Don’t dishonor our veterans by denying their choice of a physician

Our nation’s veterans have risked their lives fighting for our country. It is wrong to make them risk their lives now in the operating room because of a new policy that would prevent them from receiving the safest level of care under a physician anesthesiologist.

The U.S. Department of Veterans Affairs is considering a major policy change that would expand the duties of advanced-practice nurses – this would remove physician anesthesiologists from surgery and operating rooms and replace them with nurses.

The practice of anesthesia can be a highly complex and risky endeavor. Veterans are often sicker and have medical conditions that put them at greater risk for complications – these are the patients and cases who require the highest level of training. The VA system is plagued with enough challenges, and should not knowingly create increased anesthesia risk for its patients.

I was a nurse for four years prior to my medical training. I have a deep appreciation of the role nurses play, but I also have a deep understanding of how nurses and physicians are different.

Nursing training is often protocol-based and uses algorithms. Unfortunately, in an acute care setting like the operating room and intensive care unit, things happen quickly and are unpredictable.

When events do not unfold according to plan, one needs the training and expertise to make an immediate diagnosis, manage complications and direct patient care accordingly.

Our veterans should have access to care by physician anesthesiologists just like patients in non-VA hospitals across the country. Accepting anything less than a physician-led, team-based model creates a two-tier health system that is a disservice and dishonor to those who have served our country.

The impetus for the VA nursing policy proposal was the unacceptable wait times and lack of access to healthcare services at the VA due to shortages of some types of physicians. Government officials believed that expanding the role of advanced practice nurses could help address the backlog.

But despite the well-known challenges with primary care access, there is no shortage of physician anesthesiologists, and there is no need to make this change to improve access to anesthesia care.

Expanding nursing duties may be safe and acceptable for primary care or other specialties. But when it comes to anesthesiology, the risks are too high.

The 28,000 veterans who are served by the VA Central California Health Care System need and deserve physician anesthesiologists leading their anesthesia care. We should not accept a lower standard of care for this vulnerable population.

The Veterans Integrated Service Network that covers our region states on its website: “VISN 21 is committed to ensuring that Veterans have full access to the highest quality of care, and that patients and staff alike have high levels of satisfaction. Currently we face one of the most challenging times in VA and must restore trust and faith in VA health care services.”

Lowering the standard for patient safety by allowing nurses to deliver care without medical direction by an anesthesiologist will not help meet these goals. In order to deliver the safest care possible and restore trust in VA health services, it is essential that physician anesthesiologists maintain their role in anesthesia patient care.

The proposed policy is not a done deal. It was published in the Federal Register and is open for public comment until July 25 – which can be accessed by visiting SafeVACare.org. We must protect the health and safety of veterans by voicing opposition to this rule – they have fought for our country, now it’s our time to fight for them.

This story was originally published June 28, 2016 at 3:05 PM with the headline "Don’t dishonor our veterans by denying their choice of a physician."