By Bruce Weiner, Opinion Contributor - 10/19/2017
THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL
Back in January, the Department of Veterans Affairs (VA) passed on an opportunity to improve access to anesthesia care for military veterans—a decision that’s now coming home to roost. And it’s our veterans who are once again paying the price.
On Oct. 11, Fox News Denver reported that since the beginning of August, 65 to 90 surgeries have been canceled or postponed at the Denver Veterans Affairs Medical Center. According to the Eastern Colorado Health Care System, which operates the medical center, the delays are due to “a shortage of staff, specifically anesthesiologists and Certified Registered Nurse Anesthetists.”
Nine months ago, the VA claimed that there was not an access to anesthesia care problem in Veterans Health Administration (VHA) facilities, despite substantial evidence to the contrary gathered through a 2015 congressionally-mandated, independent assessment of VHA facilities. The assessment confirmed that due to lack of anesthesia support, veterans routinely experience delays for health care services such as cardiovascular surgery, colonoscopies, and procedures requiring anesthesia outside of the operating room. The VA dismissed this evidence, succumbing to intense political pressure from physician anesthesiologists. As a result, the VA reversed its own proposal to grant Certified Registered Nurse Anesthetists (CRNAs) full practice authority and enable all of the VA’s CRNAs and anesthesiologists to be utilized to the full extent of their education, training and licensure. This would have ensured our veterans increased access to surgery and other procedures requiring anesthesia services.
The problems at the Denver Veterans Affairs Medical Center reflect the problems of the VHA as a whole. The solution to anesthesia-related surgical delays at the Denver facility, as at other VHA facilities dealing with similar delays, is most likely right there under the administration’s nose: Just make full use of the CRNAs and anesthesiologists who work there. At the Denver facility, there are 10 CRNAs and eight anesthesiologists. Instead of having all 18 anesthesia professionals provide hands-on anesthesia care for 18 different patients, the facility uses a costly and inefficient anesthesia delivery model where for every two CRNAs providing hands-on patient care, there is one anesthesiologist available to assist those highly qualified CRNAs if needed. The result: Only 10 veterans are receiving care instead of a possible 18. By allowing VHA anesthesia departments to waste resources in this manner, the VA perpetuates the access-to-care problem and veterans pay the price with their health. It is even more astounding when one considers that since 2000 eight different research studies have confirmed the safety and cost-effectiveness of CRNAs.
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Bruce Weiner, DNP, MSNA, CRNA, is president of the American Association of Nurse Anesthetists, which represents more than 52,000 nurse anesthetists.