Under Fire, But Well Represented

Vol. 56, No. 1 / First Quarter 2013
The Official Publication of the Florida Society of Anesthesiologists / Serving Anesthesiologists and Patients
FSAPAC. . . . . . Page 4
“The FSA has undergone a change in
administration and management. … Changes
have already been implemented in the society
that will position us well for the future …”
Charles J. Chase, D.O., FSA President
Under Fire, But Well Represented
Health Care to
Dominate 2013
Session. . . . . . Page 5
ASA Component
News. . . . . . . . Page 6
A New
Win-Win. . . . . . Page 8
FSA Annual
Meeting. . . . . . Page 9
Calendar . . . Page 10
or the first time in over a decade,
the FSA has undergone a change
in administration and management. This
seamless transition was due to the efforts
of Barbara Berci and Christina Kasendorf
of BSC Management Inc. BSC has over
25 years of experience in association
management and meeting planning for 14
medical nonprofits. Christina Kasendorf
is the new executive director; please note
her contact information included within
this edition of FSA Today. Changes have
already been implemented in the society
that will position us well for the future via
lower expenses and the increased efficiency
of a larger management company that
has all services within its domain. We
are happy to have them finally on board.
I am excited about the opportunities we
have for an improved public relations
campaign that highlights the importance of
anesthesiologists’ involvement in providing
for patient safety.
Speaking of firing …
The Florida Association of Nurse
Anesthetists (FANA) has fired the first
shot in its annual legislative war to gain
unsupervised practice. Rep. Erik Fresen, a
land use consultant, is sponsoring a health
care bill that gives nurse anesthetists the
legal right to collaborate with physicians
through a protocol established for the
building (facility). Many problems could
arise from this arrangement. For example,
who makes the ultimate treatment decision
when there’s a disagreement? The nurse
with two to three years of training or the
physician? Who will be liable for the
outcome? The American Association of
Nurse Anesthetists (AANA) sponsored
a study that concluded more patients
died if a physician wasn’t supervising
the anesthesia team. Dr. J.P. Abenstein
concluded that 4.5 extra deaths occurred
for every 10,000 anesthetics if a physician
wasn’t supervising the anesthesia. Now is
the time for all FSA members to answer
the call to action to meet with legislators
and to educate the electorate on this
important matter. Floridians deserve the
best of care and should not be subject to
the confusion of an unsupervised nurse
anesthetist who introduces him or herself
as “Doctor.” Our state’s residents deserve
the best and the safest care provided by
highly trained physicians in all fields.
continued on page 3
FSA Today
is published quarterly
by the Florida Society
of Anesthesiologists
Inc., 701 Brickell
Avenue, Ste. 1550
Miami, FL 33131
786/300-3183
Editor: Lawrence S.
Berman, M.D.
All items for publication
should be submitted to
Christina Kasendorf,
FSA executive director,
at the above address
or via email: [email protected]
fsahq.org, or emailed to
Dr. Berman ([email protected]
anest.ufl.edu).
Unless otherwise noted,
all articles are the opinions
of the contributors, and
the FSA does not agree,
disagree or endorse any
services or products.
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Speaking of firing …
The military has the dubious
distinction of having fired
a warning shot at political
involvement. The military surgeon
general, who is a nurse anesthetist,
has issued an edict stating that
military anesthesiologists may
not continue to hold leadership
roles in the American Society
of Anesthesiologists (ASA) or
they will face discharge from
the service. JAG, the legal arm
of the military, believes the ASA
holds views at odds with military
standards, or substandards, as
may be the case. The chairman
of the ASA Committee on the
Anesthesia Care Team and many
others were forced to resign
mid-term. This is completely
unfair and untenable. The ASA
will be negatively impacted by
losing the service of many stellar
leaders. Can the assumption be
made that those military lawyers
are going to be forced to resign
from American Bar Association
leadership positions? So, with the
example of the military, do we
give the same ultimatum to the
nurse anesthetists in our groups
that hold leadership positions
in FANA (www.FANA.org/
leadership.asp)? As Americans,
we still believe in freedom of
speech, so this battle will have
to be won fairly by repeating
our mantra of physician-led
anesthesia ... advanced training,
less cost = lives saved.
