January
2002
Volume 66 |
Number
1
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| 2001:
We Did This Together |
Neil Swissman, M.D., 2001 President
This report was presented by the 2001 ASA President, Neil
Swissman, M.D., to the ASA House of Delegates on October 14, 2001,
in New Orleans, Louisiana.
The 2001 ASA presidency has been like a roller coaster ride —
twists, turns, steep climbs and rapid descents have characterized
this year. In spite of the turbulence, our motivation has steadfastly
been patient safety.
It was mid-January when the Clinton Administration, yielding
to outrageous political pressure, published its rule. That rule
would have allowed anesthesia nurses to practice without physician
supervision. Trying to remedy that wrong and protect our nation’s
seniors occupied the majority of my time this year. With the help
of staff, skilled lobbyists, our public relations consultants
and advertising experts, we were able to convince President Bush
and his administration to review the ill-considered Clinton rule.
They postponed the implementation of that rule twice and have
now proposed a new rule. The new rule will maintain physician
supervision or anesthesiologist direction of anesthesia care for
Medicaid and Medicare patients. However, a governor may opt out
of this requirement if it is consistent with state law and if
other requirements have been fulfilled. The rule also proposes
an outcome study to determine the safety of alternate forms of
anesthesia delivery.
In an effort to derail the proposed new rule and prevent its
publication, the American Association of Nurse Anesthetists (AANA)
continues to twist facts. Half-truths, personal attacks and distortions
are still the methods they use to try to achieve their goal. Whatever
that goal is, it is not patient safety! If it were patient safety,
they would support the study before changing the system.
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“Almost all of the nation’s physicians
and the nation’s seniors want physicians involved
in their anesthesia care, and they support the new
proposed rule. The ‘bottom line’ is no
excuse to diminish the quality of health care. There
is no alternative to patient safety. Patient safety
is our oath and our motto.”
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ASA has never resorted to personal attacks on their profession
or their leadership. We have never used anecdotal cases to prove
our point. We know that access (rural or urban) is not the issue,
and we know that anesthesia nurses do not, as AANA claims, deliver
65 percent of the nation’s anesthetics alone. They do participate
in anesthesia care. We know they are not better trained than anesthesiologists
and we know they are not safer anesthesia providers. Anesthesiology
is the practice of medicine — not the practice of nursing.
Almost all of the nation’s physicians and the nation’s
seniors want physicians involved in their anesthesia care, and
they support the new proposed rule. The “bottom line”
is no excuse to diminish the quality of health care. There is
no alternative to patient safety. Patient safety is our oath and
our motto.
Over the past year, I have been involved in a number of public
affairs, public education and communication opportunities to favorably
affect the perception and opinion of our specialty. This includes
the public and the media along with federal and state legislators.
The decision by the Bush administration to reverse the Clinton
supervision rule was obviously affected by the overwhelming public
affairs and lobbying campaign organized by the ASA Washington
office, communications department and outside consultants. Two
major supporters who delivered our message of patient safety to
people nationwide were the public/political advocacy groups of
e-advocates and The Seniors Coalition. Earlier this year, their
combined Web-based and direct-mail efforts generated more than
125,000 letters, faxes, postcards and e-mail messages that went
to the White House, Centers for Medicare & Medicaid Services
(CMS) and Congress protesting the Clinton rule. A more recent
effort to raise public support for the Bush rule that reinstates
supervision garnered another 13,000-plus responses. These efforts
were synchronized with ASA-sponsored radio and television advertising
in Washington, D.C. Our message also was delivered to legislators
and regulators through large diorama signs in the Ronald Reagan
National Airport promoting anesthesiology and ASA with the message:
“Keeping You Safe for Surgery: Our Concern, Your Life.”
Numerous high-profile editorials and news stories appeared in
the media. An editorial in the Milwaukee Journal stressed
the need for a patients’ outcome study. This editorial was
published the day before I met with former Wisconsin Governor
and Health and Human Services Secretary Tommy Thompson. Also present
at the meeting was Milwaukee anesthesiologist and former nurse
anesthetist Catherine M. Drexler, M.D.
National media outlets also showcased anesthesiology this past
year, including the Cable News Network (CNN), NBC News and the
New York Times. The women’s publication Self magazine wrote
about the benefits of physician involvement in anesthesia care
following a face-to-face meeting with editors and Galveston anesthesiologist
S. Lynn Knox, M.D., who is also a former nurse anesthetist.
The medical diversity of our profession was highlighted through
numerous media opportunities coordinated by the Committee on Communications.
I was proud to be part of the ASA video and radio news releases
on pain medicine produced and distributed this spring. The releases
featured Boston anesthesiologist Carol A. Warfield, M.D., and
reached more than 6 million people.
While we await approval and implementation of the final rule
to retain physician involvement in the anesthesia care of Medicare/Medicaid
patients, we know that our message of patient safety was heard
coast to coast and, we hope, will be heeded.
Committees
All ASA committees have met and carried out their respective tasks.
Their annual reports are in this handbook.
In particular, I urge you to read the annual reports of the committees
on Quality Management and Departmental Administration (429-3)
and Outreach Education (534-1). These committees are helping ASA
answer the request of the American College of Surgeons for assistance
in developing educational programs for their members. These programs
are to provide them with appropriate knowledge to medically manage
a patient when a nonphysician provides or administers anesthesia.
