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Expanding nurse anesthetists’ scope of practice will not improve access to surgical care in rural areas

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Do you remember the movie, “Jurassic Park?”

It was based on what seemed like a brilliant idea: clone dinosaurs. It seemed a good solution — until, of course, everything went horribly wrong. It turns out that letting velociraptors roam free wasn’t just dangerous; it was also a spectacularly bad plan for solving humanity’s problems. Expanding the scope of practice of Certified Registered Nurse Anesthetists (CRNAs) feels a lot like that. In theory, it may sound like a good idea, but in practice, it’s risky and doesn’t deliver the ‘promised’ results.

Let’s dive into why.

The setup: Who are nurse anesthetists and what do they want?

Nurse anesthetists are skilled professionals who assist in delivering anesthesia, an essential part of the anesthesia care TEAM. However, some nurse anesthetists want to take on more than their training allows — like administering anesthesia without any supervision from a physician.  In fact, part of the failure was that Hammond thought he could go it alone and engage in something that was far outside of his league.

Spoiler alert:  it didn’t end well.”

The plot twists: Their arguments fall apart

Over the years, nurse anesthetists have tried several pitches to sell this bad idea, but each one crumbles under scrutiny:

— “It’s safe!”

A study they funded to show that letting them work alone wouldn’t harm patients, unfortunately, proved the opposite: patients were more likely to have serious complications, especially the really sick ones, proving that so-called “independent practice” was a dangerous proposition.

— “It will save money!”

Next, they argued that letting nurse anesthetists work solo would lower costs. But anesthesia billing doesn’t work that way — insurance pays the same regardless of who delivers the medicine. Plus, what is the cost of fixing mistakes from complications? Priceless (and not in the fun credit-card-commercial way).

— “It will help patients in rural areas get surgery faster!”

This is the latest claim: Letting nurse anesthetists work alone will cause them to relocate to rural communities. Sounds great, except for one problem: it’s not true. Florida already has a severe nurse shortage, and overloading nurse anesthetists with responsibilities they’re not trained for won’t suddenly fix it. Nor will they magically uproot themselves from well-paying jobs in urban areas to move into rural communities.

The facts: What science says

A new study from professors at Florida Atlantic University (FAU) — funded by the Florida Society of Anesthesiologists and the American Society of Anesthesiologists—looked into this rural access claim. This group of professors was approached because they had released several prior studies in this arena.  Spoiler alert: it’s not working and there is no evidence that it will work. States that expanded Nurse Anesthetists’ roles outside of their training (and allowed for independent practice) DID NOT see any increase in care for underserved rural areas.

The takeaway: Keep the team together

Nurse anesthetists are an important part of the anesthesia care team — emphasis on “team.” Like Jurassic Park, where things worked best when the experts stuck to their lanes (before the dinosaurs started eating everyone), anesthesia care needs strong leadership from physicians to stay safe and effective. Removing physician supervision isn’t just a bad idea—it’s a very real disaster waiting to happen. And especially in relation to their latest false claim, it won’t help solve Florida’s healthcare access in rural areas either.

Let’s focus on real solutions, not risky sequels no one asked for. After all, we’ve seen how those movies turn out — and to be sure, we are not talking about a movie thriller but a truly scary proposition.

When it comes to anesthesia, we know that the physician-led team model works.  It’s not just the safest but also the most cost-effective means of administering anesthesia medicine – and it is not science fiction but a proven scientific fact.

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Dr. Asha Padmanabhan, M.D. is a Board-Certified Anesthesiologist and the Florida Society of Anesthesiologists president.


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Politics

Disney World firefighter sues CFTOD for discrimination

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A Disney World firefighter is suing her employer and accusing the governing district of discrimination and creating a workplace that’s “intimidating, hostile, and offensive” in a new federal lawsuit.

Thinh Rappa, an Asian-American woman born in Vietnam, said she faced sex and race discrimination while working for the Central Florida Tourism Oversight District (CFTOD), which handles emergency services at Walt Disney World.

CFTOD did not immediately respond to a request for comment.

Rappa alleged that in 2021, a fellow male firefighter-paramedic was cooking dinner at the station when he told her, “Maybe you should speak English, Thinh,” according to her federal lawsuit filed in the U.S. District Court’s Orlando division. “He then slammed a ladle on the countertop and blurted out mockingly, ‘Ying, yang, yong, ping, pang, pong,’” her lawsuit said.

Rappa’s complaint alleged she was once on a 2022 call to a sick child having trouble breathing at an unnamed hotel, but her colleague insisted the boy was OK.

“See I got us out of there early and we get to go home now,” he told her afterward, Rappa said in her lawsuit.

Rappa responded by telling her coworker he acted unprofessionally and he should have brought the airbag from the fire engine to help the child she believed was suffering from Croup.

Her coworker “acted extremely defensively and shoved an ambulatory stretcher into Ms. Rappa so as to pin her between the stretcher and the wall, and yelled, ‘I am the medic here not you!’” Rappa’s lawsuit said. “Ms. Rappa was frightened for her life and attempted to deescalate the situation, responding, ‘I’m so sorry and you’re right. You do what you need to do.’”

Rappa said she complained to human resources and then was moved to a different fire station, a move she called punishment because it was known for high volume calls.

Rappa went on medical leave in May 2022 which she claimed was from post-traumatic stress disorder from working at the district. She returned to work in January 2023 and the lawsuit described Rappa as “presently working at the district.”

