Veterans debate patient care, safety amid new VA pandemic policy

ATLANTA — The coronavirus epidemic has swept through long-term care homes throughout the country, including facilities that care for our nation’s heroes.

The Department of Veterans Affairs has recorded more than 10,000 COVID-19 cases nationwide and roughly 800 deaths throughout the department’s hospitals.

Channel 2 investigative reporter Nicole Carr learned that 11 of those deaths stemmed from the Atlanta VA Hospital, which has seen 198 cases to date.

Now, there is fierce debate over a new policy allowing specialized nurses, or CRNAs, to work on their own with anesthesia without the oversight of a physician anesthesiologist.

“Right now, I think the veterans deserve the best,” veteran Amos King said.

King is a retired Army lieutenant colonel and activist. He recently rallied for stricter shelter-in-place orders to protect military families.

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Now he's weighing in on veterans' health and the VA hospital system's new pandemic policy. It allows full authority to nurse anesthetists. In other words, no physician anesthesiologist would be required to lead care while the system deals with a public health crisis.

“I was alarmed, really shocked because we need the top people doing the work. We need the doctors in there doing the work,” King said.

It’s creating fierce debate between veterans who happen to be healthcare providers. Some believe the absence of physician-led care can be dangerous, if not deadly.

“There’s been an increase in mortality and morbidity with just CRNAs or AAs practicing by themselves or practicing independently,” said Atlanta anesthesiologist and Navy veteran, Dr. Will Epps.

“When physicians bring up a quality of care concern, or some other veterans, what do you say about experience in knowing what you’re doing?” investigative reporter Nicole Carr asked CRNA and veteran Randy Moore.

Moore is also CEO of the American Association of Nurse Anesthetists.

“A couple things," he replied. “One I would say, show me the data. You don’t have any.”

The Department of Veterans Affairs cited the COVID-19 pandemic and access to care as its reasoning behind the move in a April 21 memo.

Nurse anesthetists are specially trained to safely administer anesthesia and perform nursing duties, typically by the side of a physician anesthesiologist.

Physician anesthesiologists are the doctors who administer and oversee the entire process, including care after procedures.

They typically back each other up and work side-by-side. The policy leaves room to separate the pair and give CRNAs full authority over any procedure.

The VA memo notes 18 states that have already granted full practice authority to CRNAs and nine that have suspended licensure requirements during the pandemic.

Georgia is not one of them, but under the policy the VA across the country are encouraged to allow CRNAs full practice authority.

In a statement, the Atlanta VA pointed out that they still employ 27 physician anesthesiologists to their 18 CNRAs, but some doctors are worried by the door the new policy opens.

“This is not a new issue,” Epps said. “It’s kind of been politicized and a bit divisive among the anesthesia world whether certified registered nurse anesthetists should be able to practice independently of their physician colleagues.”

Dr. Epps is also a member of the group Physicians for Patient Protection, which strongly opposes the move.

“There’s no shortage of anesthesia providers so really there’s no need for this rule at this time,” Epps said.

He pointed out to Carr that the VA opted against giving CRNAs full authority just a few years ago. At the time resources for elective surgeries were the focus, but the V-A ultimately decided against granting full CRNA Authority. Their reports did not challenge CRNA capabilities or qualifications.

“But veterans and their families were very outspoken, there are over 200,000 comments saying, you know, we want our veterans to have the same level of care that non-veterans have,” Epps said. “They’ve earned that right to have that care, you know, they’ve sacrificed their time and, you know, volunteered to be on the front lines to help us live as we live now. I think they deserve the same level of care that everybody else gets.”

“To me that’s a pretty empty argument for a few reasons,” said Moore.

Moore pointed out that if highly-specialized CRNAs can take over operations in war time, why not during a pandemic?

“We have a mountain of data on this topic. We’ve been having conversations about this for well over four years. And in the heat of a global pandemic that’s having significant impact on the healthcare infrastructure of this country including the VA,” Moore said. “What other conversations do you want to have?”