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Speaking of firing …
Fire off those emails to the FSA
office and register to attend our
annual meeting, June 7-9, 2013, at
The Breakers in Palm Beach. It is
going to be a spectacular event and
a perfect chance to become involved
in the FSA. We have a large group
of dedicated anesthesiologists who
volunteer endless amounts of time
to help our profession weather
the political, clinical and financial
storms of our specialty. I would like
to thank them all for their tireless
efforts, including Dr. Jay Epstein, our
president-elect, who never seems to
sleep if email traffic is the standard.
Vol. 56 No. 1 / First Quarter 2013
Under Fire, But Well Represented, from page 1
Thank you all, and we’ll see you in
Palm Beach.
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Page 3
Physician Anesthesia Is in Jeopardy Today
A bill has been filed in the state legislature (HB 305) that would “authorize CRNAs to practice within a protocol
established in collaboration with (emphasis mine) rather than the approval of, the physicians and medical staff ...”
This seems like an innocuous change, but let me assure you, collaboration as used in this context will lead to
the elimination of physician supervision of CRNAs in the state of Florida. The Colorado courts supported the
CRNAs’ Opting Out of Medicare Supervision rule because their practice was legally defined as “collaborative,” and
therefore a requirement of supervision was not valid.
Let me reassure you that FSA’s leadership has been aggressively pursuing this issue. Who is FSA’s leadership? We
are anesthesiologists like you who volunteer our time to advance and support the practice of anesthesiology here in
Florida.
What do you need to do?
Now more than ever we need a strong FSAPAC. Access the link below and join the FSAPAC at the Circle of
Distinction ($1,000) or Chairman’s Council ($500) level. Entire groups like North Florida Anesthesia Consultants
have been contributing at this level routinely for years. They are known and respected in Tallahassee.
Last year 100% of the FSA Board of Directors supported the FSAPAC. Less than 15% of our general membership
did.
Kurt Markgraf, M.D.
Chairman, FSAPAC
Contributions to the FSAPAC can come from your group practice. Your contribution can be made as a monthly pledge. Any amount will be welcomed.
www.fsahq.org | [email protected]
Health Care to Dominate
2013 Session
by Jon Johnson, FSA Legislative Consultant
ealth care issues will likely
dominate discussions during
the 2013 Legislative Session, which
began Mar. 5. The Florida House
and Senate have each created a
Select Committee on the Patient
Protection Affordable Care Act
(PPACA) to explore Florida’s role
in the implementation of the federal
health care law as well as to decide
whether or not to expand the state’s
Medicaid system. Early signals from
members of the House’s leadership
indicate they are not interested in
pursuing Medicaid expansion. The
Senate’s leadership may be more
open to the idea, citing attractive
draw downs from the federal
government.
On a micro level, several scope of
practice issues will be circulating
through the chambers. The advanced
registered nurse practitioners
(ARNPs) will be filing legislation
that will allow them additional
Vol. 56 No. 1 / First Quarter 2013
Tallahassee Report
prescribing rights, including
prescribing controlled substances.
Additionally, the Florida Optometric
Society has filed similar legislation
(HB 239 by Rep. Matt Caldwell and
SB 278 by Sen. Garrett Richter) to
expand an optometrist’s prescribing
abilities to include ocular
pharmaceutical agents.
We are closely monitoring another
scope of practice issue that is
particularly important to FSA
members. The certified registered
nurse anesthetists (CRNAs) have
filed HB 305 by Rep. Erik Fresen to
decrease their existing requirement
to have a physician’s supervision to
mere “collaboration.” At this time,
there is no Senate companion to
HB 305; however, we expect a bill
to be filed soon.
