November 22, 2002
Dear Ohio Physician:
We are writing to alert you to proposed radical changes in the use of office anesthesia in Ohio.
State Medical Board Proposal
The Ohio State Medical Board has proposed new rules that place severe restrictions on the use of conscious sedation in the office setting. Specifically, the proposed regulations would impose mandatory CME, set onerous staffing requirements, and demand accreditation of your office if you plan to use conscious sedation (i.e., intravenous Versed). It will also become much more difficult to use a certified nurse anesthetist (CRNA) in your office.
They claim that the purpose is to assure patient safety-despite the lack of any data showing that a patient has ever died because of conscious sedation.
The regulations will have the actual effect of forcing procedures out of the office setting back into the hospital and ambulatory surgery centers, where anesthesiologists practice.
A Dangerous Precedent
This is a dangerous precedent, not only for surgeons but for all Ohio physicians. It is the first regulation giving a special trade advantage to a particular specialty-in this case, anesthesiology. It is nothing less than a restriction on your license to practice medicine!
What happens next? Will the Board mandate that only ob/gyn specialists be allowed to perform deliveries? That only gastroenterologists may do endoscopies? That only dermatologists may examine pigmented lesions? This is a prescription for endless conflict between physicians.
The mandatory office accreditation could also be an invitation to JCAHO or its equivalent to enter all Ohio physicians' offices.
A Conflict of Interest?
One of the members of the Ohio State Medical Board, who is on the subcommittee drafting the regulations, is a certified AAHC inspector! That is, he could mandate inspections, and then do the inspecting. Moreover, his son is an anesthesiologist practicing in Ohio. Anesthesiologists, not surprisingly, are heavily promoting these rules.
Where Is the Ohio State Medical Association?
In May, 2002, the OSMA House of Delegates voted that: "The Ohio State Medical Association oppose mandatory accreditation for the use of conscious (mild and moderate) sedation (as defined by the State Medical Board of Ohio) in the physician's office."
It is indeed sad that a past president of OSMA, who is now a member of the Ohio State Medical Board, has deliberately chosen to ignore the OSMA House of Delegates.
While Dr. Thomas, OSMA President, intends to testify against parts of these proposed regulations at the December 12 hearing, it is not at all certain that OSMA will send a representative to the Joint Committee on Agency Rule Review (JCARR), where the real battle will take place.
Costs Without Benefits
The mandatory accreditation rule will mean that Ohio physicians with office operating rooms will have to pay at least $3,000 to $4,000-possibly more-for accreditation inspections. This does not include the cost of meeting the requirements. They will have to hire a half-time employee just to process the paperwork. This will not be a one-time expense, but one that will have to be paid every three years.
There is NO evidence that accredited offices are safer than non-accredited ones.
Patients will assuredly pay higher costs in fees, insurance premiums, and inconvenience.
Do we really want to start down this path?
What You Can Do
In order for the proposed rules to become legally binding, the Ohio State Medical Board must hold a public hearing on the rules. This is scheduled for Thursday, December 12, at 9:00 a.m. in the North Room on the 31st Floor of the Riffe Center, 77 South High Street, Columbus, Ohio 43215-6127.
BE THERE! It is critically important for the Board to hear from you. We must stop mandatory accreditation to use our own operating rooms now! Imagine not being able to use conscious sedation in our offices-even if we are credentialed to use the very same drugs in the hospital!
You can help. Plan to be present and to testify against these rules. We need all of you!
Additionally, please write Mr. Brent Mulgrew, Executive Director, OSMA, 3401 Mill Run Dr., Hilliard, OH 43026 and insist that he send a representative to the JCARR hearing to carry out the official policy passed by the OSMA House of Delegates.
If you have any questions, please call or write.
Kenneth Christman, M.D.
P.S. Please join national AAPS, which is helping us on this and other critical issues in Ohio and nationwide!