Vol. 56, No. 1 / First Quarter 2013 The Official Publication of the Florida Society of Anesthesiologists / Serving Anesthesiologists and Patients FSAPAC. . . . . . Page 4 “The FSA has undergone a change in administration and management. … Changes have already been implemented in the society that will position us well for the future …” Charles J. Chase, D.O., FSA President Under Fire, But Well Represented Health Care to Dominate 2013 Session. . . . . . Page 5 ASA Component News. . . . . . . . Page 6 A New Win-Win. . . . . . Page 8 FSA Annual Meeting. . . . . . Page 9 Calendar . . . Page 10 or the first time in over a decade, the FSA has undergone a change in administration and management. This seamless transition was due to the efforts of Barbara Berci and Christina Kasendorf of BSC Management Inc. BSC has over 25 years of experience in association management and meeting planning for 14 medical nonprofits. Christina Kasendorf is the new executive director; please note her contact information included within this edition of FSA Today. Changes have already been implemented in the society that will position us well for the future via lower expenses and the increased efficiency of a larger management company that has all services within its domain. We are happy to have them finally on board. I am excited about the opportunities we have for an improved public relations campaign that highlights the importance of anesthesiologists’ involvement in providing for patient safety. Speaking of firing … The Florida Association of Nurse Anesthetists (FANA) has fired the first shot in its annual legislative war to gain unsupervised practice. Rep. Erik Fresen, a land use consultant, is sponsoring a health care bill that gives nurse anesthetists the legal right to collaborate with physicians through a protocol established for the building (facility). Many problems could arise from this arrangement. For example, who makes the ultimate treatment decision when there’s a disagreement? The nurse with two to three years of training or the physician? Who will be liable for the outcome? The American Association of Nurse Anesthetists (AANA) sponsored a study that concluded more patients died if a physician wasn’t supervising the anesthesia team. Dr. J.P. Abenstein concluded that 4.5 extra deaths occurred for every 10,000 anesthetics if a physician wasn’t supervising the anesthesia. Now is the time for all FSA members to answer the call to action to meet with legislators and to educate the electorate on this important matter. Floridians deserve the best of care and should not be subject to the confusion of an unsupervised nurse anesthetist who introduces him or herself as “Doctor.” Our state’s residents deserve the best and the safest care provided by highly trained physicians in all fields. continued on page 3 FSA Today is published quarterly by the Florida Society of Anesthesiologists Inc., 701 Brickell Avenue, Ste. 1550 Miami, FL 33131 786/300-3183 Editor: Lawrence S. Berman, M.D. All items for publication should be submitted to Christina Kasendorf, FSA executive director, at the above address or via email: christina@ fsahq.org, or emailed to Dr. Berman (lberman@ anest.ufl.edu). Unless otherwise noted, all articles are the opinions of the contributors, and the FSA does not agree, disagree or endorse any services or products. Practicing medicine these days can be like swimming with sharks. As a healthcare provider, you deal with risk daily. In fact, in a highly litigious environment, statistics demonstrate there’s a one in eight chance you’ll be sued this year and 40% chance you’ll have a claim filed against you in the next five. These suits often seek millions of dollars, jeopardizing your personal assets and reputation. But if you’re with Medical Protective, you’re safe. Last year alone, our healthcare providers won 93% of their trials and thousands of claims were dismissed without liability or payment–over 90% in many jurisdictions. Trust the insurance carrier that provides you over a century of experience delivering the strongest defense for your assets and reputation. Make Medical Protective your steel cage. FREE nationally recognized anesthesia CME program for new customers. Call 800-4MEDPRO for details. All products are underwritten by either The Medical Protective Company® or National Fire and Marine Insurance Company,® both Berkshire Hathaway businesses. Product availability varies based upon business and regulatory approval and may be offered on an admitted or non-admitted basis. ©2011 The Medical Protective Company.