Follow-up on Anesthesia Bylaws Vote at Minneapolis VAMC: Next Steps

Overview of Bylaws Vote

The NAVAPD would like to inform our members about recent developments following the bylaws vote at the Minneapolis VA Medical Center. The vote concerned CRNAs and whether they should be allowed to practice independently, without physician anesthesiologist oversight. The Minneapolis VA, a Level 1a tertiary care facility and the fifth largest VA medical center in the United States. This medical center performs complex procedures like cardiac, neurosurgery, and orthopedic operations for some of the nation’s most vulnerable Veterans.

Context and Voting Details

This vote took place in the context of losing 10.5 out of 11 full-time physician anesthesiologists within a period of seven months. The meeting and voting occurred over Microsoft Teams rather than in person, with facility leadership declaring a quorum with only 60 members of the house staff present. According to the Minneapolis VA’s 2023 annual report, there were 2,022 Title 38 employees, including 494 physicians and dentists; the remaining Title 38 employees were nurses.  In 2023, over 100,600 unique Veterans were enrolled for healthcare in this system. Of the 60 staff present, only 31 votes were needed to pass the bylaw change eliminating physician anesthesiologist oversight.

Professional Advocacy

Prior to the vote, the American Society of Anesthesiologists (ASA) met with the American Association of Oral and Maxillofacial Surgeons (AAOMS). AAOMS maintained that nurse anesthetists should be supervised by either a dentist or physician with equivalent or greater anesthesia or sedation training, in alignment with ASA’s focus on proper supervision for patient safety.

Concerns About Patient Safety

Despite strong assurances from Minnesota's Society of Anesthesiologists and the Association of VA Anesthesiologists (AVAA) that short-term staffing solutions were possible, facility leadership held off on posting job vacancies. AVAA then activated the VA’s whistleblower program, stating that “The physician-led anesthesia care team model is employed by the University of Minnesota and private facilities throughout the Twin Cities. To attempt this untested model at a Level 1a VA center is reckless, unprecedented, and will provide Veterans with a lower standard of care than they would receive in the community setting. The Veterans served by MVAMC are among the sickest and present the highest risk undergoing anesthesia. They deserve leadership committed to the gold standard of care, not one that cuts corners by abandoning that standard.”

Advocacy and Response

A “Stop the Line” email was distributed, and was promoted by NAVAPD on our website and social media.  230 physicians signed this call to action. NAVAPD also contacted the Secretary of the VA and several Senators asking for their intervention.

Outcome and Ongoing Concerns

Despite the efforts of ASA, AVAA, and NAVAPD, the bylaw change allowing nurses to perform anesthesia care independently passed. NAVAPD remains deeply concerned, as this precedent could be replicated at other VA facilities, potentially putting patients at risk for adverse outcomes, including death, at the hands of nurses whose training does not match that of physician anesthesiologists.

Next Steps

NAVAPD has reached out again to the Secretary of the VA and Congressional contacts, urging them to reverse the bylaws change. Members are encouraged to contact the Secretary of the VA, their Senators, and Congresspersons to advocate for reversal of this decision. NAVAPD will continue monitoring developments and promptly update members.