We are working diligently to oppose
HB 305 and hope you will respond
if called to action. As always,
“We thank all of our
current FSAPAC
supporters...”
FSAPAC is one of the most effective
and integral tools in our society’s
active advocacy program. If you
haven’t participated before, we
hope you will consider becoming
an active part. We thank all of our
current FSAPAC supporters and
hope they will take an even more
active role this year so we are able
to work together to build upon our
continued success. Contributions
can be made by visiting
www.fsahq.org/donate-to-the-fsapolitical-action-committee-pac/.
Page 5
Florida Society of Anesthesiologists / FSA Today
State Component Society News
Federal Update
Click on the following links for
national news:
•
Cuts to Medicare Physician
Payments as Part of
Sequestration Increasingly
Likely
•
Voice Opposition to the
‘Company Model’
•
President Obama Delivers State
of the Union, Calls for More
Quality-Based Reforms to
Medicare
•
ASA Raises Concerns to FDA
About Proposed Changes to
Opioid Labeling
•
New Rules Require
Manufacturers to Report Gifts
and Meals to Physicians
•
FDA Provides Update Regarding
Ongoing Propofol Shortage:
Teva to Restart Production
State Legislatures Convene
At this point in the year, nearly
all state legislatures have
convened; many are considering
legislation that can help or hurt the
anesthesiology profession and the
patients anesthesiologists serve.
The professional and educational
backgrounds of state-level
lawmakers vary, but a constant
among most is they are not likely
anesthesiologists or even physicians.
To date, only two anesthesiologists
serve as members of a state
Page 6
legislature—American Society
of Anesthesiologists’ president,
Dr. John Zerwas (R-TX),
and Tennessee Society of
Anesthesiologists’ president,
Dr. Steve Dickerson (R-TN).
With the tens of thousands of bills
already introduced in 2013, it is
critical for lawmakers to have
knowledgeable individuals available
to explain the impact legislation
could have on their constituents.
Naturally, anesthesiologists are the
best advocates for their profession.
Unfortunately, non-physicians are
positioning themselves as resources
to lawmakers, sharing their beliefs
on anesthesia legislation and
claiming to know what is in the
best interests of anesthesiologists’
patients. Patient safety requires
anesthesiologists to make their
expertise available beyond the
operating room. Now more than
ever, legislators need your expertise
to make informed decisions on
how to vote for anesthesia-related
legislation.
To learn more about your
legislators and how you can
help protect and promote your
profession and patients, please
contact the American Society of
Anesthesiologists Division of
Advocacy at [email protected] or
by phone at 202/289-2222.
ASA Legislative Conference
– ‘Focus on the Future’
Don’t miss the premier grassroots
advocacy conference for
anesthesiologists, being held
Apr. 29-May 1, 2013, in
Washington, D.C. The ASA
Legislative Conference focuses
on state and federal legislative,
regulatory and political issues
impacting the ASA and
anesthesiology. The purpose of
the conference is to prepare ASA
members to engage effectively in the
legislative, regulatory and political
processes on behalf of the specialty.
A significant amount of time at the
conference will be spent briefing
attendees on the ASA’s priority
issues. Attendees will be provided
with information on the status
of key issues, points to be made
when speaking with lawmakers
and their staff, responses to
opponents’ arguments and other
helpful information to assure
full preparedness during “Hill”
meetings, as well as meetings with
state lawmakers. Position papers
and supporting documents will also
be provided as part of the briefings.
Additionally, ASA leadership and
staff will be available to answer any
questions. Register now for the ASA
Legislative Conference through
your state component society.
Visit https://www.asahq.org/ForMembers/Advocacy/LegislativeConference.aspx to learn more.
First Anesthesiologist
Elected to Tennessee
Senate
On Nov. 6, 2012, Steve
Dickerson, M.D., ASA member
and president of the Tennessee
Society of Anesthesiologists,
Dr. Dickerson, along with family,
friends, supporters and staff,
knocked on more than 60,000 doors
and made more than 100,000 voter
contacts throughout the campaign.