® All Rights Reserved. Speaking of firing … The military has the dubious distinction of having fired a warning shot at political involvement. The military surgeon general, who is a nurse anesthetist, has issued an edict stating that military anesthesiologists may not continue to hold leadership roles in the American Society of Anesthesiologists (ASA) or they will face discharge from the service. JAG, the legal arm of the military, believes the ASA holds views at odds with military standards, or substandards, as may be the case. The chairman of the ASA Committee on the Anesthesia Care Team and many others were forced to resign mid-term. This is completely unfair and untenable. The ASA will be negatively impacted by losing the service of many stellar leaders. Can the assumption be made that those military lawyers are going to be forced to resign from American Bar Association leadership positions? So, with the example of the military, do we give the same ultimatum to the nurse anesthetists in our groups that hold leadership positions in FANA (www.FANA.org/ leadership.asp)? As Americans, we still believe in freedom of speech, so this battle will have to be won fairly by repeating our mantra of physician-led anesthesia ... advanced training, less cost = lives saved. Lancet Indemnity RRG “The Insurance Co. Physicians TRUST” Physician Owned and Directed Managed by Professional Liability Specialists • • • • • Speaking of firing … Fire off those emails to the FSA office and register to attend our annual meeting, June 7-9, 2013, at The Breakers in Palm Beach. It is going to be a spectacular event and a perfect chance to become involved in the FSA. We have a large group of dedicated anesthesiologists who volunteer endless amounts of time to help our profession weather the political, clinical and financial storms of our specialty. I would like to thank them all for their tireless efforts, including Dr. Jay Epstein, our president-elect, who never seems to sleep if email traffic is the standard. Vol. 56 No. 1 / First Quarter 2013 Under Fire, But Well Represented, from page 1 Thank you all, and we’ll see you in Palm Beach. “I have been with Lancet from the beginning. It seemed too good to be true that I could have effective insurance and the cost was the most competitive. My insurance costs have never been lower and I have never looked back.” ~ Ralph Rosato, M.D. ~ Why Lancet? ~ 2000+physicianpolicyholdersandgrowing InHouseClaimscommitteeconsistingofphysicians LancetisreinsuredbycertainunderwritersatLloyd’s InnovativeUnderwritingcapabilitiestoinsurereducedpremiums IncludedCoverages: a. $10,000ofvoluntarymedicalpayments b. $25,000ofadministrativeactionsdefense c. Uptolifetimeextendedreportingendorsementincludingdeath,disabilityandretirement d. E-Meddefensecoverage’s a. STARK c. HIPPA e. LocumTenensCoverage b. EMTAL d. MedicalRecords TollFree:877-370-2262•Tel:813-290-8282•Fax:813-290-7070•www.lancetindemnity.com Page 3 Physician Anesthesia Is in Jeopardy Today A bill has been filed in the state legislature (HB 305) that would “authorize CRNAs to practice within a protocol established in collaboration with (emphasis mine) rather than the approval of, the physicians and medical staff ...” This seems like an innocuous change, but let me assure you, collaboration as used in this context will lead to the elimination of physician supervision of CRNAs in the state of Florida. The Colorado courts supported the CRNAs’ Opting Out of Medicare Supervision rule because their practice was legally defined as “collaborative,” and therefore a requirement of supervision was not valid. Let me reassure you that FSA’s leadership has been aggressively pursuing this issue. Who is FSA’s leadership? We are anesthesiologists like you who volunteer our time to advance and support the practice of anesthesiology here in Florida. What do you need to do? Now more than ever we need a strong FSAPAC. Access the link below and join the FSAPAC at the Circle of Distinction ($1,000) or Chairman’s Council ($500) level. Entire groups like North Florida Anesthesia Consultants have been contributing at this level routinely for years. They are known and respected in Tallahassee. Last year 100% of the FSA Board of Directors supported the FSAPAC. Less than 15% of our general membership did. Kurt Markgraf, M.D. Chairman, FSAPAC