Florida needs help stopping AA use

Published Apr 12, 2004

1,093 Posts

hello all - this is a message from colleagues in Florida requesting help writing/calling representatives to stop House Bill 579. It is in our best interest to protect our patients!! help if you can - and thanks for reading all this. Andrea

I hate to bug you all with this, but I know that you are all movers and shakers in your states! I also don't want to be telling you in 2 weeks that FL lost the AA battle either, so...if 700 AAs can make a fuss, think of what 26,000 CRNAs can do! Please share this message with your state leaders or your own state's blast email list, then use the links below to contact our FL Representatives, and state your objections to the licensure and training of AAs in FL!!!!!! If you have particular experiences with AAs and their misadventures in your state, or how AAs have not worked out in your state, then say so! We are looking at stopping (House Bill) HB579. If you have trouble with the links, try doing a search for "FL House of Representatives" or link from the FL state official website, called, "myflorida.com" Please help!!! You wouldn't believe the tactics this year. Passing the AA bill is the #2 priority for the FMA!!! There's over 30 lobbyists working it. Al!

CALL AND EMAIL ALL MEMBERS OF THE HOUSE HEALTH APPROPRIATIONS SUBCOMMITTEE (LIST ATTACHED). THANK THE FOLLOWING MEMBERS FOR THEIR PAST OPPOSITION TO THE AA BILL, AND ASK THEM TO VOTE "NO" ON HB 579 WHEN IT COMES BEFORE THE SUBCOMMITTEE: REPRESENTATIVES GREEN, GARCIA AND ROBERSON. ASK ALL SUBCOMMITTEE MEMBERS TO OPPOSE HB 579, OR IF THEY CAN'T OPPOSE IT, TO SUPPORT AMENDMENTS TO TIGHTEN UP THE DEFINITION OF "DIRECT SUPERVISION" AND HOW TRAINEES ARE SUPERVISED.

CALL AND EMAILYOUR HOUSE MEMBER ( you can find your House member at the Florida House website: http://www.myfloridahouse.com/myrepresentative.aspx). WE NEED TO GET MANY PHONE CALLS AND EMAILS TO ALL HOUSE MEMBERS FROM PEOPLE WHO LIVE IN THEIR DISTRICT.

When calling or writing legislators, stress the following points - BUT PUT THEM IN YOUR OWN WORDS:

Please vote "NO" on HB 579. If you can't vote no, then by all means support amendments that would correct the following serious problems with the bill:

"Direct Supervision"

- The bill does not require that AAs be supervised only by a Board Certified Anesthesiologist.

- The bill does not specify how far away the supervising anesthesiologist must be from the AA being supervised.

- The bill does not require that the supervising anesthesiologist be present with the AA (or the patient) at any time before, during, or after surgery. Four other states require that the supervising anesthesiologist personally participate in the most demanding parts of the procedure - when the patient is put to sleep (induction) and when the patient wakes up (emergence).

o Number of AAs supervised - the bill allows the Board of Medicine to double (from 2 to 4) the number of AAs that can be supervised by one anesthesiologist at the same time.

o AA Trainees - the bill does not specify who must supervise AA trainees. This means a trainee could be supervised by a non-certified anesthesiologist or by a nurse anesthetist.

o Regional Anesthesia -- the bill allows AAs to administer regional anesthesia, even though the Emory AA program does not provide training in regional anesthesia.

No Prior Health Care Experience -- the bill does not require that AAs have any previous health care experience.

Other Points to Stress:

The bill is not necessary because PAs can become AAs and practice in Florida under current law.

This bill would let people with no prior health care training or experience bypass PA training and the PA licensure law. AAs are not PAs.

The definition of "direct supervision" in the bill needs to be revised. Under the current definition, the supervising anesthesiologist does not have to be board certified, and does not have to be in the same room with the AA at any time before, during or after the surgery.

AAs should only be supervised by a BOARD CERTIFIED ANESTHESIOLOGIST, and the anesthesiologist should be IN THE SAME ROOM OR AN ADJACENT ROOM OR HALLWAY.

The supervising anesthesiologist should personally participate in induction and emergence (4 other states require this).

An anesthesiologist should not supervise more than 1 AA at a time.

The FMA does not speak for all doctors on this bill. Many surgeons oppose AA licensure. MORE THAN 100 FLORIDA DOCTORS, INCLUDING 5 ANESTHESIOLOGISTS AND MANY SURGEONS, HAVE WRITTEN LETTERS OPPOSING THE AA BILL. In the words of one of the four surgeons who testified before the Senate Criminal Justice Committee: "Why should Florida settle for less qualified anesthesia assistants if there are enough well trained anesthesiologists and nurse anesthetists in this state?"

There is no shortage of anesthesia providers in Florida. The four Florida CRNA programs graduated nearly 100 new nurse anesthetists in 2003, and will graduate another 136 this year. And 88% of the Florida graduates practice in Florida after they graduate. These new graduates have met the need for anesthesia providers in this state, and will continue to do so in the future.

As are not as well qualified or trained -- Nurse anesthetists are highly educated and well-trained advanced practice nurses. Most nurse anesthetists have 5-7 years of critical care nursing experience before they enter a 28 month master's degree nurse anesthesia program. By contrast, AAs are not required to have any health care training or experience before they begin their anesthesia program.

The bill does not require the supervising anesthesiologist to be in the same operating room with the AA at any time before, during or after surgery. The bill requires only that the anesthesiologist be "present in the office or the surgical or obstetrical suite" - which may be far removed or even on different floors of the hospital.

AAs are not utilized by the U.S. Armed Forces. If the military has concluded that AAs should not be used, why should they be allowed to practice in Florida

AAs are not used in the VA -- despite a committee recommendation that AAs should be utilized, many questions raised by members of Congress have not been answered, and as a result there are no AAs in the VA.

AAs are not Physician Assistants -- Most AAs are not educated, trained, or certified as Physician Assistants (PAs). Graduates of the two AA programs do not meet the requirements for taking the PA certification exam. PAs have a generalist education in health care and often move among specialties. In contrast, AAs do not have a generalist education in health care and are only trained to deliver anesthesia care under the supervision of an anesthesiologist direction.

Approving AA licensure will make it more difficult to attract, recruit and retain nurses in Florida, and will make the nursing shortage in this state even worse. Although only a small number of RNs go on to become CRNAs (there are 180,000 RNs in Florida, as compared with 2,400 CRNAs), it is an avenue for advancement that keeps nurses in clinical nursing practice. Bringing in a new type of non-nurse provider to provide services that nurses now provide would be just one more indication of how Florida restricts advanced nursing practice, and will discourage people from going into nursing in Florida. The argument that AA licensure will in some way help the nursing shortage is pure fantasy.

AA training is more limited. According to the Emory AA program website, "the program does not provide clinical instruction in the administration of regional anesthesia." In contrast, nurse anesthetists receive instruction in the administration of all types of anesthesia, including general and regional anesthesia, conscious sedation, and monitored anesthesia care.

The cost of regulating a new profession is unjustified. The Board of Medicine estimates that the cost of regulating AAs will be more than $50,000 per year, which will create a deficit of more than $40,000 on an ongoing basis. The cost of regulating a new licensed profession cannot be justified in view of the financial problems already facing the Board of Medicine and the overall state budget.

WE CAN STILL DEFEAT THE AA BILL -- BUT IT WILL TAKE A CONCERTED EFFORT BY ALL CRNAs, SRNAs AND THEIR FRIENDS. CALL AND EMAIL YOUR HOUSE MEMBER TODAY!