[n_g]

Originally Posted by stanman1968

It does not set "precedent" as the ruling was based on the louisina BON wording on the scope of practice. The only way this is a national pecedent or a precedent of any kind is if another state BON has the same problem with the same regulation.

The BON attempt at expanding scope without going through the legislature was the case that went to the Louisiana Supreme Court.

This is a different case. In this one, the plaintiffs wanted the courts to declare specifically that pain is medicine and not nursing.

If the appeals fail, how could this have national implications? Anywhere else in the country where there is a CRNA who is practicing pain, some MDA will file a lawsuit and ask the courts to declare that pain is medicine. Those courts will then carefully review this case to make their decisions.

[ready4crna?]

Originally Posted by n_g

The BON attempt at expanding scope without going through the legislature was the case that went to the Louisiana Supreme Court.

This is a different case. In this one, the plaintiffs wanted the courts to declare specifically that pain is medicine and not nursing.

If the appeals fail, how could this have national implications? Anywhere else in the country where there is a CRNA who is practicing pain, some MDA will file a lawsuit and ask the courts to declare that pain is medicine. Those courts will then carefully review this case to make their decisions.

n_g: Please study more than politics before making legal assertions (This is two now).
The challenge brought before the court was that the BON had not followed procedure in issuing an advisory statement to a single CRNA and that the statement was in effect a "rule" by the board which required procedurally more involvement than what was followed. The decision of "pain management is the exclusive practice of medicine" is well beyond the scope of this particular trial and due to this technicality will most likely result in some modification or kick back to the district for review. Should appeal not occur or for some unkown reason be unsuccessful, it still sets no precedent for other states unless similar circumstances exist that would make the case germaine (Ex-A crna petitions for a statement of scope and recieves it in a manner that violates that particular states rules and regulations for rule making.) Not that big of a landmark case except for the CRNAs in LA.

And now my dodgy friend-there is still the pending question as to your backround so that others may see the particular bias in your comments. (Mine is clear, as is jwk's and pain doc's.)

[Oldsalt]

Originally Posted by Qwiigley

In anesthesia, there is no diagnosing.

To be polite - that is inaccurate...identifying conditions or states based on their presentation is something that a good educated clinician does all the time....you have to make differential diagnosis all the time to accordance with surgical conditions

For example, In aggressive trauma resuc. or vascular cases - Using TEG how do you differentiate between the cause of delayed clot formation between anticoagulation or a true factor deficiency? or if the 25% rise in INR related to the blood loss or the 30ml/kg hespan that was given? or... Is the increase in BE related to volume issues or some other anion gap issue? or when consumptive coags. are refractory what is the next option?

These are all basic and rhetorical questions -

...we do advance diagnosis in the process of everyday procedures...day in and day out..

OS

[wtbcrna]

N G,

I have briefly read most of your 70+ odd posts, and it appears that you continue to degrade APNs in your posts. Now obvisously that may not be your intent, and merely my interpretation.

It does also appear rather obvious that for some reason you are ashamed of your educational level, because you refuse time and time again to enlighten us to your educational/motivational background.

Can your educational background be that bad?

[n_g]

CRNA's have nothing to worry about this little insignificant trial. They should just go on practicing pain. Nobody will care, right? It'll take a few years for this to all shake out. As far as I'm concerned, I'll wait to hear the rulings by the courts.

Look at this way. If the Louisiana ruling does stand, why wouldn't some MDA in a different state feel emboldened to challenge any CRNA who does pain? People who think that this is contained just to Louisiana are fooling themselves. This has national implications.

[wtbcrna]

Originally Posted by n_g

CRNA's have nothing to worry about this little insignificant trial. They should just go on practicing pain. Nobody will care, right? It'll take a few years for this to all shake out. As far as I'm concerned, I'll wait to hear the rulings by the courts.

Now N G, why are you so opposed to divulging your educational background? Have you even attended college? Well with no feedback from you I guess we are just to assume you either a) have no college education or b) are a pre-med student, but either way like to express the views from SDN.

I see no reason for any of us to continue to discuss this matter with you. Especially, when you can't be honest and forthright from the beginning.

