Soapbox

Anesthesia bill puts patient safety at risk

Anesthesiologist Dondee Almazan, center, receives a tote bag of information at Kaiser Permanente in Roseville in 2010. There’s a bill to allow anesthesiologist assistants to practice in California.
Anesthesiologist Dondee Almazan, center, receives a tote bag of information at Kaiser Permanente in Roseville in 2010. There’s a bill to allow anesthesiologist assistants to practice in California. Sacramento Bee file

When it comes to anesthesia during surgery and other procedures, you expect the most qualified professional overseeing your care. Assemblyman Sebastian Ridley-Thomas apparently has a different point of view, and the measure he is proposing – Assembly Bill 890 – may threaten the quality and safety of anesthesia care for all Californians.

This misguided bill would expand the highly intricate field of anesthesiology by allowing anesthesiologist assistants to practice in California. These assistants are trained to depend on a supervising specialist anesthesiologist, who might not be immediately available to help with emergency decisions if they are busy supervising several other assistants. This could place patients at risk.

While anesthesia is commonplace today, most people don’t understand the complexities that make it so challenging. It’s not a simple matter of just putting patients to sleep. Instead, it requires providing a precise combination of drugs intravenously or through inhaled gases, often in combination with local anesthetics to numb specific parts of the body. The patient needs constant, vigilant monitoring – something which should only be performed by a highly trained professional.

Anesthesiologists and certified registered nurse anesthetists are those highly trained professionals. Today, in addition to more than 7,800 anesthesiologists, there are more than 2,200 California nurse anesthetists licensed and regulated by the state. In seven counties, they provide 100 percent of anesthesia services. They are more cost-effective than anesthesiologists, require no physician oversight, and have the rigorous education, training and experience needed to make decisions in the operating room that ultimately reduce health care costs. Disturbingly, however, up to 40 percent of graduates of California nurse anesthetist programs are unable to find a job in the state.

In the entire country, there are only about 1,800 anesthesiologist assistants licensed in only 14 states. Their lesser experience and training are a key factor in the limited role they play. They are not required to have any health care experience prior to beginning their training, and they are not educated to exercise independent judgment.

AB 890 does not require the assistants to have a California license, nor does it establish any oversight, which is critical to protect patient safety and ensure a high level of professional conduct. The bill would also cost the state money because two anesthesia providers – one an expensive physician specialist – must be educated to utilize this outdated medically directed model.

Advanced practice nurses, registered nurses, retirees and labor groups oppose this legislation, stating that anesthesiologist assistants would drive up health care costs rather than reducing them as the author of the bill has claimed.

Simply put, AB 890 is bad medicine for Californians.

Charles Griffis is president of the California Association of Nurse Anesthetists and an associate clinical professor in the UCLA Department of Anesthesiology.

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