Contributions to the FSAPAC can come from your group practice. Your contribution can be made as a monthly pledge. Any amount will be welcomed. www.fsahq.org | [email protected] Health Care to Dominate 2013 Session by Jon Johnson, FSA Legislative Consultant ealth care issues will likely dominate discussions during the 2013 Legislative Session, which began Mar. 5. The Florida House and Senate have each created a Select Committee on the Patient Protection Affordable Care Act (PPACA) to explore Florida’s role in the implementation of the federal health care law as well as to decide whether or not to expand the state’s Medicaid system. Early signals from members of the House’s leadership indicate they are not interested in pursuing Medicaid expansion. The Senate’s leadership may be more open to the idea, citing attractive draw downs from the federal government. On a micro level, several scope of practice issues will be circulating through the chambers. The advanced registered nurse practitioners (ARNPs) will be filing legislation that will allow them additional Vol. 56 No. 1 / First Quarter 2013 Tallahassee Report prescribing rights, including prescribing controlled substances. Additionally, the Florida Optometric Society has filed similar legislation (HB 239 by Rep. Matt Caldwell and SB 278 by Sen. Garrett Richter) to expand an optometrist’s prescribing abilities to include ocular pharmaceutical agents. We are closely monitoring another scope of practice issue that is particularly important to FSA members. The certified registered nurse anesthetists (CRNAs) have filed HB 305 by Rep. Erik Fresen to decrease their existing requirement to have a physician’s supervision to mere “collaboration.” At this time, there is no Senate companion to HB 305; however, we expect a bill to be filed soon. We are working diligently to oppose HB 305 and hope you will respond if called to action. As always, “We thank all of our current FSAPAC supporters...” FSAPAC is one of the most effective and integral tools in our society’s active advocacy program. If you haven’t participated before, we hope you will consider becoming an active part. We thank all of our current FSAPAC supporters and hope they will take an even more active role this year so we are able to work together to build upon our continued success. Contributions can be made by visiting www.fsahq.org/donate-to-the-fsapolitical-action-committee-pac/. Page 5 Florida Society of Anesthesiologists / FSA Today State Component Society News Federal Update Click on the following links for national news: • Cuts to Medicare Physician Payments as Part of Sequestration Increasingly Likely • Voice Opposition to the ‘Company Model’ • President Obama Delivers State of the Union, Calls for More Quality-Based Reforms to Medicare • ASA Raises Concerns to FDA About Proposed Changes to Opioid Labeling • New Rules Require Manufacturers to Report Gifts and Meals to Physicians • FDA Provides Update Regarding Ongoing Propofol Shortage: Teva to Restart Production State Legislatures Convene At this point in the year, nearly all state legislatures have convened; many are considering legislation that can help or hurt the anesthesiology profession and the patients anesthesiologists serve. The professional and educational backgrounds of state-level lawmakers vary, but a constant among most is they are not likely anesthesiologists or even physicians. To date, only two anesthesiologists serve as members of a state Page 6 legislature—American Society of Anesthesiologists’ president, Dr. John Zerwas (R-TX), and Tennessee Society of Anesthesiologists’ president, Dr. Steve Dickerson (R-TN). With the tens of thousands of bills already introduced in 2013, it is critical for lawmakers to have knowledgeable individuals available to explain the impact legislation could have on their constituents. Naturally, anesthesiologists are the best advocates for their profession. Unfortunately, non-physicians are positioning themselves as resources to lawmakers, sharing their beliefs on anesthesia legislation and claiming to know what is in the best interests of anesthesiologists’ patients. Patient safety requires anesthesiologists to make their expertise available beyond the operating room. Now more than ever, legislators need your expertise to make informed decisions on how to vote for anesthesia-related legislation. To learn more about your legislators and how you can help protect and promote your profession