South Florida Sun-Sentinel

July 22, 2002

Medicine board relaxes rule restricting nurse-anesthetists

By Glenn Singer
and Bob LaMendola HEALTH Writers

Coral Gables · Florida's nurse-anesthetists and cosmetic surgeons won some relief on Sunday from a state rule that, in the name of patient safety, restricts their ability to perform surgeries in doctors' offices.

The state Board of Medicine agreed to open a loophole in the rule, permitting nurse-anesthetists to continue to sedate patients during complex office surgeries if doctors supervising them meet guidelines suggesting they know how to deal with an office emergency. The board would approve the waivers upon recommendation of its surgical-care committee.

The office surgery rule forbids nurse-anesthetists from handling such procedures unless a physician anesthesiologist is on hand, in essence shutting the nurses out of the procedures.

"There's never been any evidence that nurse-anesthetists perform worse than anesthesiologists," said the medical board chairman, Zachariah P. Zachariah, a Fort Lauderdale cardiologist. "We ought to allow them to continue doing it, under certain circumstances."

Nurse-anesthetists have extra training in the field and are less costly than anesthesiologists, who have years more schooling. The nurses can earn more than $100,000 a year.

The medical board passed a series of tougher rules in 2000 after two years of wrangling about how to address dozens of deaths and hundreds of injuries during unregulated office surgery, mainly cosmetic procedures. Anesthesia caused some of the deaths. The anesthesia rule was tied up in legal actions until an appellate court upheld it in March. It took effect on April 15, and the medical board has been lobbied to relax it.

The nurses contend they are losing work and being punished unfairly. Cosmetic surgeons, who perform a large majority of an estimated 12,000 office surgeries annually, complained their costs had grown.

The board would not change the rule, but after hashing out the issue during a two-day meeting, agreed to a wide-ranging set of criteria to be used as guidelines that doctors should follow in requesting waivers.

Surgeons seeking waivers would not have to meet all the criteria in the guidelines, the board said, but would have to show overall competency to supervise anesthesia. Among the criteria are various board certifications, continued medical education in office-based anesthesia, completion of 500 surgeries involving supervision of nurse-anesthetists, and no reportable "adverse incidents" in the prior two years. The board said the surgical care committee also would consider disciplinary and malpractice history, financial responsibility, education, board certification and hospital staff privileges in considering waiver requests.