The American Association of Nurse Anesthetists (AANA) has launched an aggressive new lobbying blitz urging the U.S. Department of Veterans Affairs (VA) to abandon physician-led team-based models of anesthesia care for Veterans. The campaign follows recent Congressional hearings during which VA officials and other stakeholders voiced support for maintaining VA's current physician-led team-based patient safety standard.
ASA President-Elect Jeff Plagenhoef, M.D., is asking ASA members to respond to the AANA lobbying campaign by redoubling their efforts to expand participation in the SafeVACare.org Veteran patient safety campaign.
On March 2, VA Secretary Robert McDonald and Under Secretary of Health David Shulkin, M.D., expressed support for maintaining VA's current physician-led team-based model of anesthesia care, saying that “We believe that the current system is serving Veterans adequately and safely.” This exchange occurred during the House Appropriations Military Construction and Veterans Affairs Subcommittee hearing on the FY 2017 VA budget when committee member, Rep. David Jolly (R-FL-13), asked about the VHA Nursing Handbook and reiterated the Committee’s stance that the Handbook should not conflict with the current VA Anesthesia Service Handbook.
In a separate hearing, the importance of physician-led anesthesia care within the VA was discussed by key stakeholders at a Joint Hearing of the House and Senate Veterans’ Affairs Committees. In written testimony prepared for the hearing of the Committees, the National Guard Association of the United States (NGAUS) and the Association of the United States Navy (AUSN) wrote about the patient safety implications of abandoning physician involvement in Veteran's anesthesia care. AMVETS, which has also supported the ASA-led effort to maintain high-quality, physician-led anesthesia care in the VA, also participated in the hearing.
NGAUS wrote to the committees that it "does not fully support the sweeping language… that directs the Secretary to grant ‘full practice authority’ to advanced practice nurses, physician assistants, and other health providers, regardless of state law." The association wrote that “The risks and complications associated with the administration of anesthesia during surgeries should not be reduced when serving an aging and injured veteran population.” Similarly, AUSN commented to the committee regarding anesthesia care standards that “our nation’s Veterans deserve the highest level of medical attention, and this proposed shortfall in care is unacceptable.”
ASA is encouraged by these recent developments and honored to have the support of distinguished Veteran and military organizations. However, the final decision about the model of anesthesia care adopted by VA remains unresolved and the target of the AANA's aggressive campaign.
The proposed Nursing Handbook is currently under review by the Office of Management and Budget (OMB) as a proposed rule entitled "Advanced Practice Registered Nurses." ASA has not been granted access to the proposed rule, and anticipates that the proposed rule may still contain the provisions sought by the AANA. The proposed rule will move into a public comment period during which comments will be accepted from the public and other stakeholders. The comment period is expected to begin at the end of March. At the conclusion of the public comment period, VA will tally and review the comments received and issue a final rule.
ASA members are urged to take action now at SafeVACare.com and engage in the "1+5" campaign, seeking the participation of 5 of their physician colleagues, friends and family members in the SafeVACare.org comment initiative.
Watch Secretary McDonald and Under Secretary Shulkin respond to Rep. Jolly during the House Military Construction and Veterans Affairs Subcommittee hearing here.
Read the written testimony provided by NGAUS here and the submission for the record provided by AUSN here.
Additionally, ASA interested in learning if you have a relationship with a Veterans organization. To report those relationships, or obtain assistance in building support within your state component, please contact ASA Grassroots Program Administrator Max Steininger at firstname.lastname@example.org.