and patients, please contact the American Society of Anesthesiologists Division of Advocacy at [email protected] or by phone at 202/289-2222. ASA Legislative Conference – ‘Focus on the Future’ Don’t miss the premier grassroots advocacy conference for anesthesiologists, being held Apr. 29-May 1, 2013, in Washington, D.C. The ASA Legislative Conference focuses on state and federal legislative, regulatory and political issues impacting the ASA and anesthesiology. The purpose of the conference is to prepare ASA members to engage effectively in the legislative, regulatory and political processes on behalf of the specialty. A significant amount of time at the conference will be spent briefing attendees on the ASA’s priority issues. Attendees will be provided with information on the status of key issues, points to be made when speaking with lawmakers and their staff, responses to opponents’ arguments and other helpful information to assure full preparedness during “Hill” meetings, as well as meetings with state lawmakers. Position papers and supporting documents will also be provided as part of the briefings. Additionally, ASA leadership and staff will be available to answer any questions. Register now for the ASA Legislative Conference through your state component society. Visit https://www.asahq.org/ForMembers/Advocacy/LegislativeConference.aspx to learn more. First Anesthesiologist Elected to Tennessee Senate On Nov. 6, 2012, Steve Dickerson, M.D., ASA member and president of the Tennessee Society of Anesthesiologists, Dr. Dickerson, along with family, friends, supporters and staff, knocked on more than 60,000 doors and made more than 100,000 voter contacts throughout the campaign. Dr. Dickerson is a practicing anesthesiologist and a delegate to the ASA House of Delegates. At this time, ASA is aware of only one other anesthesiologist, ASA President John Zerwas, serving as a member of a state legislature. Dr. Zerwas is serving his fourth term in the Texas House of Representatives. Connecticut Board of Education Approves New AA Master’s Program On Jan. 9, 2013, the Connecticut State Board of Education approved the creation of a new Anesthesiologist Assistant Master of Health Science (MHS) program at Quinnipiac University. The 27-month MHS program will educate qualified individuals to practice on an anesthesia care team under the direction of an anesthesiologist. Upon the new program’s accreditation by the Commission on Accreditation of Allied Health Educational Programs (CAAHEP), students will be eligible during their last semester to take the national certification exam developed and administered by the National Board of Medical Examiners (NBME). Anesthesiologist assistants are non-physician anesthesia providers “The purpose of the conference is to prepare ASA members to engage effectively in the legislative, regulatory and political processes on behalf of the specialty.” who assist anesthesiologists in developing and implementing a patient’s anesthesia care plan. Anesthesiologist assistants work exclusively within the anesthesia care team environment as described by the ASA. To date, eight accredited anesthesiologist assistant education programs exist nationwide, with approximately 1,800 anesthesiologist assistants practicing in 17 states, the District of Columbia and the Veterans Affairs system. In November 2012, the University of Colorado Board of Regents also approved a new Master of Science in Anesthesiology program within the University of Colorado School of Medicine. In 2013, anesthesiologist assistant licensure is once again anticipated to be a major legislative issue. State legislatures in several states are considering legislation on the subject, which could allow those states to replicate the recent successes in Colorado and Wisconsin. In 2012, legislation was signed into law in Colorado (2012 Colo. Sess. Laws 1051) and Wisconsin (2011 Wisconsin Act 160) authorizing anesthesiologist assistants, who had been practicing under delegatory authority, to obtain licensure. Legal Success for Patients in New Jersey and Oklahoma On Dec. 12, 2012, the Superior Court of New Jersey, Appellate Division, upheld a New Jersey Department of Health (NJDOH) regulation requiring anesthesiologists to supervise nurse anesthetists when they administer anesthesia in hospitals. New Jersey Association of Nurse Anesthetists, Inc. v. New Jersey Department of Health and Senior Services addressed the validity