Scope of Practice

stanman1968 · Mar 6, 2008

NG if you had read the courses the advanced class (one whole extra day) involved SCS which is invasive, a 4 day class including vetebroplasty, epiduroscopy etc. These are pretty invasive my friend.

In addition it appears that you ignored the point of an earlier post that these "Basic" injections are the vast majority of pain procedures.

The outcome of paralysis is regretable but I am sure that there is at least one case of poor outcome with MD pain mangment.

Try again get some real information peer into the real world and then come back with an INFOMED OPINION instead of the SDN party line. You are looking more partisan and less informed in every post.

Home Health Columnist / Guide · Mar 6, 2008

if you want to do vertebroplasty, spinal cord stimulators, cervical injections add a four day course and you will be good to go.http://www.sppm.org/pdffiles/sppm_interventional_pain_course_sc.pdf
i think at this point we can see that there are a lot of doctor weekend pain warriors. the silence on the regulation of these practitioners will be deafening.

who should attend

[color=#231f20]this program is designed for physicians who are skilled at

[color=#231f20]performing basic injection techniques

[color=#231f20]http://www.sppm.org/pdffiles/sppm_interventional_pain_course_sc.pdf

:yeah:

Biotechnology · Mar 6, 2008

If you want to do vertebroplasty, spinal cord stimulators, cervical injections add a FOUR DAY course and you will be good to go.http://www.sppm.org/PDFfiles/SPPM_Interventional_Pain_Course_SC.pdf
I think at this point we can see that there are a lot of DOCTOR weekend pain warriors. The silence on the regulation of these practitioners will be deafening.

See........Now this is a darn shame!!!!:angryfire What in the world is going on in medicine today? This is scary!!!

I heard that an ophthomologist in our area is going to start doing some non-invasive procedure on varicose veins....something that they went to a weekend course to learn. What does an ophthomologist know about veins in the leg (invasive or not)?

stanman1968 · Mar 6, 2008

Iwould belive this outrage but I have to see a single thread court case or orginized effort to curb these providers, I do however here and see multiple efforts to limit non-physicians.

I am sorry your concern over these providers rings hollow.

stanman1968 · Mar 6, 2008

The basic injections learned at a 2 day course, wow a lot of training. I just am tired of hearing of unqualified CRNA's. The most unqualified are the doctors attending these courses and then performing procedures. All the posturing is just sickening.

n_g · Mar 6, 2008

Maybe you should bother to read what your degree says.

A medical license specifically states that a person is a doctor of medicine and surgery. A FP is a medically licensed professional.

What does your degree say? It says you are a nurse. Invasive procedures is not within the scope of nursing. In fact, no NP or CRNA curriculum has their students even do surgery rotations, ie, scrubbing in, taking care of post-op complications.

Furthermore, CRNA's would be opening a pandora's box with pain. I think that most if not all practice acts states that CRNA's give anesthesia under the direction of a supervising provider, ie, anesthesiologist, surgeon, dentist. You don't give anesthesia whenever you want. If CRNA's do pain, there is no supervising director. You have to know diagnosis, indications, and treatment. You would also be assuming all liability, ie, no one like a surgeon or anesthesiologist to hide behind if you screw up. If CRNA's do pain, then all CRNA's would expose themselves to more liability regardless if they do pain or not when something goes wrong because they have now established themselves as a group as truly independent providers. You can't have your cake and eat it too.

skipaway · Mar 6, 2008

Stanman and Skipaway, don't be so naive that you believe organized medicine is not outraged by fly by night organizations teaching MDs an entire medical specialty in a weekend or procedures in the same timeframe. We have and will continue to take action, and I will glady lend my expertise to plaintiffs that sue these unethical unprincipled physicians that place their pursuit of money over the safety of patients. There is no place in pain medicine for amateurs.

These courses are taken and taught by "organized medicine." I have yet to see, as stanman1968 pointed out, any organized effort to curtail these "unethical, unprincipled physicians." However, I do see efforts to curtail by any means possible my practice.

paindoc · Mar 7, 2008

Of course you haven't seen any evidence to curtail these course offerings since you are not either a program director or course director. I can assure you that behind the scenes it is exactly these discussions that are happening. As far as CRNAs go, if you want to do all the blind epidural steroids in the world given that many are simply ligament or muscle injections, I say go for it! No curtailing here!