I urge your support of this activity.
I want to thank each chair and the members of all ASA committees
for their dedication and service.
Task Forces
There are many task force reports in this year’s handbook.
These task forces were asked to consider new issues facing ASA
and have provided us with meaningful evaluations of those issues.
The report from the Task Force on Structure and Governance (400-3)
is far-reaching. I have appointed a special Reference Committee
to receive testimony on only that report. Please consider that
report carefully. It is not necessary to adopt it in its entirety.
Many of its “recommendations” may require further study.
Please refer any item that you are not absolutely convinced is
appropriate to President-Elect Barry M. Glazer, M.D.
I urge adoption of the “recommends” from the Task Force
on Educational Affiliate Membership (414-1). We have already offered
our support to anesthesiologist assistants. They are a valuable
part of the anesthesia care team and committed to that mode of
practice.
I also urge your support of the Task Force on Graduate Medical
Education (400-5) report. The problems addressed in that report
are critical to the training of new anesthesiologists and to the
survival of our specialty. We must support academic anesthesiology.
I want to personally thank each task force chair and the members
of those task forces for their service to ASA.
ASA Political Action Committee (ASAPAC)
ASAPAC continues to be an important part of our political presence
in Washington. In the year 2000, contributions were received from
24 percent of ASA’s members. This year, contributions are
running at a disappointing 12 percent. Our needs have not diminished,
and we must strengthen our resolve. Please support ASAPAC. More
anesthesiologists must participate!
This is the last year of service to the PAC Board for Rodney
C. Osborn, M.D. Thank you for your service and untiring efforts
on our behalf.
Foundations
Every ASA foundation continues to thrive as witnessed by their
reports. They remain a source of pride to our Society and vital
to our future. I urge continued support of these foundations.
Sections
All the sections of our Society continue to function well and
provide leadership in their respective areas.
Membership
Those naysayers who predicted a drop in ASA membership were wrong!
Our membership continues to grow, and we represent almost all
of our country’s anesthesiologists.
Finances
While the economy has changed and our ASA expenses have soared,
we continue to remain financially healthy. My special thanks to
ASA Treasurer Orin F. Guidry, M.D., Assistant Treasurer Roger
A. Moore, M.D., and the Section on Fiscal Affairs for guiding
us through these times. Please read my progress report (411-3)
for a further update of this year’s ASA activities.
Gratitudes
There are so many to thank for this spectacular year and our successes.
The Administrative Council has provided me with all the time I
needed from them, sometimes at less than 24-hour’s notice.
Their advice, dedication to ASA, friendship and support have been
more than could be expected. They have been a constant source
of strength.
ASA President-Elect Barry M. Glazer, M.D., and First Vice-President
James E. Cottrell, M.D., have been at my side every step of the
way. Their advice and involvement have been invaluable. When I
was not available, without question, they carried the baton for
ASA. With their wisdom and leadership, the future of ASA is secured.
This year, ASA discovered a new medical condition—Siamese
triplets. Glenn Johnson, Mike Scott and Neil Swissman were a seamless
unit. At all hours of the day or night and at any location, they
were there to brainstorm, debate and plan. We shared each victory
and each sorrow. The wisdom they bring to ASA is beyond description,
and all of us are fortunate to have them as part of the ASA team.
They are dedicated to our Society, our specialty and our patients.
They are very much a part of anesthesia care in this country.
A simple thanks to them is no measure of their value or what they
mean to me.
We are equally fortunate to have outstanding colleagues in Park
Ridge, Illinois and Washington. Their tireless energies and professional
skills played a vital role in our success. On behalf of every
ASA member, I extent the most sincere thanks to Ron, Frank, Sue,
Dee, Janice, Phil, Diane, Karin, Manuel and the rest of the staff.
You cared not because it was ASA but because it was right. No
other organization has a better or more loyal team.
My partners at Summit Anesthesia Consultants deserve special
thanks. They tolerated my prolonged and often unplanned absences
without ever missing a beat.
I must acknowledge the encouragement and support the Nevada State
Society of Anesthesiologists has given me for many years. I am
proud of my component society and its political activities.
My family has been a tower of strength. When I had to miss family
functions, they filled in for me. They understood the obligation.
They take great pride in what ASA stood for and that I had the
privilege of representing the nation’s anesthesiologists.
Now, I must give special recognition to my best friend and wife
of 31 years. I can honestly say I have never before subjected
her to the stresses we shared this year as the scope-of-practice
issue evolved. Without question, she accepted my responsibility.
Her advice was always appreciated and appropriate. She always
gave me a shoulder to lean on at the most trying times. She truly
deserves the title “First Lady of Anesthesiology!” Debbie,
all of ASA thanks you for the sacrifices you have made this year.
I love you very much.
The privileges of being your President, a member of ASA and an
anesthesiologist have been great honors. I am so proud to be part
of this specialty and this Society. I would do it all over again
in a heart beat.
Casey D. Blitt, M.D., Director of ASA District Number 21, told
me there are three times in a man’s life — youth, middle
age and “boy you look good!” I hope I have looked good
to you and represented you well.
Thank you for this extraordinary honor!
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Neil
Swissman, M.D., is a private practitioner in Las Vegas, Nevada,
and Associate Professor of Anesthesiology, University of Nevada-Reno
College Medical School, Reno, Nevada. |
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