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In response to the release of a new U.S. Department of Veterans Affairs (VA) rule, the American Society of Anesthesiologists (ASA) cautioned the VA not to weaken current anesthesia safety standards. The rule issued today is an Interim Final Rule titled “Authority of VA Professionals to Practice Health Care.” It is effective immediately but includes a 60-day comment period. ASA members are strongly encouraged to provide comments.
While the Interim Final Rule does not directly address the issue of existing anesthesia patient safety standards, it codifies VA’s claim that they have the authority to circumvent state scope of practice laws. Most relevant to ASA, the rule leaves open the possibility that VA could attempt to change the anesthesia standards in the future. ASA opposes any weakening of protections that ensure patients have access to the safe, physician-led model of anesthesia care. ASA will continue to work to ensure that the Department retains the well-established, physician-led anesthesia care team model that is the national standard for anesthesia care. ASA urges VA to uphold its current patient-centered policies governing anesthesia care including the Advance Practice Nurses final rule (38 CFR § 17.415), and Directive 1123, which provides for physician-led anesthesia care for Veterans.
Our nation’s Veterans have earned and deserve the safest, highest-quality anesthesia care. This was reaffirmed after an exhaustive, multi-year rulemaking process that garnered a record-breaking number of comments---more than 200,000 comments during two comment periods overwhelmingly directing VA to ensure our nation’s Veterans do not receive a lower standard of anesthesia care than the general public. ASA will work strenuously to ensure that VA upholds the standard of care for Veterans and that VA does not take any action that diminishes VA anesthesia care through any new policy or sub-regulatory action following this Interim Final Rule.
Because of the generally poorer health of patients in VA facilities, VA must continue to ensure the involvement of a physician anesthesiologist in Veterans’ care. This is particularly important for Veterans with existing compromised health status who are also suffering from COVID-19. The care of these complex, very sick patients should not be compromised by the removal of a physician from their health care team.
To date, both the Trump and prior Obama Administrations have recognized the unique nature of the acute care surgical setting and preserved the longstanding and nationally recognized standard of physician-led anesthesia care. ASA looks forward to a robust and ongoing dialogue with VA to ensure Veterans continue to receive high-quality anesthesia in VA facilities.
In April, VA’s Executive in Charge, Dr. Stone, issued a memo encouraging VA medical facilities to temporarily change their hospital bylaws to allow for the provision of nurse-only anesthesia care. The memo is strongly opposed by more than 350 of VA’s own frontline anesthesia medical experts who urged VA to rescind the “Stone Memo” by invoking VA’s “Stop the Line” patient safety initiative – an initiative through which any VA employee can notify VA leadership of any risk to Veterans’ health. In invoking “Stop the Line,” the VA anesthesiologists noted that the Executive in Charge had excluded VA’s own National Anesthesia Service from the development of this memo. ASA will continue to work for the “Stone Memo” to be rescinded immediately.
ASA believes removing physician anesthesiologists from the care of Veterans lowers the standard of care in VA and places Veterans’ health and safety at risk.
