III.

IV.

The 1972 Joint Statement, as well as the 1976 AANA proposal for revision and the 1977 ASA proposal for revision, are attached. While professing to support the concept of the physician as the director of the care team, even in their 1976 statement, the AANA has stated in presentations before angressional committees, the Social Security Administration and other government agencies that their services are on parity to that provided by anesthesiologists and they should, therefore, be eligible for independent purveyor status under Medicare.

PATIENT RESPONSIBILITY

Under most state laws, the practice of medicine is defined to include diagnosis,
prescription and therapeutics; expressly or by implication, these laws also
require that nurse anesthetists function under the direction of a physician --
a surgeon, if an anesthesiologist is not present.

The Joint Commission on Accreditation of Hospitals requires that departmental
heads define and review the qualification and duties of non-physician personnel
in their respective departments. Anesthesiologists in private practice who are
the chairmen of anesthesiology departments, in a hospital employing nurse anes-
thetists, have been charged with vicarious liability for the acts of hospital-
Continued...

employed nurse anesthetists.

Anesthesiologists today pay annual premiums of $3,000 to $40,000 for professional liability insurance; nurse anesthetists $300 to $900. These disparities directly relate to the medical and legal responsibility assumed by the two types of practitioner, respectively.

SUMMARY AND CONCLUSION

Given the differences referred to above, it seems clear that proper anesthesia care requires, for the foreseeable future, a systemic approach to the rendition of patient care. The nurse anesthetist is equipped neither by education, training nor experience to function property on a basis independent of anesthesiologist, or at least physician, direction. In the last analysis, the critical difference lies in the application of medical judgment to the patient's condition and needs. The technically-trained and experienced nurse anesthetist does not, by definition, possess that judgment. The physicians' entire educational exposure (the basic sciences in undergraduate school; physiology, pharma∞ology and other basic disciplines in medical school and in this clinical application of this knowledge and the knowledge gained through formal and informal programs of continuing medical education) conditions his every activity in the practice of his specialty in a technique of critical patient observation.