DEFENDING AMERICA
BY DAVID H. HACKWORTH
8 December 1999

NO, NO, NOT BETHESDA

If your name is Bill Clinton or Strum Thurman or if you're a senior naval brass hat you can check into Maryland's Bethesda Naval Hospital and be assured that you'll get VIP treatment that includes real doctors to put you to sleep while the surgeon wields his knife.

But if you're a nobody -- a lowly serving or retired sailor who's been promised top quality medical treatment for life if you just stand down range and let enemy sharpshooters have at you for at least 20 years -- don't expect the same treatment as what's given to the new American royalty at the U.S. Navy's flagship hospital.

Admiral Bonnie Potter, who runs Bethesda, has recently set up a double standard medical treatment system -- one for the powers-that-be, another for the common folk -- which has outraged medics at the hospital and doctors across the nation.

VIPs such as Admiral Fat Bottom get real doctors to administer sleeping stuff while the troops get only specially-trained nurses.

Last month Potter sacked Navy Captain Alvin Manalaysay, the head man of Bethesda's Department of Anesthesiology, because the good doctor refused to go along with her scheme to allow nurse anesthetists to care for surgical patients without the supervision of trained M.D. anesthesiologists.

Before undergoing major surgery recently, I spent as much time selecting the anesthesiologist as I did the surgeon who slit me open. I first met with a good pal, Dr. Herman Turndorf, Chief of Anesthesiology at NYU, and then with his hand-picked protegee, Dr. Marisol Garcia-Main. I wanted to make sure I had the best team going. I'm the healthy living proof that I made the right choice. My doctor brother-in-law is now almost blind because he didn't take similar precautions.

Dr. Ronald A. MacKenzie, the President of the American Society of Anesthesiologists says, "In other hospitals, it's a physician who determines if a patient is fit to undergo surgery. Who's going to make that medical assessment at Bethesda…?"

Anesthesiologists are medical doctors. They've years of medical and specialized training and according to MacKenzie, anesthesiologists directly supervise 90 percent of all the anesthetics provided to patients during surgery in the USA.

Dr. MacKenzie says "A generation ago, one surgical patient would die for every 10,000 anesthetics, but now (because of hands-on anesthesiologists) the rate of patient deaths has plummeted to one in 250,000 anesthetics or less."

"It is unconscionable" says MacKenzie, that Potter would expect someone with only nursing training to be solely responsible for the administering of anesthesia.

Another Navy Doc makes it more personal. "Anesthesia is not just the practice of Medicine, it is the practice of Critical Care Medicine. You have to ask yourself, if my child came through the ER door and had to go to the Operating Room, who would I want, a CRNA (Certified registered nurse anesthetist) or an MD? For the Navy and Adm. Potter to institute this reduced level of care except for the VIPs is not acceptable. Can she really look at herself in the mirror and think she's a responsible person, a leader and advocate for her troops?"

"Anesthesiologists must be involved in the planning, induction, maintenance and emergence of anesthesia as well as the post anesthetic care. I've worked extensively with the CRNAs and I know they just don't have the comprehensive knowledge base that is not infrequently required," says another Navy Doc.

My father-in-law, Dr. Jerry Haidak, a Dean at the University of Massachusetts Medical School and a combat surgeon who made the invasions of Salerno, Anzio and Normandy during The Big War, says he's worked alongside "Some damn good anesthesia nurses over the years, but they don't have the training to deal with all the circumstances that can come up."

Dr. Haidak is adamant that they "should only work under the direct supervision of a board certified anesthesiologist."

The bottom line is if there's validity to Potter's policy to have nurses practice independently as anesthetists, why aren't they good enough for everyone without exception across the board? Either they're as qualified as board-certified anesthesiologists or they're not.

Perhaps the Navy should put Potter under the knife and see who she picks to spec the drugs to keep her alive if things don't go according to plan.