registered nurse or the doctor who has more training. Which do you think the public would choose?

Rhonda Rowland: It is our understanding that most patients are not familiar with who is responsible for their anesthesia. There is a lack of awareness in general regarding the way in which anesthesia is prescribed. We understand both the physician anesthesiologists and nurse anesthetists have their own evidence showing the public feels comfortable with them delivering their anesthesia. I'm not aware of a scientific study that has specifically polled the general public on this issue. I do know the American Society of Anesthesiologists says in their polls, about two-thirds of respondents feel more comfortable with an anesthesiologist.

CNN Moderator: In most cases, wouldn't this decision be left up to the policies of the individual hospital?

Rhonda Rowland: What the Bush administration is proposing is that governors of individual states, after consulting with their state boards of medicine and nursing, could seek a waiver to allow nurse anesthetists to practice unsupervised. Currently, across the country, there are situations, for example, in doctor's offices where nurse anesthetists administer anesthesia without the supervision of an anesthesiologist. But these are not on Medicare and Medicaid patients.

Question from chat room: Numerous studies support safe and equal outcomes whether an anesthetic is administered by a CRNA or physician. What seems to have caused the delay in this ruling?

Rhonda Rowland: There are a number of studies that have shown the way in which anesthesia is delivered today is safe and effective. In most cases of Medicare and Medicaid patients, physician anesthesiologists work together with nurse anesthetists as a team. Indeed, the nurse anesthetist often does the anesthesia procedure from start to finish, and stays with the patient. The physician is often present during two critical points, when the patient is put to sleep, and when they're brought out of anesthesia. It's our understanding that no scientific study has been done showing whether or not it's safe for nurse anesthetists to practice unsupervised.

CNN Moderator: Noting that there is actually a professional association for nurse anesthetists, this must be a relatively organized branch of nursing. How much training do they receive?

Rhonda Rowland: The nurse anesthetists now have strict requirements for training. They should have a nursing degree or similar science degree. They must be licensed registered nurses. It's recommended that they have one-year practical nursing experience, and two to three years of graduate training in anesthesia.

Question from chat room: I live in Enid, Oklahoma and recently the hospitals here almost lost their anesthesiologists due to the strain on their time between surgeries and doing epidurals for women in labor. Is there a shortage nationwide of qualified anesthesiologists?

Rhonda Rowland: In some parts of the country, there is a lack of anesthesiologists, especially in rural areas. In those cases, if there were not a nurse anesthetist available, patients would not have anesthesia services. In those cases, the surgeon or other physician takes on the role of supervisor. But clearly the nurse anesthetist provides a valuable service in those areas.

CNN Moderator: Do you have any final thoughts to share with us today?

Rhonda Rowland: The supervision requirement has been quite contentious, and both sides have strong reasons for their arguments. As it stands today, both specialists work well together in providing safe and effective anesthesia to patients across the country. The physicians value the services of the nurses, and nurses understand the expertise anesthesiologists bring to high-risk situations. The Bush administration is expected to rule on the decision in another six months. They're taking these upcoming months to fine-tune their recommendations.

CNN Moderator: Thank you for joining us today.

Rhonda Rowland: Thank you, everyone, for your questions.

Rhonda Rowland joined the chat room via telephone from Atlanta, Georgia and CNN.com provided a typist. The above is an edited transcript of the interview on Friday, May 18, 2001 at 11 a.m. EDT.

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