Clinical Privileges, Not CRNA Supervision, at Issue in Fla. Endo Center

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).

Irene Tsikitas

Jury Clears Whistle-Blowing Nurse

A Texas jury promptly acquitted a nurse on trial and facing 10 years in prison for delivering medical file numbers to the Texas Medical Board in an anonymous whistle-blowing letter.

The jury unanimously agreed on Feb. 11 that Anne Mitchell, RN, did not misuse official information, a third-degree felony, when she and another nurse at Winkler County Memorial Hospital in Kermit wrote a letter to the medical board complaining about emergency medicine specialist Rolando G. Arafiles Jr., MD, who allegedly performed an emergency skin graft without surgical privileges, sutured a rubber tip to a patient's crushed finger and wrote improper prescriptions. The letter included 6 medical file numbers to investigate, according to a published report.

Ms. Mitchell and Vickilyn Galle, RN, wrote the letter in April and were fired in June from the hospital where they were compliance and quality improvement officers, after which they were arrested by the local sheriff's department.

Ms. Galle, whose criminal case was dismissed earlier this month, told the New York Times, "We're just in disbelief that you can be arrested for doing something you had been told your whole career was an obligation."

The case garnered national attention and outraged nurses. The Texas Nurses Association and the American Nurses Association created legal defense funds for the 2 and publicly criticized the officials prosecuting the case against them, arguing it would scare nurses from reporting justified offenses to authorities.

Ms. Mitchell hopes that's not the case. "I would say to every nurse, if you witness bad care, you have a duty to your patient to report it, no matter the personal ramifications," she told the Texas Nurses Association. "I was just doing my job."

Kent Steinriede

A Routine, But Not Risk-Free, Procedure

The death of a Pennsylvania congressman weeks after a minimally invasive gallbladder procedure has drawn attention to the risks ever present even in routine surgeries.

U.S. Rep. John Murtha, a Democrat from Johnstown, died at age 77 on Feb. 8 as a result of "major complications from surgery," according to physicians who treated him. Rep. Murtha had been hospitalized in December with gallbladder issues and underwent a laparoscopy cholecystectomy at the National Naval Medical Center in Bethesda, Md. In late January, a fever and infection brought him to the Virginia Hospital Center in Arlington, Va., where he died.

The Associated Press's national healthcare correspondent reports a congressional colleague's assertion that a nicked intestine caused the complications that led to Rep. Murtha's death. The article also highlights nicking the bile duct or liver, and delayed detection leading to infection, as rare but weighty risks involved in removing diseased or inflamed gallbladders by minimally invasive means.

"It should not happen, but sometimes, despite everyone's best efforts, it can happen," says a gastrointestinal specialist quoted in the article.

David Bernard

InstaPoll: Should Accreditation for Office Surgery Be Mandatory?

Ten states have passed laws requiring physicians who perform office-based surgery to do so only in fully accredited settings. Many others have some type of oversight for office-based surgery on their books. Should accreditation for office surgery be mandatory? Weigh in on this week's poll question. We'll report the results in this space next week.

Last week we asked what your surgeons complain about the most. Far and away, their most popular gripe is that the surgical schedule is not to their liking, which 56% of our 142 respondents selected. Surgeons also have something to say about the equipment (19%), the anesthesia team (13%), staff know-how (8%) and the lounge (4%).

Dan O'Connor

News & Notes
  • Tip of the week Letting each member of your nursing staff take a turn leading your facility's departments gives them a view on how and why your facility operates as it does, says Elizabeth Edel, RN, MN, CNOR, CNS. This educational process may take some coaching, she notes, but the result is confidence for the staff member and respect from others.

  • Fentanyl tech's plea deal Kristen Diane Parker, the surgical tech who infected patients at two Colorado surgical facilities with hepatitis C after stealing and tampering with fentanyl syringes, renewed her guilty plea in a Feb. 5 hearing at which a federal judge dismissed 28 of prosecutors' charges as part of the agreement. She still faces 5 counts each of tampering with a consumer product and obtaining a controlled substance by deceit or subterfuge, for which she is scheduled to be sentenced on Feb. 24. Ms. Parker had originally agreed to 20 years' imprisonment, which the judge rejected last month as insufficient.

  • BD recalls IV sets Medical device manufacturer BD is voluntarily recalling its Q-Syte luer access devices and Nexiva closed IV catheter systems due to concerns that the sets may cause air embolisms or may allow blood or medication leakage, which may result in serious patient injury or death. The company reports that it has investigated and fixed the problem.

  • Health industry issues reviewed Costs and regulatory concerns dominate consulting firm PricewaterhouseCoopers' "Top 10 Health Industry Issues in 2010," a report that advises facilities and practitioners to "step ahead of the changes" that rocked the industry in 2009 by "squeezing the most value out of new and current relationships, impending health reform and regulatory changes, and consumer demands." Even though federal healthcare reform efforts are currently stalled, the firm counts the potential aftermath as its number 1 issue, especially considering how stimulus funding for healthcare IT and infection prevention affected 2009. Other top issues addressed include "managing through the recession," changes in government reimbursement models and care delivery moving "out of traditional venues."