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Dear Colleagues,
ASA has become aware of a decision by the Department of Veterans Affairs (VA) on April 21 to remove physician supervision of nurse anesthetists, citing the COVID-19 pandemic. It is unclear from the document if this is a temporary or permanent action. I am extremely disappointed by this decision, which unnecessarily puts the health and lives of our Veterans at risk and also ignores the two public rule-making processes of 2017 that reaffirmed the importance of safe, physician-led anesthesia care for our nation’s Veterans.
According to the memo by VA Under Secretary for Health Richard Stone, M.D., this directive urges VA medical facilities to “amend medical facility by-laws to allow CRNAs to have full practice authority to the extent that is within the full scope of their license.” ASA is aware that VA made unsuccessful attempts to effectuate this change through the regulatory and legislative processes before Dr. Stone unilaterally overturned the final VA APRN rule by memo. I have been in communication with VA about the patient safety risks of this change.
Throughout this public health emergency, ASA has been closely tracking anesthesia services and is not aware of any shortage of anesthesia providers that would necessitate this change. In fact, many VA anesthesiologists have been encouraged to deploy in support of critical care services because VA operating rooms, like those throughout the nation, have been under capacity.
It is unworthy of the Department of Veterans Affairs, or any entity for that matter, to ask physicians to deploy in the care of COVID-19 patients with the intention of displacing them from their jobs upon their return.
The demands of the current crisis do not require these changes to the care team model, and, in fact, the current National Anesthesia Service Directive provides sufficient flexibility to meet the demands of the breadth of patient care during the pandemic. ASA will soon execute a strong response, and we will continue to maintain open lines of communication with VA and the Administration.
In the meantime, I urge you to CONTACT YOUR LAWMAKER about the dangers of this unilateral change within VA and continue to monitor AANA activities disrupting the physician-led, team-based anesthesia care team in your state. In 2017, we successfully fought to preserve physician-led anesthesia care for our nation’s Veterans, and I call on you to renew this effort today. Most importantly, we need to continue to work closely with our nurse anesthetist and anesthesiologist assistant colleagues on our care teams to deliver the care our patients deserve.
Thank you for your leadership on the front line of this pandemic and on the front line of ensuring safe, high-quality care for our Veterans.
Mary Dale Peterson, M.D., M.H.A., FACHE, FASA
President, American Society of Anesthesiologists
