Do circulating nurses need to be in ORs for the entire procedure? Some facility administrators are debating this question in Pennsylvania, but the language in House Bill 1867 will give a clear answer: Yes.

The Circulating Nurse Act, which is scheduled for a state legislature vote on Jan. 29, would require that a circulating nurse be present for the duration of surgical procedures performed by physicians in healthcare facilities. Exceptions include cases performed in ASCs where the patient is not under general anesthesia or moderate sedation.

Rick Bloxdorf, the president of the Pennsylvania Ambulatory Surgery Association and an administrator at Village SurgiCenter in Erie, Pa., supports the bill, which has caused debate. "What some people are trying to do in the state of Pennsylvania is say that it isn't necessary to have an RN as the circulating nurse in the OR," he says. "That's something that AORN, and PASA, does not support. We believe a circulating nurse is important for the quality and efficiency of a procedure."

CMS regulations already require a circulating nurse to be present and free from other duties in order to assist during emergencies. However, these rules do not go far enough, says Catherine Becker, JD, MSPH, AORN's senior analyst for legislative affairs, because they don't require the nurse to be in the OR for the duration of the procedure. "States are trying to get a handle on healthcare, and by putting this wording into state law, the facilities gain a level of protection by assuming the patient care standards," she says.

Nathan Hall

The Medical Association of Georgia filed a motion to intervene in Superior Court last week in support of the state's general surgeons as they fight for recognition as a single specialty, a designation general surgeons enjoy in every other state. The MAG intervention is in response to a lawsuit filed in late December by the Georgia Alliance of Community Hospitals that aimed at negating a ruling by the Georgia Board of Community Health. The ruling would let the state's general surgeons build freestanding surgery centers without first going through a certificate of need process.

"Georgia's hospitals continue to oppose a measure that would greatly increase access to care and affordable treatment options for our patients," says MAG president Jack M. Chapman Jr., MD. "Hospital interference is simply not good medicine - rather, it stifles growth and limits a patient's choice in health care. MAG recognizes this and will fight for the rights of Georgia's citizens and general surgeons."

The MAG's intervention complements the opinion of Michael J. Bowers, Georgia's attorney general, who says that the Department of Community Health has the authority to designate general surgery as a single specialty for purposes of the CON act.

Similarly, a report in the Chattanooga Times Free Press says a Tennessee law passed in 2007 addressed the same situation as the current debate in Georgia. In Tennessee, general surgeons may now perform up to Level III surgeries (which require patients to be sedated) without going through the CON process, according to the Times Free Press.

Meanwhile, Alaska Gov. Sarah Palin has proposed a repeal of the state's CON program as part of her Health Care Transparency Act. The potential repeal stems from Gov. Palin's recognition that healthcare must be "market- and business-driven, rather than restricted by government." She also referenced a report conducted by the state's Health and Social Services organization that notes "a lack of data on whether the CON process actually accomplishes its intended purpose" of containing costs and improving access to healthcare for the state's citizens.

Daniel Cook

New Jersey's ASC physician-owners are breathing a slight sigh of relief now that State Senate President Richard Codey has introduced a bill that would exempt the state's 200 physician-owned surgical centers from a state law that prohibits self-referral.

In November, a state judge ruled that such physician-owned ASCs were violating the Codey Law, New Jersey's own version of the federal Stark Law (introduced in 1991 by Richard Codey), which prohibits a physician from referring a patient to a healthcare facility if the practitioner (or an immediate family member) has a financial interest. Although the centers have remained open, enforcement of the ruling could force them to close because it would forbid them to receive facility fee reimbursements.

The bill would allow currently operating centers to continue, but would prevent others from opening. In December, the New Jersey Board of Medical Examiners proposed an emergency amendment to its regulations that would broaden the definition of a physician's medical office to include a separate site where surgery is performed, allowing the centers to operate without violating the self-referral law. The board has not yet formally adopted the amendment, which requires the governor's approval.

Dan O'Connor