"ASA President Jeffrey Plagenhoef, M.D. Appeals to Members"

[Carbocation1]

Some strong rhetoric by the ASA president:

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Members don't see this ad.

 

[Consigliere]

Good. About time.

 

[soorg]

Testicles.

 

[AdmiralChz]

Excellent videos! This guy seems very legit.

 

[mostwanted]

It is shocking to see the number of dislikes on the video. It seems like it was sent to the national crna mailing list for thumbs down. Everyone here should give it a thumbs up.

 

[sevoflurane]

Link pleaase... couldn't find it.

 

[Psai]

I love this guy. Finally someone who seems to care about us and the profession.

 

[Aether2000]

Well said, but about 15 years too late. Where was this guy in 2000?

 

[Shimmy8]

Had lunch with him last year when he visited our program and gave Grand Rounds, spoke to the residents.

This is not an act. He is exactly like this in person. Love it.

 

[Southpaw]

I met Dr Plagenhoef at the ASA a few years years back when I was a resident. He is absolutely legit. A great leader for us right now.

 

[WFMD17]

excellent videos. this is exactly what the profession needs moving forward - no backing down.

 

[Robotic Wis-Hipple]

Link:

https://asahq.quorum.us/campaign/3181/

 

[ProwlerturnGas]

I'll give him props only if he can cut out some of the MOCA BS.

 

[Robotic Wis-Hipple]

I'll give him props only if he can cut out some of the MOCA BS.

Well, if we lose and even a nurse can do it I don't see why anyone needs to maintain Board certs....

 

[deleted126335]

I'll give him props only if he can cut out some of the MOCA BS.

ASA is not the ABA.

 

[zero0]

Similar bill up for congress in my home state NC, HB 88 to give CRNAs independent practice. I sent in my letter fwiw

 

[ProwlerturnGas]

ASA is not the ABA.

They are all in the same bed together man

 

[anbuitachi]

he spoke at PGA this year. isn't he leaving? He introduced the next ASA president

 

[turnupthegas]

Letter sent.


Sent from my iPhone using SDN mobile

 

[deleted126335]

he spoke at PGA this year. isn't he leaving? He introduced the next ASA president

The term of ASA president is one year. I assume he was introducing the president elect.


Sent from my iPhone using SDN mobile app

 

[anbuitachi]

The term of ASA president is one year. I assume he was introducing the president elect.


Sent from my iPhone using SDN mobile app

ONE year?! so short. imagine if our US president term was 1 yr, we'd get no where hahaha

 

[DrCommonSense]

Some strong rhetoric by the ASA president:

Notice how they had to shut down the comment section and it has 2:1 downvotes.

CRNAS ARE ON THE WAR PATH

 

[DrCommonSense]

Good. About time.

Yeah I signed the letter.

However, we will see how many even stand up and do anything.

The viewcount seems very low and the CRNAs are far more aggressive.

Dont know what the F is wrong with most physicians to be honest. Most are passive as hell.

 

[Noyac]

I'm not an Arizona resident but I sent my letter in anyway. No telling where it will end up.

 

[DrCommonSense]

I'm not an Arizona resident but I sent my letter in anyway. No telling where it will end up.

Same here but the CRNAs will bombard the opposite message.

From the video itself, the downvotes are 2 to 1 already on the ASA OWN YOUTUBE VIDEO.

I suspect the letters will be that or worse to Congress members.

Most docs will just sit on their butt and do jack squat while it burns.

 

[anbuitachi]

Yeah I signed the letter.

However, we will see how many even stand up and do anything.

The viewcount seems very low and the CRNAs are far more aggressive.

Dont know what the F is wrong with most physicians to be honest. Most are passive as hell.

i guess they used up all their energy on 10 yrs of post college training

 

[DrCommonSense]

i guess they used up all their energy on 10 yrs of post college training

yeah docs are useless in a fight

 

[Carbocation1]

Update:
Arizona Governor Signs Law Maintaining Physician Presence and Direction
04.27.17
American Society of Anesthesiologists - Arizona Governor Signs Law Maintaining Physician Presence and Direction

On April 21, 2017, Governor Doug Ducey (R-AZ) signed into law legislation (SB 1336) that preserves physician direction of anesthesia in the state. Additionally, the new law maintains physician presence when anesthesia is delivered by a nurse anesthetist. The physician directing anesthesia must be within the same health care institution or office and available as necessary. The new law also includes language providing immunity to physicians or surgeons working with nurse anesthetists; the language states that “a physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics…” This language renders nurse anesthetists liable for their actions when ordering or administering anesthesia.

