In response to the commentary (BDN, May 27) by Dr. Thomas Floyd expressing his concerns over the proposed Health Care Finance Administration attempt to remove the supervision requirement for nurse anesthetists, several points made require a rebuttal.

Dr. Floyd’s praise and obvious respect for nurse anesthetists, as a profession, is commendable. The anesthesia care team he described, where nurse anesthetists work in collaboration with anesthesiologists to povide anesthesia care, is a concept that has worked well for many years in Maine hospitals and hospitals around the country.

Quality anesthesia care is also provided in hospitals that employ nurse anesthesists who are supervised by the operating surgeon. What was not mentioned, however, is that in 24 states (Maine not being one of them), nurse anesthetists can administer anesthesia without the supervision of an anesthesiologist or an operating surgeon. There are no studies that indicate anesthesia care given in those states is inferior or of less quality just because there is no supervision requirement. In those states, the present HCFA supervision requirement places a restriction on nurse anesthetists that the states felt was unnecessary.

Recognizing this, HCFA is now proposing removal of this supervision requirement at the federal level, and deferring to state rights. This is the portion of the HCFA proposal that is conveniently forgotten in this debate. It is not a question of mandated supervision, it is a state rights issue. HCFA is acknowledging that the state regulation boards are better qualified to determine quality anesthesia care for its citizens than a federal bureaucracy. HCFA’s mission is to regulate Medicare disbursement and safeguard against fraud, not to regulate clinical practice.

Sen. Lauch Faircloth, R-N.C., and Rep. David Weldon, R.-Fla., have a bill called the Safe Seniors Care Act that attempts to force HCFA to keep this supervision requirement under the guise that it will provide better-quality anesthesia care even though there are no studies that provide it would. What it will succeed in going, if passed, is to deny individual states the right to make their own decisions. Denying state rights is a curious approach for Republican congressmen.

There is further misconception that removal of this physician supervision requirement will result in less quality anesthesia care being provided. I am a nurse anesthetist who administers anesthesia care in a small rural hospital in central Maine. I have been providing anesthesia care at this facility for more than 12 years. Like many small rural hospitals around the country, there are no anesthesiolgosits employed by this facility. Under Maine state law, I practice under the supervision of the operating surgeon. This does not mean this physician is responsible for formulating the anesthesia plan nor is he responsible for administration of the anesthetic. This would be quite a feat since most surgeons do not have the anesthetic expertise to make such decisions and, at the time, the operating surgeon is quite busy performing the surgical procedure.

Supervision in this context means that a collaboration between the nurse anesthetist and the operating surgeon must be demonstrated in the formulation of the anesthetic plan and the administration of the anesthetic. Many legal precedents have also demonstrated that the surgeon does not even have a legal responsibility for the anesthetic administered by a nurse anesthetist. Surgeons can be sued for an anesthesia mishap regardless of whether the anesthesia provider is a nurse anesthetist or an anesthesiologist. In lieu of an anesthesiologist as part of my anesthesia care team, I rely on the other nurse anesthetist whom I work with, the operating surgeon, the patient’s primary physician, the in-house internist, the nurses and nursing assistants who provide 24-hour care for the patient, the pharmacist, the radiologist, the physician assistants, the radiology technicians, cardiopulmonary technicians, the numerous other allied health professionals who come into contact with the patient before, during or after his surgical procedure. I also have a consulting anesthesiologist who is always just a phone call away to provide guidance and advice for any anesthesia concerns I may have. Reliance on this anesthesia care team would not change if mandated physician supervision was no longer required. To do so would be absurd and dangreous. The fear that the quality of anesthesia care provided would change without mandated physician supervision, therefore, is unfounded.

When discussing the difference between nure anesthetists and anesthesiologsits, the level of education is always addressed. Idealistically, it always seems to make a difference when realistically everyone knows the level of education does not guarantee a competent practitioner in any profession. When an anesthesiologist attempts to compare the educational requirements of a nurse anesthetist and an anesthesiologist, inevitably the requirements for the nurse anesthsits are minimized in an attempt, I suppose, to demontrate the huge difference in education between the two professions.

To set the record straight, I offer the following description. Nurse anesthetists are not physicians. They are nurses with specialized training in anesthesia administration. Nurses were administering anesthesia in this country long before physicians became anesthesia providers. In today’s military, nurse anesthesia providers far outnumber physician anesthesia providers. To become a nurse anesthtists, one must graduate from a four-year baccalaurate nursing program and successfully complete a state licensure exam. He or she must then have a minimum of two years experience in a critical care nursing unit. In order to work in this unit, however, most hospitals require nurses to have at least one year of experience in a noncritical nursing unit. Anesthesia training requires two to three years of study in a master’s level program. Upon graduation, the nurse anesthetist to practice unless they have passed this certificiation exam. To become a nurse anesthetist, therefore, is a none- to 10-year commitment, not the six- to seven-year requirement that is so often quoted. In addition, man nurse anesthetists continue their post-graduate study in law or pursue doctorate degrees in pharmacology, nursing research, education, etc. Nurse anestheitsts are highly motivated, competent health care professionals. To minimuze their educational requirements is misleading and unfair.

Wouldn’t it be wonderful to live in a country where nurse anesthetists and anesthesiologists value each other’s input in providing anesthesia care to their patients. I, for one, am getting tired of the political bickering that has infested this profession.

Bruce Rioux, CRNA lives in Millinocket.