of a regulation issued by the NJDOH requiring the “physical presence of a collaborating anesthesiologist (CA) during induction, emergence and critical change in status when an Advanced Practice Nurse/Anesthesia (APN/A) administers general or major regional anesthesia, conscious sedation or minor regional blocks in a hospital.” Vol. 56 No. 1 / First Quarter 2013 was elected to serve as state senator for Tennessee’s 20th District. Dr. Dickerson is the first anesthesiologist elected to the Tennessee State Senate and will be one of only three physicians serving in Tennessee’s upcoming legislative session. The New Jersey Association of Nurse Anesthetists challenged the physical presence requirement, arguing among other things that the NJDOH exceeded its authority. In ruling against the New Jersey Association of Nurse Anesthetists, the court referenced previous case law holding that the “administration of anesthesia is, in fact, the ‘practice of medicine’ since it is used in the treatment of ‘human ailment, disease, pain, injury, [or] deformity.’” The court also drew a special distinction between the nurses’ contention that this rule regulated the nursing profession and explained that the rule was “... regulating the practice of administering anesthesia in a hospital setting.” Finally, the court highlighted that it was within the Department of Health’s authority to “recognize the differences in education, training and skill of APN/As and anesthesiologists in establishing anesthesia staffing regulations.” continued on page 8 Page 7 Florida Society of Anesthesiologists / FSA Today State Component Society News, from page 7 The New Jersey State Society of Anesthesiologists filed several briefs on the case and also presented arguments to the court, providing an important perspective for its deliberations. On Dec. 13, 2012, Oklahoma’s attorney general issued an Attorney General Opinion (201221) with language favorable to anesthesiology. Written at the request of the Oklahoma Board of Nursing, the opinion addressed: • The meaning of “timely on-site consultation” with regard to the actual physical presence of a nurse anesthetist’s supervising practitioner • Whether a nurse anesthetist’s supervising practitioner must be available for timely on-site consultation throughout all stages of the administration of anesthesia • Whether the Board of Nursing may distinguish between analgesia and anesthesia as related to supervision of the nurse anesthetist by the supervising practitioner According to the opinion, what constitutes timely on-site consultation “… is left to the sound medical judgment of the supervising practitioner.” The opinion further provided that under Oklahoma law, the supervising practitioner need not be on site in all instances in order to be “available” for timely on-site consultation. However, a nurse anesthetist’s supervising practitioner must be available for timely on-site consultation at all recognized stages of the administration of anesthetic services. Finally, the opinion determined the Oklahoma Board of Nursing may not promulgate rules defining analgesia and anesthesia in such a way that would allow less supervision than is required by statute. The Oklahoma Society of Anesthesiologists submitted written materials to the Oklahoma Attorney General’s Office and worked with its staff to ensure a thorough understanding of anesthesia delivery and the practical implications these answers could have on patient safety. © 2013 American Society of Anesthesiologists Society News A New FSA Win-Win By Al Rothstein f you are looking for a dream vacation, or maybe a simple gift basket, you will soon have an opportunity to purchase items like that while contributing to the FSA—and you won’t have to leave home to do it! We are setting up an online auction that you can visit anytime and select from items donated by FSA members, as well as special travel opportunities arranged by our auction company. BlueTree Marketing, a Fort Lauderdale company, offers the travel packages and sets up the auction. Page 8 The FSA will have a dedicated event homepage that links to the auction items and allows us to promote them to all of our members. When you see an item displayed, you will also see the minimum bid for that item. You can start by entering that amount or more. Subsequent bidders will have to increase their bids by certain increments until the time limit for that item runs out. You will also have the