 

[Iso4ane]

Same here but the CRNAs will bombard the opposite message.
From the video itself, the downvotes are 2 to 1 already on the ASA OWN YOUTUBE VIDEO.
I suspect the letters will be that or worse to Congress members.
Most docs will just sit on their butt and do jack squat while it burns.

It's how you frame the message, in states with physician coverage, who do you call when **** hits the fan, the anesthesiologist. We are the last line when it comes to patient safety. When it comes down to it, we are the ultimate advocates for patient safety.

Unsupervised CRNAs are like the Ford Pintos of the automotive industry, sure they may be able to to job (cheaper, and I sure hospital will also factor in settlement costs) of getting you from one place to another as well any other car, but they're a disaster waiting to happen.

 

[DrCommonSense]

Update:
Arizona Governor Signs Law Maintaining Physician Presence and Direction
04.27.17
American Society of Anesthesiologists - Arizona Governor Signs Law Maintaining Physician Presence and Direction

On April 21, 2017, Governor Doug Ducey (R-AZ) signed into law legislation (SB 1336) that preserves physician direction of anesthesia in the state. Additionally, the new law maintains physician presence when anesthesia is delivered by a nurse anesthetist. The physician directing anesthesia must be within the same health care institution or office and available as necessary. The new law also includes language providing immunity to physicians or surgeons working with nurse anesthetists; the language states that “a physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics…” This language renders nurse anesthetists liable for their actions when ordering or administering anesthesia.

Thank God it wasn't a Democrat

 

[aneftp]

Thank God it wasn't a Democrat

Does it matter? Think California Kansas Alaska Iowa North Dakota South Dakota etc had republicans governors when they opted out?

 

[DrCommonSense]

Does it matter? Think California Kansas Alaska Iowa North Dakota South Dakota etc had republicans governors when they opted out?

True but its 100% chance with a Democrat and 50/50 with a Republican

 

[d9sccr]

The new law also includes language providing immunity to physicians or surgeons working with nurse anesthetists; the language states that “a physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics…” This language renders nurse anesthetists liable for their actions when ordering or administering anesthesia.

Did we just skip over this part?? This seems incredible to me. Hopefully more states follow this suit

 

[BLADEMDA]

Did we just skip over this part?? This seems incredible to me. Hopefully more states follow this suit

Medical Conditions/Co-Morbidities are complicated in nature. They are part of the Physical status of the patient and blur the line between Surgeon and CRNA. Surgeons will still be liable for these MEDICAL DECISIONS prior to the start and immediately after the anesthetic:

1. Pulmonary- Risk status and postop issues belong to the surgeon even if the anesthetic plan could have reduced these risks.
2. Cardiac- "cleared for surgery" doesn't mean a thing when the patient develops chest pain postop or has an MI.
3. Aspiration risks- Surgeons share co-responsibility for most periop aspirations when CRNA choose MAC/TIVA or LMA.
4. Nerve Injury secondary to positioning- Surgeon's full responsibility

The law reduces the risk to the surgeon for airway issues such as trauma to the throat, perforation of pharyngeal wall, vocal cord damage, etc. But, will a jury accept the fact that the surgeon failed to trach the patient emergently if the CRNA loses the airway?

 

[BLADEMDA]

Statement on Principles Underlying Perioperative Responsibility
Online September 1, 1996


The following statement was approved by the College's Board of Regents in February 1996.