Dr. Dickerson is a practicing
anesthesiologist and a delegate to
the ASA House of Delegates. At
this time, ASA is aware of only
one other anesthesiologist, ASA
President John Zerwas, serving as
a member of a state legislature. Dr.
Zerwas is serving his fourth term in
the Texas House of Representatives.
Connecticut Board of
Education Approves New AA
Master’s Program
On Jan. 9, 2013, the Connecticut
State Board of Education
approved the creation of a new
Anesthesiologist Assistant Master of
Health Science (MHS) program at
Quinnipiac University.
The 27-month MHS program
will educate qualified individuals
to practice on an anesthesia care
team under the direction of an
anesthesiologist. Upon the new
program’s accreditation by the
Commission on Accreditation of
Allied Health Educational Programs
(CAAHEP), students will be
eligible during their last semester
to take the national certification
exam developed and administered
by the National Board of Medical
Examiners (NBME).
Anesthesiologist assistants are
non-physician anesthesia providers
“The purpose of the conference is to prepare ASA
members to engage effectively in the legislative, regulatory
and political processes on behalf of the specialty.”
who assist anesthesiologists in
developing and implementing
a patient’s anesthesia care plan.
Anesthesiologist assistants work
exclusively within the anesthesia
care team environment as described
by the ASA.
To date, eight accredited
anesthesiologist assistant education
programs exist nationwide,
with approximately 1,800
anesthesiologist assistants practicing
in 17 states, the District of Columbia
and the Veterans Affairs system.
In November 2012, the University
of Colorado Board of Regents also
approved a new Master of Science
in Anesthesiology program within
the University of Colorado School
of Medicine.
In 2013, anesthesiologist assistant
licensure is once again anticipated
to be a major legislative issue.
State legislatures in several states
are considering legislation on
the subject, which could allow
those states to replicate the
recent successes in Colorado and
Wisconsin. In 2012, legislation
was signed into law in Colorado
(2012 Colo. Sess. Laws 1051) and
Wisconsin (2011 Wisconsin Act
160) authorizing anesthesiologist
assistants, who had been practicing
under delegatory authority, to obtain
licensure.
Legal Success for Patients
in New Jersey and Oklahoma
On Dec. 12, 2012, the Superior
Court of New Jersey, Appellate
Division, upheld a New
Jersey Department of Health
(NJDOH) regulation requiring
anesthesiologists to supervise nurse
anesthetists when they administer
anesthesia in hospitals.
New Jersey Association of Nurse
Anesthetists, Inc. v. New Jersey
Department of Health and Senior
Services addressed the validity of
a regulation issued by the NJDOH
requiring the “physical presence
of a collaborating anesthesiologist
(CA) during induction, emergence
and critical change in status when an
Advanced Practice Nurse/Anesthesia
(APN/A) administers general or
major regional anesthesia, conscious
sedation or minor regional blocks in
a hospital.”
Vol. 56 No. 1 / First Quarter 2013
was elected to serve as state
senator for Tennessee’s 20th
District. Dr. Dickerson is the first
anesthesiologist elected to the
Tennessee State Senate and will be
one of only three physicians serving
in Tennessee’s upcoming legislative
session.
The New Jersey Association of
Nurse Anesthetists challenged the
physical presence requirement,
arguing among other things that
the NJDOH exceeded its authority.
In ruling against the New Jersey
Association of Nurse Anesthetists,
the court referenced previous case
law holding that the “administration
of anesthesia is, in fact, the ‘practice
of medicine’ since it is used in the
treatment of ‘human ailment, disease,
pain, injury, [or] deformity.’” The
court also drew a special distinction
between the nurses’ contention
that this rule regulated the nursing
profession and explained that the
rule was “... regulating the practice
of administering anesthesia in a
hospital setting.” Finally, the court
highlighted that it was within the
Department of Health’s authority
to “recognize the differences in
education, training and skill of
APN/As and anesthesiologists in
establishing anesthesia staffing
regulations.”
continued on page 8
Page 7
Florida Society of Anesthesiologists / FSA Today
State Component Society News, from page 7
The New Jersey State Society of
Anesthesiologists filed several
briefs on the case and also presented
arguments to the court, providing
an important perspective for its
deliberations.