ability to refer colleagues to the auction. Once you have made a bid, you will receive emails letting you know when another bid on your item has been placed. Stay tuned for more information on our online auction kickoff and how to participate as we get closer to creating this new FSA opportunity! Register now! Reserve your spot at the 2013 Annual Meeting today! Click here to register online. Please continue to visit the FSA 2013 Annual Meeting webpage in the coming months. More information will be available soon regarding: • Our distinguished lecturers • Course topics, objectives and disclosures • Social and family events Hotel Reservations The host hotel for the 2013 Annual Meeting will again be The Breakers, Palm Beach. The Breakers One South County Road Palm Beach, Florida Call 1-888-BREAKERS and be sure to mention the FSA, or use the online reservation link. Rooms are available at The Breakers at the group rate of $225 plus tax per night for deluxe category rooms (maximum two adults, no children). More room categories are also available at discounted rates. Please visit the online reservations page to review the available room categories and reserve your room today. The block fills up quickly each year. Please do not delay— reserve today! Exhibitors and Sponsors The 2013 vendor prospectus and trade show floor plan will be available online by September 30. We are exploring some new and exciting innovations for you next year, including: • Lead tracking systems • Refreshed trade show layout and traffic flow • Enhanced sponsorship opportunities • Longer breaks and shorter trade show hours for more quality time with attendees outside the exhibit hall • Fun ways to generate more visitors to your booth, such as scheduled giveaway times and a special social area for vendors and attendees to network We welcome suggestions and feedback from our loyal supporters and exhibitors new to the FSA meeting. FSA Board of Directors April 29-May 1, 2013 ASA Legislative Conference J.W. Marriott Washington, D.C. www.asahq.org June 7-9, 2013 FSA Annual Meeting Patient Satisfaction The Breakers Palm Beach, Fla. Hotel reservations and course information online at http://fsahq.org/2013AnnualMeeting.cfm July 26-28, 2013 FMA Annual Meeting Hilton Bonnet Creek Orlando, Fla. www.flmedical.org October 12-16, 2013 ANESTHESIOLOGY 2013 ASA Annual Conference Moscone Center San Francisco, Calif. www.asahq.org Officers ASA Delegates President Charles Chase, D.O. ASA Director, Florida David Varlotta, D.O. President-Elect Jay Epstein, M.D. ASA Alternate Director, Florida Jeffrey Jacobs, M.D. Vice President Jeffrey Jacobs, M.D. ASA Delegate 1 J. Knox Kerr, M.D. Secretary Jonathan Slonin, M.D., M.B.A. ASA Delegate 2 Rebecca Welch, M.D. Treasurer Steven Gayer, M.D. ASA Delegate 3 Kurt Markgraf, M.D. Assistant Treasurer D. Kurt Jones, M.D. ASA Delegate 4 Sonya Pease, M.D. Immediate Past President David Varlotta, D.O. ASA Delegate 5 Michael Lewis, M.D. District Directors District Director 1 North Mark Rice, M.D. District Director 1 North Brence Sell, M.D. District Director 1 North Chris Giordano, M.D. District Director 2 Central Frank Rosemeier, M.D. District Director 2 Central Clarkson Driggers, M.D. District Director 2 Central Greg Schroeder, M.D. District Director 3 West Devanand Mangar, M.D. District Director 3 West George Alvarez, M.D. District Director 3 West Russ Brockwell, M.D. District Director 4 East Sharon Ashley, M.D. District Director 4 East Adam Blomberg, M.D. Florida CME Events The American Society of Anesthesiologists sponsors CME courses throughout Florida. For a complete listing of ASA educational opportunities, visit http://events.asahq.org. District Director 4 East Leopoldo Rodriguez, M.D. District Director 5 South David Birnbach, M.D. District Director 5 South Tom Fuhrman, M.D. District Director 5 South Gerald Rosen, M.D. ASA Delegate 6 Leopoldo Rodriguez, M.D. ASA Delegate 7 David Lubarsky, M.D. ASA Delegate 8 Jeffrey Jacobs, M.D. ASA Delegate 9 Jay Epstein, M.D. ASA Delegate 10 Charles Chase, D.O. ASA Delegate 11 Hector Vila, Jr., M.D. ASA Delegate 12 Rafael Miguel, M.D. ASA Delegate 13 Gary Richman, M.D. ASA Delegate 14 Devanand Mangar, M.D. ASA Delegate 15 Steven Gayer, M.D. ASA Delegate 16 Jonathan Slonin, M.D., M.B.A. ASA Delegate 17 D. Kurt Jones, M.D. Executive Office 701 Brickell Avenue, Ste. 1550 Miami, FL 33131 786/300-3183 www.fsahq.org Executive Director Christina Kasendorf [email protected]