Home Health Columnist / Guide · Mar 7, 2008

furthermore, crna's would be opening a pandora's box with pain. i think that most if not all practice acts states that crna's give anesthesia under the direction of a supervising provider, ie, anesthesiologist, surgeon, dentist. you don't give anesthesia whenever you want. if crna's do pain, there is no supervising director. you have to know diagnosis, indications, and treatment. you would also be assuming all liability, ie, no one like a surgeon or anesthesiologist to hide behind if you screw up. if crna's do pain, then all crna's would expose themselves to more liability regardless if they do pain or not when something goes wrong because they have now established themselves as a group as truly independent providers.

somehow you are missing the message that they are independent providers responsible for their own actions and held legally liable for acts omission and commission.

supervision

crna's develop their own care plan regarding the administration of anesthesia, type of anesthesia to be provided in relation to planned surgery, use of airway devices along with monitoring devices, which drugs, iv fluids and when they will administer them during surgical procedure and immediate post surgical airway management. they collaborate with the surgeon re this plan. when something goes wrong due to airway/anesthesia issues they are held responsible and assume the liability as solo provider or when care is negligent from acts they personnally commit under group practice.

crna's provide anesthesia services at the request of a physician, dentist or podiatrist. when performing pain manangment, same thing would occur: patients would be referred by a physician, dentist or podiatrist for the crna's pain managment expertise. i'm assuming that patients who self refer for consultation, crna's would confir with primary physician re need for pain mgmt eval and treatment and receive rx for pain mgmt "eval and treat" or written referral if required by insurance company.

this is similar to how i obtain referrals for my patients home health care services....can't provide skilled care without doctor request and care plan collaboration.

p.s. they've been eating cake longer than the 30+ years i've been practicing.

see pa state regs: 21.17. anesthesia.

the administration of anesthesia is a proper function of a registered nurse and is a function regulated by this section; this function may not be performed unless:
(1) the registered nurse has successfully completed the educational program of a school for nurse anesthetists accredited by the council on accreditation of education programs of nurse anesthesia of the american association of nurse anesthetists.
(2) the registered nurse is certified as a registered nurse anesthetist by the council on certification or on recertification of nurse anesthetists of the american association of nurse anesthetists.
(3) the certified nurse anesthetist is authorized to administer anesthesia in cooperation with a surgeon or dentist. the nurse anesthetist’s performance shall be under the overall direction of the chief or director of anesthesia services. in situations or health care delivery facilities where these services are not mandatory, the nurse anesthetist’s performance shall be under the overall direction of the surgeon or dentist responsible for the patient’s care.
(4) except as otherwise provided in 28 pa. code 123.7© (relating to dental anesthetist and nurse anesthetist qualifications), when the operating/anesthesia team consists entirely of nonphysicians, such as a dentist and a certified registered nurse anesthetist, the registered nurse anesthetist shall have available to her by physical presence or electronic communication an anesthesiologist or consulting physician of her choice.
(5) a noncertified registered nurse who has completed an approved anesthesia program may administer anesthesia under the direction of and in the presence of the chief or director anesthesia services or a board certified anesthesiologist until the announcement of results of the first examination given for certification for which she is eligible. if a person fails to take or fails to pass the examination, the person shall immediately cease practicing as a nurse anesthetist. if the applicant, due to extenuating circumstances, cannot take the first scheduled examination following completion of the program, the applicant shall appeal to the board for authority to continue practicing.
(b) for purposes of this section, ‘‘cooperation’’ means a process in which the nurse anesthetist and the surgeon work together with each contributing an area of expertise, at their individual and respective levels of education and training.
the provisions of this 21.17 adopted october 22, 1976, effective october 23, 1976

stanman1968 · Mar 7, 2008

Look ASIPP is the one holding these 4 day courses to teach vetebroplasty, this does not seem to be a way of limiting procedures to qualified pain practitioners. Sorry paindoc, ng your protests for patient saftery as the issue are as hollow as a chocolate easter bunny.

stanman1968 · Mar 8, 2008

I am not sure what has happened to other posts but I find the concern over public saftery doubtful when ASIPP is sponsering these conferencs, the qualifications to attend and participate are none, other then an MD. I just do not buy the idea that doctors are policing themselves, I just do not see it, however I see numerous efforts both personal and public to limit the practice of CRNA's

stanman1968 · Mar 8, 2008

Let me get this straight, if someone had a surgical rotation regardless of the duration or how long ago as long as they have MD they are good to go for invasive procedures?

Again to repeat to you NG ad nauseum, the vast majority of procedures we are speaking of are those "simple injections" not epiduroscopies, vertebroplasties etc. These procedures are not done frequently by anesthesiologists practicing pain.

"A FP is a medically licensed professional."

And I suppose my licence was issued by gandolf lord of the faeries? Oh look it is issued by the state, I too am a licensed medical professional.