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Action Alert
Oppose the Governors Budget Proposal to Lower New Yorks Safe Anesthesia Standards PART H Budget Bill A9507/S7507

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Your State Upper Chamber Representatives
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Subject:
Oppose the Governors Budget Proposal to Lower New Yorks Safe Anesthesia Standards PART H Budget Bill A9507/S7507
Required text to State House:
(This text will be included in your message)
I am writing to express my grave concerns about and opposition to the proposal within the governors budget that eliminates physician supervision of nurse anesthetists, which is currently mandated by New Yorks health code. This proposal would lower the standard of care for the administration of anesthesia and put New Yorks patients at increased risk. On behalf of my patients and your constituents, I ask you to remove this dangerous proposal from the state budget.

Under existing law, a patient undergoing any medical treatment requiring anesthesia is guaranteed a standard of care that requires a physician anesthesiologist or the operating surgeon to administer the anesthetic or to supervise the nurse anesthetist in the administration of anesthesia. With this proposal, physician supervision will be eliminated and replaced with an ill-defined collaborative agreement that allows nurse anesthetists to practice completely unsupervised. Furthermore, the governors proposal will provide nurse anesthetists with unrestricted prescriptive authority, allowing more than 1,240 mid-level providers to prescribe narcotics at a time when New York is experiencing a critical opioid epidemic.

Anesthesiology is the practice of medicine. Nurse anesthetists lack the medical decision-making skills needed in critical situations where seconds matter, the very skills obtained by physicians during four years of medical school and four years of residency. Making a phone call to a collaborating physician or a hospital representative at a time when the patient is at risk for dire consequences is an inappropriate and dangerous action, yet one that will occur should the physician anesthesiologist be removed from the anesthesia care team.

There are no routine surgical procedures that involve the use of anesthesia. By their very nature, anesthetics are potentially lethal drugs, the administration of which can result in an immediate need for medical intervention on the part of the physician anesthesiologist or operative physician. Even healthy patients undergoing low-risk surgeries are at risk for potentially disastrous outcomes. When these unpredictable events occur, the immediate presence of a physician anesthesiologist has been shown to save lives.

Approximately 30 years ago the Department of Health mandated that a nurse anesthetist must be supervised when administering an anesthetic. This same department is now supporting this radical policy change without presenting any peer review studies or data relating to the impact of this proposal, and without conducting one public hearing. This begs the question: Why is the Department of Health now willing to jeopardize the safety of patients undergoing anesthesia? Could this proposal have been promoted just to pacify a small but vocal group of mid-level medical providers?

The governor is supporting this proposal based on an unrealistic claim of $10 million in savings. In fact, there is no cost savings associated with this change to the current standard of care. Under Medicare and Medicaid, reimbursement for anesthesia services is exactly the same whether it is administered by a physician anesthesiologist or by a nurse anesthetist who is medically directed by a physician anesthesiologist or supervised by a surgeon.

Perhaps the most troubling aspect of this proposal is that it will create a two-tier anesthesia delivery system. Patients in more economically favorable positions will continue to benefit from and have ready access to physician anesthesiologists while those of lesser means will be required to utilize nurse anesthetists.

The governors proposal is misguided and unnecessary. It will lower the current medical standard for the administration of anesthesia and place our patients and your constituents at higher risk. Once again I ask that you remove this item from the budget and do your job to keep New York patients safe.
Required text to State Senate:
(This text will be included in your message)
I am writing to express my grave concerns about and opposition to the proposal within the governors budget that eliminates physician supervision of nurse anesthetists, which is currently mandated by New Yorks health code. This proposal would lower the standard of care for the administration of anesthesia and put New Yorks patients at increased risk. On behalf of my patients and your constituents, I ask you to remove this dangerous proposal from the state budget.

Under existing law, a patient undergoing any medical treatment requiring anesthesia is guaranteed a standard of care that requires a physician anesthesiologist or the operating surgeon to administer the anesthetic or to supervise the nurse anesthetist in the administration of anesthesia. With this proposal, physician supervision will be eliminated and replaced with an ill-defined collaborative agreement that allows nurse anesthetists to practice completely unsupervised. Furthermore, the governors proposal will provide nurse anesthetists with unrestricted prescriptive authority, allowing more than 1,240 mid-level providers to prescribe narcotics at a time when New York is experiencing a critical opioid epidemic.

Anesthesiology is the practice of medicine. Nurse anesthetists lack the medical decision-making skills needed in critical situations where seconds matter, the very skills obtained by physicians during four years of medical school and four years of residency. Making a phone call to a collaborating physician or a hospital representative at a time when the patient is at risk for dire consequences is an inappropriate and dangerous action, yet one that will occur should the physician anesthesiologist be removed from the anesthesia care team.

There are no routine surgical procedures that involve the use of anesthesia. By their very nature, anesthetics are potentially lethal drugs, the administration of which can result in an immediate need for medical intervention on the part of the physician anesthesiologist or operative physician. Even healthy patients undergoing low-risk surgeries are at risk for potentially disastrous outcomes. When these unpredictable events occur, the immediate presence of a physician anesthesiologist has been shown to save lives.

Approximately 30 years ago the Department of Health mandated that a nurse anesthetist must be supervised when administering an anesthetic. This same department is now supporting this radical policy change without presenting any peer review studies or data relating to the impact of this proposal, and without conducting one public hearing. This begs the question: Why is the Department of Health now willing to jeopardize the safety of patients undergoing anesthesia? Could this proposal have been promoted just to pacify a small but vocal group of mid-level medical providers?

The governor is supporting this proposal based on an unrealistic claim of $10 million in savings. In fact, there is no cost savings associated with this change to the current standard of care. Under Medicare and Medicaid, reimbursement for anesthesia services is exactly the same whether it is administered by a physician anesthesiologist or by a nurse anesthetist who is medically directed by a physician anesthesiologist or supervised by a surgeon.

Perhaps the most troubling aspect of this proposal is that it will create a two-tier anesthesia delivery system. Patients in more economically favorable positions will continue to benefit from and have ready access to physician anesthesiologists while those of lesser means will be required to utilize nurse anesthetists.

The governors proposal is misguided and unnecessary. It will lower the current medical standard for the administration of anesthesia and place our patients and your constituents at higher risk. Once again I ask that you remove this item from the budget and do your job to keep New York patients safe.
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