Letters to the Editor - Feb. 28, 2005

ASA: Only one state allows nurse anesthetists independent practice - Ethics code inconsistent concerning executions and abortions - Conn. protects doctors helping the abused; why not rest of the time? - NP: Physicians don't have a monopoly on concern over patient safety

ASA: Only one state allows nurse anesthetists independent practice

Regarding "New Jersey anesthesiologists win scope-of-practice battle," (Article, Jan. 17): Thank you for your coverage regarding supervision of nurse anesthetists (CRNAs) during office-based surgery.

The American Society of Anesthesiologists would like to clarify one statement made in the article.

The concluding sentence of the article reads: "Twelve states permit CRNAs to work in hospitals without physician supervision when caring for Medicare patients."

Our members are concerned that some of your readers will interpret this statement to mean that CRNAs may practice independently in these states.

In fact, only New Hampshire law allows independent practice, and our information is that only a few hospitals permit nurse anesthetists to practice independently.

The other 11 states that have opted out of the Medicare requirement for physician supervision continue to require CRNAs to practice in collaboration with a physician so that patients continue to have a physician medically managing their care.

As your article indicates, the majority of states require CRNAs to be supervised by a physician, either an anesthesiologist or the operating surgeon.

We feel that it is important for all health care professionals to be on the same page when implementing regulations affecting patient safety.

--Eugene P. Sinclair, MD, president, American Society of Anesthesiologists, Park Ridge, Ill.

Ethics code inconsistent concerning executions and abortions

Regarding "Ethics charges related to executions dropped" (Article, Jan. 31): I continue to read with interest articles referencing the AMA Code of Ethics and specifically its prohibition against physician involvement in executions.

My interest stems from the illogic of the prohibition against our helping infrequently to take the life of a criminal when we approve of our active work to take the life of an innocent infant in the ritual of abortion. Both are, of course, legal, but the condemned has had his day(s) in court, with many people deciding his fate. The infant has had no such protection, and only one person dictates the death sentence.

When do we revise our code to prohibit physician involvement in these infant executions as well?

--Joseph Zanga, MD, Greenville, N.C.

Conn. protects doctors helping the abused; why not rest of the time?

Regarding "Ruling protects doctors investigating abuse" (Article, Jan. 31): With the edition headlined with articles regarding medical malpractice, this story is especially ironic.

The article notes that the state of Connecticut has found it prudent to protect physicians who are involved in child abuse cases against medical malpractice suits. The article quotes the state Supreme Court as stating that such a law would avoid "fear of liability."

Why the same logic does not extend to all physician activities, arguably of equal importance, is unclear.

Apparently, the state of Connecticut does not mind the fact that physicians are being discouraged from other medical activities.

That such a protected status exists for some physicians points out that even the state Legislature recognizes the detrimental effect of the current medical malpractice system on the delivery of health care.

Shouldn't all physicians be afforded these protections to carry out their equally important duties?

--Stephen Kirk, MD, Salem, N.H.

NP: Physicians don't have a monopoly on concern over patient safety

Regarding "Nonphysicians eager to pick up the prescription pad" (Article, Feb. 7): Just like we have different political parties vying for leadership of this country (each of them knowing what's best), we have different health care practitioners with varying opinions and ideas of what good health care is to the citizens of the United States.

As physicians, you say that your No. 1 concern is patient safety. I think that this comes down to one thing, and it's not patient safety. It's a matter of economics.

I'm not trying to devalue physicians or medicine -- they have a place in health care, but not the only place And physicians are not the experts in every aspect of health care that they want the rest of us to think.

As a nonphysician provider and nurse practitioner with two bachelor's degrees, a master of science degree, years of documented professional health care training and education, and licensed by the state, I think I'm perfectly capable of providing independent patient care in a safe and professional manner.

I know when a patient situation might be beyond my scope of knowledge, and I subsequently refer to a specialist. Maybe you physicians should try that instead of thinking you know everything there is to know about health care.

You are using this matter to expound your opinion on the public, legislators and media to ignite a fear of fictional "crazy carpetbagger quacks" who don't know what they're doing and only have the almighty dollar on their minds. This is only your opinion, and it may backfire on you.

All professional health care providers are committed to the safety of their patients. Physicians alone do not have a lock on this, though they do seem to be the only ones claiming that their calling is higher than the rest of us.

--David Kleberger, NP, Commerce City, Colo.