“As part of her job duties, Ms. Rappa was tasked with transporting patients to hospitals, rotating from fire trucks to rescue trucks, and assisting rescue trucks with their patients,” the lawsuit said.


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Judge tells agencies to restore webpages and data removed after Donald Trump’s executive order

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A federal Judge on Tuesday ordered government agencies to restore public access to health-related webpages and datasets that they removed to comply with an executive order by President Donald Trump.

U.S. District Judge John Bates in Washington agreed to issue a temporary restraining order requested by the Doctors for America advocacy group. The Judge instructed the government to restore access to several webpages and datasets that the group identified as missing from websites and to identify others that also were taken down “without adequate notice or reasoned explanation.”

On Jan. 20, his first day back in the White House, Trump signed an order for agencies to use the term “sex” and not “gender” in federal policies and documents. In response, the Office of Personnel Management’s (OPM) Acting Director required agency heads to eliminate any programs and take down any websites that promote “gender ideology.”

Doctors for America, represented by the Public Citizen Litigation Group, sued OPM, the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the Department of Health and Human Services.

The nonprofit group cited the executive order’s adverse impact on two of its members: a Chicago clinic doctor who would have consulted CDC resources to address a recent chlamydia outbreak in a high school and a Yale School of Medicine doctor who relies on CDC resources about contraceptives and sexually transmitted infections.

“These doctors’ time and effort are valuable, scarce resources, and being forced to spend them elsewhere makes their jobs harder and their treatment less effective,” the Judge wrote.

The case is among dozens of lawsuits challenging executive orders that Trump, a Republican, issued within hours of his second inauguration.

The scrubbed material includes reports on HIV prevention, a CDC webpage for providing clinicians with guidance on reproductive health care and an FDA study on “sex differences in the clinical evaluation of medical products.”

Removing important information from the CDC and FDA websites is delaying patient care, hampering research and hindering doctors’ ability to communicate with patients, the plaintiffs’ attorneys argued in a court filing.

“The agencies’ actions create a dangerous gap in the scientific data available to monitor and respond to disease outbreaks, halt or hamper key health research, and deprive physicians of resources that impact clinical practice,” they wrote.

Government lawyers argued that Doctors for America’s claims fall “well short of clearly showing irreparable harm” to any plaintiffs and are unlikely to succeed on their merits.

“Either failure provides a sufficient basis for denying extraordinary relief,” they wrote.

During a hearing Monday, the judge asked plaintiffs’ attorney Zachary Shelley if the removal of the online material harms the public. Shelley said the doctors’ interests align with their patients.

“There is immense harm to the public,” Shelley said. “There are massive threats to public health.”

The judge concluded that the harm in this case ultimately trickles down to “everyday Americans” seeking doctors’ care.

“If those doctors cannot provide these individuals the care they need (and deserve) within the scheduled and often limited time frame, there is a chance that some individuals will not receive treatment, including for severe, life-threatening conditions,” Bates wrote.

Doctors for America is a not-for-profit group representing more than 27,000 physicians and medical trainees. It was born from an earlier organization that pushed for health reform and supported Barack Obama, a Democrat, when he was running for president.

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Republished with permission of The Associated Press.


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Ron DeSantis says Casey ‘not seeking’ term as Governor … but it’s ‘flattering’ people keep mentioning it.

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Is a DeSantis dynasty imminent?

Not so fast, says Florida’s Governor, though he notes it’s “flattering” that it’s being discussed after reportage that First Lady Casey DeSantis is being talked up as a “very real” possibility as the logical successor to her husband as Governor, there may not be fresh polling.

“She’s a force of nature. I think people look at it, they say, ‘Well, the Governor won by 20 points. Obviously Casey would do better because she’s so much better’, but it’s not something that she’s seeking out,” Gov. Ron DeSantis said on the Ingraham Angle.

He believes that “a lot of people are just concerned about the future of the state,” which drives speculation.

“But this is not anything new,” he added. “People have been asking her to do this for a long time, but she’s not seeking to do anything. But it’s flattering that people are asking her to do it.”

Fresh reporting from Matt Dixon of NBC News says differently, with a “source familiar with her thinking” suggesting it’s a possibility.

“I would say this: I have heard donors have been urging her to run and that while it’s not something she has wanted to do, they are causing her to at least stop and listen,” Dixon cites his source.

Gov. DeSantis paints his wife as more ideologically pure than he is, which won’t stifle speculation.

“She’s one of the rare political spouses,” he told Ingraham. “Even though I’m probably the most conservative Governor in the country, she may even be more conservative than me.

Give the Governor credit for consistency: He said in May that if he “had to hypothesize her interest in getting into the political thicket as a candidate,” he would “characterize it as zero.”

That said, polls show Florida Republicans have more than “zero” interest in the DeSantis family remaining in the Governor’s Mansion.

Per a June polling memo from Florida Atlantic University, she leads a field of candidates with 43% support, ahead of Byron Donalds at 19%, with Jimmy Patronis and Matt Gaetz further back still.

poll conducted in April by FAU showed 38% of 372 Florida Republicans polled would choose the First Lady in a head-to-head race against Gaetz, who would receive 16% support in that scenario.

University of North Florida Public Opinion Research Lab survey from November 2023 showed the First Lady with 22% support, a lead in a crowded field of potential candidates.

While she previously acknowledged the talk is “humbling,” she also maintains that the seeming enthusiasm for her running is due to her “rock star” husband and the job he’s done as the state’s Chief Executive.

However, the buzz isn’t quieting, and the race will start to get real after Sine Die, so decision time is nigh for the former newscaster in the Jacksonville market.


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