Nurses want changes in office surgery rules

Recent rewrites in the rules, they say, may have contributed to a string of plastic surgery deaths.

©Associated Press
September 20, 2002

TALLAHASSEE -- Nurses certified to administer anesthesia said Thursday that an office surgery rule change that locked them out of the procedure may be to blame in a recent string of cosmetic surgery deaths.

The Florida Association of Nurse Anesthetists is asking the Board of Medicine to change rules to require that a certified anesthesia professional -- either a nurse anesthetist or a physician anesthesiologist -- be present for office surgeries that now only require the surgeon and his staff.

Nurse anesthetists used to be able to sedate patients in office surgeries -- often cosmetic procedures such as facelifts. But dozens of high-profile deaths in the late 1990s led to changes in rules governing the procedures.

One rule that took effect in April after months of legal wrangling effectively shut nurse anesthetists out of the office surgeries. It required an anesthesiologist to be present for surgeries in which the deepest anesthesia would be used, while allowing office surgeons and their staffs to administer lesser degrees of anesthesia.

The nurse anesthetists say that in at least two recent office surgery deaths, and possibly more, doctors may have performed surgeries that normally require deep anesthesia using less anesthetic to avoid having to have another doctor on hand. That means a specialist isn't available to monitor the patient's reactions to anesthesia, said Suzanne Oliver, a nurse anesthetist and a board member of the association.

"The rule change may be reducing patient safety rather than enhancing it by creating an incentive for surgeons to opt for lighter . . . anesthesia," Oliver said.

Physician anesthesiologists, who pushed for the original tougher rules, believe they should be present for the deepest types of anesthesia.

But the president of the Florida Society of Anesthesiologists, a physician group that has often been at odds with the nurse anesthetists' organization, conceded that in cases where lighter anesthesia is called for, nurse anesthetists would help avoid deaths.

"It is apparent from these recent office deaths that the current regulations may still have shortfalls," anesthesiologist James Jacque wrote to the Board of Medicine last month.

Jacque also said he has heard reports that surgeons may be using deeper anesthesia than they are reporting in order to avoid having a physician anesthesiologist present.

"Right now, the office isn't safe," said Jacque. "I think when anesthetic agents are used that have the potential for unconsciousness and respiratory depression, at a minimum, a nurse anesthetist should be present."

Five people have died in Florida this year after what appeared to be routine cosmetic surgery. The most recent was James Williams, a 62-year-old man who collapsed and died from heart disease two hours after a face lift in Palm Harbor in June. A medical examiner said stress from the surgery may have contributed to the death.

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