1. The surgeon is responsible for confirming the diagnosis for which surgical care is proposed. This responsibility should include the surgeon's personal review of all pertinent aspects of the patient's case. Appropriate consultation should be requested, if necessary.
2. The surgeon is responsible for presenting to the patient the range of options available for the patient's appropriate management, including the surgeon's recommendations and rationale for a specific approach to treatment. Choice of a specific treatment must ultimately be up to the patient; in the event that the patient is not legally competent to express a choice, for whatever reason, the decision of the patient's appropriately appointed surrogate must be substituted for that of the patient.
3. The surgeon is responsible for obtaining informed consent from the patient, or, if necessary, from the patient's surrogate, after discussion of treatment. The surgeon is responsible for conducting the discussion and for documenting that it took place. The surgeon need not personally obtain the patient's signature on the consent form.
4. The surgeon is responsible for the proper preoperative preparation of the patient. Minimizing the risk of operation, while providing maximal opportunity for a satisfactory outcome, requires a full appreciation by the surgeon of the patient's condition. Achieving optimal preoperative preparation of the patient will frequently require consultation with other physicians; however, the responsibility for attaining this goal rests with the surgeon.
5. The surgeon is responsible for the safe and competent performance of the operation. Part of this responsibility includes planning for the operation with the anesthesiologist in order to ensure anesthesia that is best for the patient.
6. The surgeon is responsible for postoperative care of the patient. This responsibility includes personal participation in and direction of postoperative care, including the management of postoperative complications. The best interest of the patient is thus optimally served because of the surgeon's comprehensive knowledge of the patient's disease and surgical management. Even when some aspects of postoperative care may be best delegated to others, the surgeon must maintain an essential coordinating role. Should complications of operation develop, the surgeon is best able to detect them and to provide or coordinate timely and appropriate therapy. This responsibility extends through the period of convalescence until the residual effects of the surgical procedure are minimal, and the risk of complications of the operation is predictably small. The surgeon is responsible for determining when the patient should be discharged from the hospital.
7. The surgeon is responsible for disclosing to the patient information related to the conduct of the operation, operative and pathologic findings, the procedure performed, and the expected outcome.
8. When the time comes that the surgeon will no longer be involved in follow-up of the patient, he or she is responsible for ensuring appropriate long-term follow-up for continuing problems associated with the patient's surgical care. All information necessary to provide care for those problems should be made available.

 

[deleted126335]

They softened the language on surgeon responsibility considerably about one year ago:

American College of Surgeons Statements on Principles | The Bulletin

 

[BLADEMDA]

They softened the language on surgeon responsibility considerably about one year ago:

American College of Surgeons Statements on Principles | The Bulletin

They softened the language on surgeon responsibility considerably about one year ago:

American College of Surgeons Statements on Principles | The Bulletin

Doze, You are correct. The ACS has really watered down the language:

C. Preoperative Diagnosis and Care
Because a team of specialists undertakes much of modern patient care, nonsurgeon physicians often may conduct the initial evaluation of patients. However, the surgeon bears the ultimate responsibility for determining the need for and the type of operation. In making this decision, the surgeon must give precedence to sound indications for the procedure over pressure by patients or referring physicians or the financial incentive to perform the operation. The surgeon is responsible for the patient’s safety throughout the preoperative, operative, and postoperative period, including ensuring the elimination of risk of wrong site, wrong procedure, and wrong patient surgery.


Delegation to Qualified Practitioners
The surgeon may delegate part of the operation to qualified practitioners including but not limited to residents, fellows, anesthesiologists, nurses, physician assistants, nurse practitioners, surgical assistants, or another attending under his or her personal direction. However, the primary attending surgeon’s personal responsibility cannot be delegated. The surgeon must be an active participant throughout the key or critical components of the operation. The overriding goal is the assurance of patient safety.

 

[dchz]

Letter written, but i guess i saw this too late?

 

[narcusprince]

All hail to Darth Plagianhoff! Nice to see someone willing to fight on the dark side of the force and get a little dirty fighting the AANA rhetoric.

 

[epidural man]

I'm not sure how I feel about this issue and video.

I don't really want to supervise a CRNA. They should stand on their own merits. If they are just as good as an anesthesiologist..so be it. If they aren't, let the outcomes dictate that. Let the patients decide who they want.

What I think we really should do is say - you can't have your cake and eat it to. If you want independence - you get it - but you have to get COMPLETE independence. We will then refuse to work in a hospital that has CRNA's. (IN fact, make it a law that they can't mix) If patients want to have their baby in a hospital with no anesthesiologists, let them. If administrators want to run a hospital and do surgeries on NICU babies without anesthesiologist, let them. CRNA's can take care of it all themselves. We should sue them if they use our research, our written materials, our guidelines. They need to develop their own.

You can't claim independence, then stand on our shoulders.