Kathleen Kidder, MSN, ARNP President, NH Nurse Practitioner Association

To the editor:I am writing in response to the recent media attention on Governor Shaheens decision to opt out of the federal requirement that physicians oversee the practice of nurse anesthetists. Some crucial details have been omitted. There are three aspects to this issue: patient safety, patient access to anesthesia services, and politics. First, assuming anesthesiologists and nurse anesthetists have an inherent conflict of interest on this issue, the most neutral and trustworthy commentary regarding patient safety comes from credible data and the anecdotal evidence provided by the surgeons who work with these professionals. After three years of research and testimony regarding patient outcomes, the federal oversight agency (HCFA) determined that there was no difference in outcomes, and no evidence to support the federal requirement of physician supervision of anesthesia care. According to the New Hampshire surgeons with whom Governor Shaheen spoke, they have absolute confidence in the ability of nurse anesthetists to deliver high quality services and safe care, and they would entrust their loved ones to the care of nurse anesthetists, who have functioned independently in their facilities since 1991, when the state Legislature gave them the authority to do so. Secondly, according to rural hospital administrators another neutral source of information they would be hard-pressed to provide their communities with anesthesia services without the Governors op-out. Their surgeons are reluctant to assume supervisory responsibility for nurse anesthetists, because they have no expertise in anesthesia. Under the federal rule, the rural hospitals only option would be to hire anesthesiologists to provide the services. Some have tried. They assert that they cannot recruit anesthesiologists, primarily due to their remote locations and financial constraints. One administrator told the Governor that he was competing with a southern-tier hospital offering a $400,000 compensation package to anesthesiologist candidates. Even those rural facilities that have managed to hire one anesthesiologist and one or two nurse anesthetists cannot meet the federal physician supervision requirement around the clock. Without the opt-out, rural hospital administrators are left with the draconian decision to either risk being shut down for noncompliance by federal regulators, or curtailing services. Anesthesia services are most often required in surgical suites, emergency departments, and obstetrics for women in labor. As one emergency room physician recently stated, Without an operating room, you have no emergency room. Over time, these cuts in services will lead to the demise of the rural health care facilities. Patients in need of emergency and non-emergent services will have to travel great distances for the care that they now receive in their own communities from well-trained and highly regulated nurse anesthetists. Finally, sound health care policy decisions are not based on political agendas or special interest-funded polling they are based on facts. To learn the facts about the delivery of anesthesia care in New Hampshire, Governor Shaheen spent many months soliciting and analyzing input from all interested parties about this issue, including: surgeons; internists and family practitioners who refer patients for anesthesia services; obstetricians; emergency room providers; anesthesiologists; nurse anesthetists; hospital CEOs; the Boards of Nursing and Medicine; the N.H. Medical Society; the New Hampshire and American Societies of Anesthesiology; and, the N.H. Nurse Practitioner Association. The Governor made a sound decision based on the facts, not politics. This is a complex issue. It is easy to mislead and frighten people into drawing the wrong conclusion. I urge your readers to call the Governors office (271-2121/in N.H.: 800-852-3456), get the facts, and decide for themselves what is in the best interest of all New Hampshire citizens.