Supreme Court Rules in Favor of The Board of Medical Examiners
At 10 am on 6/29/05 the Supreme Court posted its decision on the Internet, as is their practice.
The Supreme Court unanimously upheld the unanimous Appellate's Court's decision in favor of the Board of Medical Examiners office surgery and anesthesia regulations challenged by New Jersey CRNAs and supported by the AANA. Supervision requirement will remain in place. This has been an expensive defeat for the CRNAs whose ultimate goal was, in bringing their case to the Supreme Court, unsupervised practice. The NJSSA supported the BME as Amicus-Intervenor and the ASA and the Medical Society of New Jersey as Amicus Curiae (friends of the court). The AANA sent their lawyer who stressed that the issue was jurisdictional which turned out to be the view of the Court. The AFL/CIO wanted to join on the side of the nurses but were rejected, as was the Board of Nursing.
The decision states that ANESTHESIOLOGY IS THE PRACTICE OF MEDICINE and that the Regulations fall squarely within the Board of Medical Examiner's jurisdiction.
The Court did nor accept the CRNAs claim of equal education and ability by stating that "it is fundamentally reasonable that additional education and training would enable anesthesiologists administering or supervising anesthesia to better protect patients and to respond when complications occur. Thus the NJANA failed to overcome the presumption of validity of the regulations".
The news of the decision spread across the nation through the Internet. Dozens of e-mails have been received praising the NJSSA, the BME, and the MSNJ for putting up the long fight and winning it. All recognize the precedent setting implications in the heart of the decision as quoted above. North Carolina is facing a similar challenge in their Supreme Court and will now use the New Jersey decision. The President of the ASA, Dr. Gene Sinclair, called me at home over the Holiday to congratulate us. Several past presidents sent their congratulations as well as numerous key ASA figures. The NJSSA and New Jersey again has reclaimed its role as a leader in patient safety.
The implications of a loss would have been far reaching. At a meeting 2 weeks ago with the Commissioner of Health, Dr. Fred Jacobs, he stated that if the supervision requirements in the offices were overturned by the Court, he would amend the hospital and ASC regulations, in place since 1989, to conform to the office regulations. While a loss would have resulted, as expected, in an attack by the CRNAs on the supervision requirements in hospitals and ASCs, it was a shock to hear that changes by the Department of Health would be a giveaway to the nurse anesthetists. If the Court had acted in favor of the CRNAs, your practices in hospitals or ASCs would be forever changed. A copy of the Courts decision has been sent to Dr. Jacobs in the hope of averting any action on his part. As far as CRNAs becoming APNs by grand fathering by the Board of Nursing, he stated that it is within the power of the Board of Nursing to do so.
At this time the cost of the victory has not been totaled. The ASA contributed $20,000 in cash while paying their law firm $36,000 dollars for two briefs. The MSNJ sent Bob Conroy to speak at both the Appellate Court and the Supreme Court with no charge to the NJSSA. We have not been billed by our attorneys as yet.
Approximately 70% of the NJSSA membership contributed to the emergency legal fund with an average donation of $100. To the 30% who did not contribute, I ask that you do so now. You will reap the benefits and security on the backs of others. To everyone, it was the best investment you have ever made. If you wish to help in the expected shortfall by another contribution, we will not reject it.
In the future we will see the CRNAs move to gain APN status including prescriptive authority and collaborative arrangement. Since the Supreme Court decision addressed only the Office Regulations, what is to prevent then from attacking the Hospital and ASC regulations next? New Jersey has become a thorn in the side of the AANA. The AANA does not like to lose. Therefore we should be prepared for further attacks upon a practice that has focused on patient safety. Of note is that the CRNA'S two court cases included a stay in office regulations lasting 10 months during which office patients were at risk.
