As we all know, it is perfectly legal in Florida or any state for a CRNA to administer anesthesia in the presence of a physician such as a gastroenterologist. But last week's report about a Florida endo center being forced to shut down because of, among other violations, its "use of unsupervised nurse anesthetist for procedure" left us scratching our heads.
We did some digging and discovered that the fact is, the Fort Myers Endoscopy Center was cited by the state of Florida last month for allowing a nurse anesthetist to deliver anesthesia while working with a practicing physician who lacked "qualifications to administer or supervise the administration of anesthesia."
The Florida Agency for Health Care Administration's Jan. 20 inspection report reveals that, in addition, the practicing physician hadn't been "granted privileges by the [facility's] governing body for him to perform 'gastroenterology surgery,'" a statement that suggests the real issue was the physician's lack of documented clinical privileges in general, not his specific lack of qualifications in the administration or supervision of anesthesia.
"It looks like the facility failed to have a governing body that assumed full responsibility of the legal and ethical conduct of the organization," explains FAHCA Public Information Officer Shelisha C. Durden.
The federal CRNA supervision rule only requires nurse anesthetists to deliver anesthesia under the supervision of a physician, whether it be a surgeon, anesthesiologist or other type of doctor. Some states have opted out of this rule, but no states require CRNAs to be supervised specifically by an anesthesiologist or a physician trained or privileged in the administration of anesthesia.
In addition to the practicing physician's lack of clinical privileges, the Florida inspectors found no documentation that the endoscopy center's governing body had granted clinical privileges to the CRNA delivering anesthesia on the day of the inspection (see item M006 in the report).
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