New VA Rule Takes Effect, Veterans Win
Wed, Jan. 18, 2017

Dear Colleagues,

At 11:59pm Friday, January 13th, the thirty day comment period for VA's Advanced Practice Registered Nurses (APRN) final rule came to a close and a preliminary analysis of the comments indicates that the preservation of safe VA care for Veterans was once again a top concern by a majority of respondents.  January 13th also marked the effective date of the same APRN final rule, which contained an exclusion, or a carve out, for nurse anesthetists, maintaining safe, physician-led anesthesia care for Veterans.

While our comment analysis is only preliminary, based on the information available to date, there were more than 25,000 comments submitted through in support of maintaining physician-led anesthesia care for Veterans.  This accounts for at least 65% - a strong majority – of the overall comments received during the Final Rule comment period.  During the first comment period, VA received over 100,000 comments in support of preserving physician-delivered and physician-led, team-based models of anesthesia in VA.  Less than 10,000 comments were received from those seeking to abandon VA safe anesthesia standards.  Between the two comment periods, the voices of those supporting safe anesthesia care was clear and overwhelmingly strong.   

I want to thank each and every ASA member who demonstrated respect worthy levels of professional citizenship by taking action and executing on  ASA's "1+5 Plan" in response to both comment periods.  It's been a demanding issue, and a demanding couple of years, but these results are indicative of the tremendous effort that we directed to this critically important patient safety issue.  This unprecedented level of grassroots activism was the cornerstone of our success in protecting Veterans; this level of engagement by physician anesthesiologists must never wane.

There's a lot for which we can be proud and grateful.  Most importantly, the final rule preserves safe, physician-led anesthesia care in the U.S. Department of Veterans Affairs.  Our Veterans deserve nothing but the safest, highest quality of care – a level of care consistent with the nation's top hospitals.  ASA worked respectfully and diligently to build an unprecedented level of support from VA leadership, Veterans organizations, more than 140 Members of Congress and other Veteran health stakeholders.  I'm particularly proud of the VA Chiefs of Anesthesiology, and the Association of VA Anesthesiologists for taking a principled stand for patient safety under very difficult conditions.  I'm grateful for the efforts of the ASA leaders who came before me --Drs. Cole, Abenstein and Fitch—who built constructive relations with VA and other stakeholders and championed this cause. I'm grateful that Secretary McDonald and VA Under Secretary for Health, Dr. Shulkin, recognized the elevated risks associated with surgery and anesthesia for Veterans and maintained physician-led anesthesia care in the Final Rule.  If you did not see our announcement earlier this week, Dr. Shulkin has been nominated to be the next Secretary of the Department of Veterans Affairs, and I applaud this appointment.  Additionally, I am thankful for the resilience of our VSO partners, including the Association of the US Navy, the National Guard Association of the United States, and AMVETS, as well as our congressional champions for maintaining their support for safe care for Veterans, even when our detractors resorted to retaliatory tactics at times actually directed at Veterans.  I'm very proud of the commitment and the exemplary professionalism that we ASA members have demonstrated to our patients, and to the public, especially during the two public comment periods.

The comment periods brought heightened passion on both sides, as well as unfortunate unprofessional, and disruptive retaliatory tactics and more recently inflammatory remarks from those who led the effort to oppose the physician-led, team-based model of care.  Two words about retaliatory tactics and inflammatory remarks: "Veterans won!"  The safety of anesthesia in VA was preserved, along with Veterans' rights to receive the standard of care in their anesthesia.   If you haven't read your ASA Executive Committee's statement about inflammatory social media posts, please do so here.  Our adherence to the high road, and our professionalism have won the day.  Please, do not stoop to engage with those who resort to a consolation prize of unprofessional words and deeds.

Thank you to all ASA members who took part in the Safe VA Care Campaign to support the safe, physician-led anesthesia care that our nation's Veterans have earned and deserve.  Your participation, enthusiasm and record-breaking advocacy are a testament to the professionalism of this specialty, and I am honored to share in this achievement with you.  Your commitment to advocacy on behalf of Veterans, all of our patients, and our profession, is deeply appreciated.  Numerous challenges lie before us, and I pledge my continued passionate, convicted leadership towards advancing our specialty and securing our future.

Very sincerely yours,

Jeffrey S. Plagenhoef, M.D.
ASA President

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