From: The Honorable Dan Benishek
Sent By:
Date: 5/26/2016


Dear Colleague,

As you may be aware, the Department of Veterans Affairs has proposed revising the Veterans Health Administration (VHA) Nursing Handbook to remove anesthesiologists from the current team-based, nurse-physician approach.

As Chairman and Ranking Member of the House Veterans’ Affairs Subcommittee on Health, we are deeply concerned about the potential impact of this change to long-standing best practices on the veterans the VHA serves. In a 2014 letter to VA leadership, over 60 Chiefs of Anesthesia at VA Medical Centers wrote that “a sudden change to the status of nurses and the abandonment of the care team model would be extremely disruptive, leaving many of us with inappropriate staffing ratios which would directly compromise patient safety and limit our ability to provide quality care to Veterans.”

We are urging Secretary McDonald to leave the existing model in place, through which doctors and nurses work together in teams to provide anesthesia care in surgical settings. AMVETS, the National Guard Association of the United States, the Association of the United States Navy, and the National Association of Veteran Affairs Physicians and Dentists are all opposed to the proposed changes in the VHA Nursing Handbook, which are expected to be announced in the near future.

We hope you will join us to protect access to physician-led anesthesia care for veterans. If you have questions about the VHA Handbook, or would like to sign this letter, please contact  (Congresswoman Brownley) (Dr. Benishek) by COB Friday, May 27th.




DAN BENISHEK                                          JULIA BROWNLEY




May XX, 2016


The Honorable Robert McDonald


U.S. Department of Veterans Affairs

810 Vermont Avenue, NW

Washington, D.C. 20420


Dear Mr. Secretary,

We write to express our strong opposition to proposed changes to the U.S. Department of Veterans Affairs (VA) anesthesia delivery policies. The changes proposed by the Veterans Health Administration (VHA) would fundamentally rewrite time-tested, team-based anesthesia care protocols, thereby, affecting the quality and safety of anesthesia care administered to our Veterans.  We urge the preservation of VA’s current policies included in the VHA Anesthesia Service Handbook.

The Anesthesia Service Handbook contains VHA’s current anesthesia patient safety policies.  Due to the inherent dangers associated with administering anesthesia, these policies direct that anesthesia be administered by a “team” – consisting of a physician and nurse anesthetists – and in recognition of state licensure laws, virtually all of which require the involvement of a physician in anesthesia care.  Millions of Veterans have been well-served by these consensus policies, policies that have been embraced by independent anesthesia studies.

Under changes proposed by VHA, the current Anesthesia Service Handbook will be superseded by a new full nurse practice authority policy.  This new policy would eliminate the requirement for physician involvement in anesthesia, specifically striking the physician-nurse “team” requirement and abandoning VHA’s recognition of state licensure laws.  These changes are ill conceived and would fundamentally alter anesthesia care within VA – changes that could compromise the care of the sicker VA patient population.

We believe the interests of Veterans are best served by the preservation of VA’s team-based policies, as currently written.  This approach is supported by a range of Veterans health stakeholders including the Association of the U.S. Navy, AMVETs and the National Guard Association of the United States, all of which have expressed support for maintaining VA’s current anesthesia care policies.  Similarly, VA’s internal anesthesia experts, over 60 VA Chiefs of Anesthesiology, have urged retention of the current policies.  Congress, on a bipartisan and bicameral basis, has for two years included report language as part of the VA appropriations bills asking that the VA not advance policies that would “conflict” with VA’s current anesthesia policies.  And VA’s own internal researchers in the Quality Enhancement Research Initiative (QUERI), examined the issue and concluded that there was “insufficient” evidence to support the safety of eliminating physician involvement in VA anesthesia care.

The safety and health of American Veterans is paramount, and we request that VA retain physician involvement in anesthesia care as contained in the Anesthesia Service Handbook.