A full-page advertisement that ran several times recently in Stars and Stripes has become a contentious issue among anesthesiologists and drawn the ire of Pentagon health officials.

The advertisement asserts that Tricare — the military’s health care provider — will soon allow the use of anesthesiologist assistants in the operating room. The Certified Registered Nurse Anesthetists, which paid for the ad, claims that patients would be put at risk if the measure is approved.

Allowing anesthesiologists assistants to provide care in military medical facilities could lead to tragedy, Rodney Lester, the association’s president, said in a telephone interview Wednesday.

“We have concerns about the quality,” that such an arrangement would provide, he said.

According to Lester, AAs don’t receive the training and don’t have the experience that the nurses and doctors do. Regulations prohibit AAs from conducting procedures in an operation without the supervision of an anesthesiologist, but those rules aren’t always followed, he said.

On the other hand, nurse anesthetists, he said, are required to only be supervised by any doctor in the operating room.

But Dr. James Cottrell, president of the American Society of Anesthesiologists, said the measure could increase patient safety.

Cottrell, who practices in New York, said under regulations, anesthesiologists are required to be “readily available,” for consultation or assistance when AAs are performing their duties.

This allows an anesthesiologist to participate in more than one surgery at a time. And since there’s a shortage of those giving anesthesia, hospitals can schedule more surgeries instead of sometimes delaying them, he said.

Cottrell said he wouldn’t be concerned himself if he faced an operation with an AA at work: “I would see no difference between an AA and a CRNA as long as an anesthesiologist is there to supervise.”

The debate aside, some at the Pentagon think the issue has been distorted by the ad that ran in Stars and Stripes.

“I was disappointed that a professional organization like the CRNA would resort to the use of scare tactics to frighten military personnel and their families ...” said Edward Wyatt, principal deputy to the deputy secretary of defense (health affairs).

He said the Tricare proposal — which officials are now starting to consider after a 60-day comment period ended June 2 — would not affect any care in states that does not currently allow anesthesiologist assistants to practice. Rather, he said the measure would put Tricare in line with Medicare — which pays only providers in conformity to state law.

He said the argument isn’t relevant to those stationed overseas, “because we don’t have any plans to hire AAs as civilians or recruit them into the military.”

Wyatt said he was disappointed that Stars and Stripes made a business decision and published an “obviously provocative ‘issue ad’ that was clearly designed to frighten Tricare beneficiaries.”

He said Stars and Stripes should have contacted Defense Department officials before publishing the ad.

Thomas Kelsch, the paper’s publisher, said he intended to investigate the issue. He said the paper routinely evaluates the appropriateness of advertisements before they’re published. Sometimes, they don’t appear in the paper.

“We don’t take just any ad that comes along,” Kelsch said.

author picture
Kent has filled numerous roles at Stars and Stripes including: copy editor, news editor, desk editor, reporter/photographer, web editor and overseas sports editor. Based at Aviano Air Base, Italy, he’s been TDY to countries such as Afghanistan Iraq, Kosovo and Bosnia. Born in California, he’s a 1988 graduate of Humboldt State University and has been a journalist for 40 years.

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