On Dec. 13, 2012, Oklahoma’s
attorney general issued an
Attorney General Opinion (201221) with language favorable to
anesthesiology. Written at the
request of the Oklahoma Board of
Nursing, the opinion addressed:
•
The meaning of “timely on-site
consultation” with regard to the
actual physical presence of a
nurse anesthetist’s supervising
practitioner
•
Whether a nurse anesthetist’s
supervising practitioner must
be available for timely on-site
consultation throughout all
stages of the administration of
anesthesia
•
Whether the Board of Nursing
may distinguish between
analgesia and anesthesia
as related to supervision of
the nurse anesthetist by the
supervising practitioner
According to the opinion,
what constitutes timely on-site
consultation “… is left to the sound
medical judgment of the supervising
practitioner.” The opinion further
provided that under Oklahoma law,
the supervising practitioner need not
be on site in all instances in order
to be “available” for timely on-site
consultation. However, a nurse
anesthetist’s supervising practitioner
must be available for timely on-site
consultation at all recognized stages
of the administration of anesthetic
services.
Finally, the opinion determined
the Oklahoma Board of Nursing
may not promulgate rules defining
analgesia and anesthesia in such
a way that would allow less
supervision than is required by
statute.
The Oklahoma Society of
Anesthesiologists submitted written
materials to the Oklahoma Attorney
General’s Office and worked
with its staff to ensure a thorough
understanding of anesthesia delivery
and the practical implications these
answers could have on patient
safety.
© 2013 American Society of Anesthesiologists
Society News
A New FSA Win-Win
By Al Rothstein
f you are looking for a dream
vacation, or maybe a simple
gift basket, you will soon have
an opportunity to purchase items
like that while contributing to the
FSA—and you won’t have to leave
home to do it!
We are setting up an online auction
that you can visit anytime and
select from items donated by
FSA members, as well as special
travel opportunities arranged by
our auction company. BlueTree
Marketing, a Fort Lauderdale
company, offers the travel packages
and sets up the auction.
Page 8
The FSA will have a dedicated
event homepage that links to
the auction items and allows us
to promote them to all of our
members. When you see an item
displayed, you will also see the
minimum bid for that item. You
can start by entering that amount
or more. Subsequent bidders will
have to increase their bids by
certain increments until the time
limit for that item runs out.
You will also have the ability to refer
colleagues to the auction.
Once you have made a bid, you
will receive emails letting you
know when another bid on your
item has been placed.
Stay tuned for more information on
our online auction kickoff and how
to participate as we get closer to
creating this new FSA opportunity!
Register now!
Reserve your spot at the 2013 Annual Meeting today! Click here to register online.
Please continue to visit the FSA 2013 Annual Meeting
webpage in the coming months. More information will
be available soon regarding:
• Our distinguished lecturers
• Course topics, objectives and disclosures
• Social and family events
Hotel Reservations
The host hotel for the 2013 Annual Meeting will again
be The Breakers, Palm Beach.
The Breakers
One South County Road
Palm Beach, Florida
Call 1-888-BREAKERS and be sure to mention the FSA, or
use the online reservation link.
Rooms are available at The Breakers at the group
rate of $225 plus tax per night for deluxe category
rooms (maximum two adults, no children). More room
categories are also available at discounted rates. Please
visit the online reservations page to review the available
room categories and reserve your room today. The
block fills up quickly each year. Please do not delay—
reserve today!
