This Week, What Does Veterans Day Mean to Us?

  • Hertzberg, Linda, MD, FASA
| Nov 11, 2015

Linda_HertzbergvaFor many of us, the last time we set foot in a hospital run by the Veterans Health Administration (VHA or VA) was during our residency. What you probably remember is that many of these patients had multiple medical conditions complicating their care, some service-related (whether officially acknowledged or not) and some due to lifestyle issues that may or may not have been service-related.

Often, these patients were among the sickest and most anesthetically challenging that we encountered during our residencies, perhaps even in our careers. Now those veterans’ access to physician-led anesthesia care is being threatened by the VA’s proposal to change how their hospitals deliver anesthesia care.

Over two years ago, the ASA learned of an impending new version of the VA Nursing Handbook, which would abandon the VA’s proven model of physician-led, team-based anesthesia care. Specifically, the new policy would mandate independent practitioner status for all VHA advanced practice nurses, superseding state law that might otherwise require supervision. In other words, veterans would not have a choice of physician anesthesiologist’s oversight of their care, if a nurse anesthetist delivered that care.

vahandbookWithin months, it became clear that the national political clamor surrounding the concomitant reports of VA patients’ insufficient access to ambulatory care, and the lack of opposition from the primary care specialties regarding the proposed changes in the VA Nursing Handbook, meant that there was virtually no chance of defeating this terrible proposal outright.

Not only would this proposed policy lower the quality of care that our veterans receive, but it would also set a terrible precedent for anesthesia care in other health care settings, despite numerous independent, peer-reviewed studies that have shown that patients have better outcomes when physicians are involved in their anesthesia care.

When the news was made public in 2013, 67 VA Chiefs of Anesthesia, Veterans Service Organizations (VSOs), AMVETS, and the Association of the U.S. Navy expressed their concerns to the highest levels of leadership at the VA about the proposed policy change. In addition, a bipartisan group of more than 80 lawmakers has contacted the VHA to date and expressed concerns about how the proposed Handbook could negatively impact patient safety for veterans. So far the VHA has declined to pull the as yet unreleased revision of the Nursing Handbook.

The ASA believes that the consternation caused by proposed independent practice by nurse anesthetists, including its associated denial of access to physician anesthesia care within the VA system, has delayed the publishing of the new Handbook in the Federal Register; multiple anticipated release dates have come and gone. However, ASA staff and leadership think that it will be published in the next few months in the Federal Register as originally written, and public comments will then be solicited. Furthermore, the ASA believes that the Veterans Administration hierarchy has decided to allow the volume and strength of the public comments received to decide the issue.

Therefore, in March the ASA Board of Directors approved the spending of $1.5 million from the society’s unrestricted reserves to fund the member engagement strategy on this issue.

The ASA is now planning and directing a massive public commentary response campaign from its members, their networks, and their families.

This project was kicked off at the recent ASA Annual meeting, where attendees were asked to submit their comments on the issue now in anticipation of the release of the Handbook. Roving members of the ASA staff were out in full force with iPads making it easy for members to submit their comments.

The success of this campaign rests on having an overwhelming number of anesthesiologists submit comments to the Federal Register. ASA’s stated goal is 20,000 comments, a 400 percent improvement over ASA’s previous record of 4,000 public comments submitted on a governmental policy issue. As one of the largest state component societies, we have an opportunity to play a significant role in achieving this goal.

Today, on this Veterans Day, we are asking all CSA members to immediately begin submitting their comments by visiting, where your comment will automatically be sent to the Federal Register. There is a sample letter that you can use or you can write your own personalized letter.

safevaTo be successful in this campaign, it is essential that every anesthesiologist in California assume the responsibility to not only respond, but to get at least another 10 people to do the same. These comments are critical to help ensure that the health and lives of veterans are not put at risk in VA hospitals.

When an emergency or complication occurs and seconds count, veterans deserve to have a physician anesthesiologist leading their care team. What better way to honor our nation’s veterans than by preserving their access to the highest quality, physician-led care?

Remember, Protect Safe VA Care!

Michael Champeau, MD also contributed to this article.

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