Gasline Newsletter June 2006

Volume 8, No. 1

CSA Dues/GASPAC Contributions

Annual CSA dues statements have been mailed and for the fifth year, dues have not increased. Members are urged to renew on the CSA Web Site at and to support GASPAC and the Legal Defense Fund. Advocacy in the legislature and in the courts is increasingly necessary to protect members' interests. GASPAC contributions support the access and visibility of CSA through Legislative Advocates Bill Barnaby Sr. and Jr. Legal advocacy, like CSA's ongoing lawsuit against the Board of Registered Nursing is costly, but essential. Ideally, members will donate the suggested amounts to those funds, but all levels of support help strengthen the CSA's ability to advocate in those vital arenas.

The CSA House of Delegates

The CSA House of Delegates met on May 20 at the annual meeting in Palm Springs. A full agenda included consideration of many interim board actions as well as several resolutions. The approved recommendations help set the Society's work plan over the next year. Highlights include the following.

Adoption of a policy statement entitled Coverage of Anesthesiology Services during Colonoscopy/Endoscopy:
The California Society of Anesthesiologists declares that it is appropriate for an anesthesiologist to provide anesthesia services during colonoscopy and/or other endoscopy examinations at the request of the patient or the physician performing the procedure.

The CSA affirms the policy that anesthesia services provided by an anesthesiologist for colonoscopy and/or other endoscopy should be a covered benefit when the physician performing the examination has requested such services.

Formation of a subcommittee of the Legislative and Practice Affairs Division to ascertain the legality of hospital and other facilities' anesthesia service contracts which deprive anesthesiologists of the opportunity to negotiate reasonable arrangements with third party payers or which impose unreasonable conditions upon those arrangements. The subcommittee will develop recommendations for solutions to these practices, which may include legislation.
The following policy statement on Intraoperative Awareness was adopted and will be disseminated broadly on the CSA Web Site. In addition, the link to the ASA brochure on patient awareness is available in the patient information section of the web site and here.
CSA Statement on Intraoperative Awareness

The CSA expresses its concern for any patient who experiences awareness under general anesthesia. While such awareness is a rare event, it is an area of discussion in the public arena. It is the intent of the CSA to educate and inform our patients and the public on the issue of intraoperative awareness in a straightforward manner.

Anesthesiologists are trained to minimize the occurrence of awareness under general anesthesia. It is recognized that on rare occasions, usually associated with a patient's critical condition, this may be unavoidable. Furthermore, it is commonplace in contemporary anesthetic practice to employ a variety of techniques using regional nerve blocks and varying degrees of sedation. Patients often do not make a distinction between these techniques and general anesthesia, yet awareness is often expected and anticipated with the former. This may have led to a misunderstanding of "awareness" during surgery by many patients.

New Member Solicitation

Other activities taking place over the next year include a new member solicitation, which is currently underway. In addition, the CSA will seek to obtain from the Medical Board a comprehensive list of anesthesiologists in the state. The Medical Board began collecting specialty information for the first time three years ago and by the end of 2006 will have completed collection from all physicians licensed in California. In addition, the CSA Web Site will be updated with enhancements and new material available in the Members Only section.

Educational Programs Division Survey

The Educational Programs Division will conduct a survey to learn members' opinions on how to make the annual meeting a valued benefit of CSA membership and to ascertain members' needs for CME and the most effective ways to meet those needs.

CSA/BRN Lawsuit

The Board of Registered Nursing has indicated its intention to adopt nurse anesthetist regulations this year, with a notice of regulation scheduled for June 16 and hearing on July 31. Presumably the regulations will seek to adopt the language in the BRN's practice advisory that prompted the CSA's lawsuit in 2005, which stated that nurse anesthetists are independent practitioners who may practice acute and chronic pain management. The CSA will vigorously oppose any attempt to adopt such regulations, citing ample legislative language, attorney general opinions, and Medicare conditions of participation that currently prohibit independent practice by nurse anesthetists.

Coverage for Anesthesia Care For Colonoscopy/Endoscopy

The CSA has been working with Senator Deborah Bowen's office on SB 1508, a bill intended to require coverage of anesthesia care if requested by the treating physician. The bill has endured several iterations, and was approved in the Senate on May 25. The bill is expected to be assigned to the Assembly Health Committee where amendments are expected.

Medi-Cal Labor Epidural Billing

In follow-up to a meeting with the Department of Health Services medical consultants regarding billing time units for labor epidurals administered to Medi-Cal patients, the CSA sent a letter with clarifying language for the billing instructions in the Medi-Cal manual. The CSA was invited to submit wording that would assist billing representatives by clarifying what is meant by "time in attendance" as specified in the manual. This clarification would encompass the entire time an anesthesia provider remains responsible for a continuous epidural nerve block during labor and delivery.

Support Correction of the “Anesthesia Teaching Rule�

A broadcast e-mail was recently sent to CSA members asking them to contact their congressional representatives to support correction of the "anesthesia teaching rule" which reduces payments to anesthesiology teaching programs when two residents are supervised concurrently. Representatives Clay Shaw (R-FL) and Pete Sessions (R-TX) have introduced legislation, H.R. 5246, that would restore full funding to anesthesiology teaching programs. Rep. Fortney "Pete" Stark (D-CA) has also introduced legislation, H.R. 5348, for this purpose.

Action still is needed; if you have not sent a letter, please do so. A model letter and contact information for congressional representatives are available on the ASA Web Site. This takes literally a few keystrokes and a moment of your time. Please take that moment to greatly assist the Resident Training Program that gave you your professional career.

ASA Survey of Anesthesia Practice Costs

Together with Medical Group Management Association, the ASA is engaged in its second annual extensive survey of anesthesia practice costs. Last year about 120 responses were received, but the ASA is hoping for much more participation in this year's survey. Please ask your billing staff or administrator to complete the questionnaire, if they haven't already done so, by June 23, 2006.

CSA Hawaiian Seminar

Register now for the CSA Hawaiian Seminar on the big island of Hawaii, October 30-November 3, 2006. Program Chair Alex Macario, M.D., MBA, has put together a wonderful program.

Mark Singleton, M.D.