Exhibitors and Sponsors
The 2013 vendor prospectus and trade show floor
plan will be available online by September 30. We
are exploring some new and exciting innovations for
you next year, including:
• Lead tracking systems
• Refreshed trade show layout and traffic flow
• Enhanced sponsorship opportunities
• Longer breaks and shorter trade show hours
for more quality time with attendees outside
the exhibit hall
• Fun ways to generate more visitors to your
booth, such as scheduled giveaway times
and a special social area for vendors and
attendees to network
We welcome suggestions and feedback from our
loyal supporters and exhibitors new to the FSA
meeting.
FSA Board of Directors
April 29-May 1, 2013
ASA Legislative Conference
J.W. Marriott
Washington, D.C.
www.asahq.org
June 7-9, 2013
FSA Annual Meeting
Patient Satisfaction
The Breakers
Palm Beach, Fla.
Hotel reservations and course
information online at
http://fsahq.org/2013AnnualMeeting.cfm
July 26-28, 2013
FMA Annual Meeting
Hilton Bonnet Creek
Orlando, Fla.
www.flmedical.org
October 12-16, 2013
ANESTHESIOLOGY 2013
ASA Annual Conference
Moscone Center
San Francisco, Calif.
www.asahq.org
Officers
ASA Delegates
President
Charles Chase, D.O.
ASA Director, Florida
David Varlotta, D.O.
President-Elect
Jay Epstein, M.D.
ASA Alternate Director, Florida
Jeffrey Jacobs, M.D.
Vice President
Jeffrey Jacobs, M.D.
ASA Delegate 1
J. Knox Kerr, M.D.
Secretary
Jonathan Slonin, M.D., M.B.A.
ASA Delegate 2
Rebecca Welch, M.D.
Treasurer
Steven Gayer, M.D.
ASA Delegate 3
Kurt Markgraf, M.D.
Assistant Treasurer
D. Kurt Jones, M.D.
ASA Delegate 4
Sonya Pease, M.D.
Immediate Past President
David Varlotta, D.O.
ASA Delegate 5
Michael Lewis, M.D.
District Directors
District Director 1 North
Mark Rice, M.D.
District Director 1 North
Brence Sell, M.D.
District Director 1 North
Chris Giordano, M.D.
District Director 2 Central
Frank Rosemeier, M.D.
District Director 2 Central
Clarkson Driggers, M.D.
District Director 2 Central
Greg Schroeder, M.D.
District Director 3 West
Devanand Mangar, M.D.
District Director 3 West
George Alvarez, M.D.
District Director 3 West
Russ Brockwell, M.D.
District Director 4 East
Sharon Ashley, M.D.
District Director 4 East
Adam Blomberg, M.D.
Florida CME Events
The American Society of
Anesthesiologists sponsors
CME courses throughout
Florida. For a complete listing of
ASA educational opportunities,
visit http://events.asahq.org.
District Director 4 East
Leopoldo Rodriguez, M.D.
District Director 5 South
David Birnbach, M.D.
District Director 5 South
Tom Fuhrman, M.D.
District Director 5 South
Gerald Rosen, M.D.
ASA Delegate 6
Leopoldo Rodriguez, M.D.
ASA Delegate 7
David Lubarsky, M.D.
ASA Delegate 8
Jeffrey Jacobs, M.D.
ASA Delegate 9
Jay Epstein, M.D.
ASA Delegate 10
Charles Chase, D.O.
ASA Delegate 11
Hector Vila, Jr., M.D.
ASA Delegate 12
Rafael Miguel, M.D.
ASA Delegate 13
Gary Richman, M.D.
ASA Delegate 14
Devanand Mangar, M.D.
ASA Delegate 15
Steven Gayer, M.D.
ASA Delegate 16
Jonathan Slonin, M.D., M.B.A.
ASA Delegate 17
D. Kurt Jones, M.D.
Executive Office
701 Brickell Avenue, Ste. 1550
Miami, FL 33131
786/300-3183
www.fsahq.org
Executive Director
Christina Kasendorf
[email protected]