[Qwiigley]

NG is right. We have to watch what is happening to our peers in other states. We have to be pro-active and not reactive. We need to support our state PAC and encourage others to do so. The A$A has TONS of money in their PACs and are very powerful.
Just one day's pay should be what you donate to your state PAC. That's not much to insure you can your scope of practice is well taken care of.
IMHO

[deepz]

Originally Posted by n_g

......It's not one judge. It went all the way to the Louisiana Supreme Court and they decided that pain management is medicine. .....

Sheesh. Get your facts straight before you insist the sky is falling.

From the AANA press release:

"In early January 2008, the Louisiana District Court, Judge Janice Clark, issued a judgment in favor of an anesthesiologist pain management group (Spine Diagnostics Center of Baton Rouge), and against the Louisiana State Board of Nursing (LSBN) and an individual CRNA who had performed chronic pain management procedures."

District court.

One judge.

And BTW, ng, what ARE your qualifications?

??

[ready4crna?]

Originally Posted by n_g

CRNA's have nothing to worry about this little insignificant trial. They should just go on practicing pain. Nobody will care, right? It'll take a few years for this to all shake out. As far as I'm concerned, I'll wait to hear the rulings by the courts.

Look at this way. If the Louisiana ruling does stand, why wouldn't some MDA in a different state feel emboldened to challenge any CRNA who does pain? People who think that this is contained just to Louisiana are fooling themselves. This has national implications.

Allow me to answer this question.

After this post, I will no longer try and get you to educate yourself as to how the courts work. Let me put it simply- It is not about a person becoming "emboldened" to sue over practice issues (If that were the true, I am sure that the ASA would keep as many autonomous CRNAs in court as possible.) One must have standing (i.e.-A reason) to have the courts hold more than a cursory review and summary dismissal. Yes, you can file a suit on anyone, any time, but you must have had a wrong that needs recourse to get to trial. In civil proceedings-If no laws or regulations have been broken causing a grievance and no damages to plaintiff occur, no trial will occur.There is no law that I am aware of against CRNAs doing pain management. There was a possible regulatory procedural violation in the LA case that allowed the court to hear argument. (I am not willing to concede that point yet, lets see how the higher courts rule.) Please see my previous post for an explanation as to why this case ruling was beyond the scope of the trial and would only be germaine in a suit of similar/exact circumstances.
And now back to the pending question- Your backround please?
Your refusal to answer the simple question of backround so that everyone can know where your bias lies speaks to character and honesty in a debate. Let everyone read your other posts and make a decision on whether to waste any more time on your statements and "advice" to APRN's. I for one will do my best to correct the fallacies and ignore the invectives you utter with regularity.

[paindoc]

My initial question was designed to gauge the CRNA perception of what defines the scope of practice.... Pain medicine has virtually nothing to do with anesthesiology and is a separate specialty. The scope of practice is partially defined by legislatures, state boards of medical and nursing practice, but the perception of what defines scope of practice is very interesting. For instance, since CRNAs treat heart conditions during surgery and in the ICU, what would prohibit CRNAs to train themselves in interventional cardiology and begin to do TEEs, echocardiograms, etc on patients? Then why not cardiac caths? The state boards of nursing defer to the AANA and the AANA may very well say the treatment of heart conditions is an extension of the practice of CRNA. This is exactly the parallel we are seeing in CRNAs experienced in OR and OB anesthesia beginning to practice spine surgery with one weekend of training by other CRNAs on cadavers. The scope of practice, as being defined by the AANA, permits treatment of ANY pain as long as the CRNA has training, even if the training is a single cadaver course without any proctoring or fellowship training. Since 80% of patient visits to physicians and NPs in the US are for pain, the CRNAs are in effect declaring war on medicine and are setting up their own parallel medical system based on weekend training courses. There is Zero interventional pain training available in CRNA schools throughout the country. Scope of practice is interestingly being defined by the AANA based on the POTENTIAL for being trained in a weekend course, rather than COA or AANA based long term training. There is simply no end to where CRNAs may take their scope of practice as they are now emboldened to take on the traditional medical boundaries. Ultimately, the practice of putting the cart before the horse may badly backfire for CRNAs that perceive their scope of practice to be whatever weekend course they can enroll into.