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1 Volume 66, Number 1 January 2002 As presented by this year s Emery A. Rovenstine Memorial Lecturer, Glenn W. Johnson, the three-legged stool represents ASA s balanced commitment to education, scientific inquiry and tireless advocacy for the specialty and for our patients. (See back cover for photo descriptions) EDITORIAL BOARD Editor Mark J. Lema, M.D., Ph.D. Associate Editors Douglas R. Bacon, M.D. Lawrence S. Berman, M.D. David E. Byer, M.D. Daniel F. Dedrick, M.D. Norig Ellison, M.D. Stephen H. Jackson, M.D. Jessie A. Leak, M.D. Jill Mhyre, M.D. Paul J. Schaner, M.D. Jeffrey H. Silverstein, M.D. Ronald D. Smith, M.D. R. Lawrence Sullivan, Jr., M.D. Carlos O. Viesca, M.D. Editorial Staff Denise M. Jones David A. Love Roy A. Winkler Karen L. Yetsky The ASA NEWSLETTER (USPS ) is published monthly for ASA members by the American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, IL mail@asahq.org Editor: Newsletter_Editor@ASAhq.org Web site: Periodical postage paid at Park Ridge, IL, and additional mailing offices. POSTMASTER: Send address changes to the ASA NEWSLETTER, 520 N. Northwest Highway, Park Ridge, IL ; (847) Copyright 2002 American Society of Anesthesiologists. All rights reserved. Contents may not be reproduced without prior written permission of the publisher. Oil painting by Ralph Canaday CONTENTS FEATURES 2001 ASA Annual Meeting: Our Foundations Are Strong 2001 Annual Meeting House of Delegates Summary : We Did This Together 8 Neil Swissman, M.D. ARTICLES Controlled Substance Prohibition Reaffirmed 4 ASA Art Show: Down by the Riverside Triumphs in Wake of September 11 Tragedy 14 Jerry J. Berger, M.D ASA Scientific Papers: Call for Abstracts 16 Nominations Sought for Award for Excellence in Research 16 Residents Invited to Enter Research Essay Contest PBLD Program Open Call for Case Submissions 17 Meg A. Rosenblatt, M.D. DEPARTMENTS Ventilations 1 Administrative Update 2 Barry M. Glazer, M.D. Washington Report 3 Medicare Fee Schedule Update Bill Gains Wide Sponsorship, But Congress Fails to Act Before Recess Practice Management 23 Coding Changes for : How Much Will You Contribute? 11 Barry M. Glazer, M.D. Nominations for Distinguished Service Award 18 28th National In-Training Exam Set for July 13, Spotlight On September 11, 2001: When Our World Was Changed 19 Roy A. Winkler ABA Announces NEWSLETTER Subject Index NEWSLETTER Author Index 39 State Beat 27 Managing the Opt-Out Process Residents Review 28 A Review of the Annual Resident Component Meeting ASA News 30 FAER Report 43 Myer Rosenthal, M.D. The views expressed herein are those of the authors and do not necessarily represent or reflect the views, policies or actions of the American Society of Anesthesiologists. SUBSTANCE ABUSE HOTLINE Contact the ASA Executive Office at (847) to obtain the addresses and telephone numbers for state medical society programs and services that assist impaired physicians.

2 VENTILATIONS Anesthesiology s Aphorisms Chapter Four nce again, I present the members very own editorial column: Aphorisms brief witticisms to inspire your journey through life. So, let s begin at the beginning (a Berra-ism?): If you can t manage the surgeon, you have no business managing the anesthetic. Friends come and go, but enemies accumulate. A smart kidney and a dumb doctor always do better than a dumb kidney and smart doctor. You can either lead the disease or let the disease lead you. Regarding Awareness: Patients owe a lot to William Morton. If it weren t for him, they could tell the anesthesiologist when they are still awake! There is a direct relationship between the number of tattoos and the propofol dose. There is an inverse relationship between the number of tattoos and the tolerance to regional anesthesia. Classical music isn t as bad as it sounds (Berra-ism). Don t be caught dead doing something you would not be caught dead doing. There is an inverse relationship between a surgeon s ability and the frequency that he/she asks for more muscle relaxant. There is no vital organ in the body that cannot be reached with a two-inch needle. There is no condition that cannot be made worse by surgery (and/or anesthesia). It s easier to do it right the first time than to do it over. It s hard to predict the future because it hasn t happened yet. (Berra-ism) (Written on an old barn in Colorado) When on thin ice dance. Beware of colleagues with no sense of humor they are not very bright and will blame you for their errors. Sick people die! (use in place of self-flagellation when a negative outcome occurs). Every patient is a preop it s just a matter of figuring out for what! The patient isn t bleeding dopamine! Practice is the best of all instructors. Statistics will prove anything even the truth. Numbers are tools, not rules. Patients don t die from their disease; they die from the physiologic consequences of their disease (Osler). Levophed, or leave them dead. If you can feel a pulse, don t panic. Pain has never been meaningless. Fibrillation is a sign of life. The better you are, the luckier you become. Mark J. Lema, M.D., Ph.D. Editor Continued on page 13 January 2002 Volume 66 Number 1 1

3 ADMINISTRATIVE UPDATE It s Going to Be a Busy Year! Barry M. Glazer, M.D., President United States presidents are historically judged after their first 100 days. Fifty days into my one-year term, I am at the equivalent of a U.S. president s first 200 days. This places me where President Bush was in August; his subsequent experiences show that I would be foolish to predict how the rest of my year will go. Nevertheless, it is not too early to ask, how am I doing? How is ASA doing? We ve been very busy! We must always keep our perspective. Thankfully, there is no crisis in anesthesiology that I can imagine which would compare to the challenges President Bush has already encountered. Nevertheless, ASA does important work. I have started with a fast pace. All matters that the House of Delegates referred to committees of the president s choice have been referred. I have appointed the new Committee on Rural Anesthesia and a 10-member Task Force on Interventional Pain Medicine to study issues of importance to this growing subset of our membership. A committee to prepare the celebration of organized anesthesiology s centennial, in 2005, has been appointed. More than 70 ASA committees were appointed and most have begun their work for 2002, many meeting at our Annual Meeting last year in New Orleans. When a society has that many committees, it either has too many or it has a lot of work to do. ASA has a lot of work to do, and our committees are our assurance that the work will be done. Our educational activities are our core function. They are executed with such excellence that ASA leadership can concentrate on our squeaky wheels. From September 11 until the Annual Meeting, I flew nine flight segments. I expect to have added another 22 by year end, with about 100 more segments planned in 2002 (this number appears inflated since I almost always need two segments to get anywhere from Indianapolis). Travel is more time consuming and more challenging than it used to be, but I am committed to keeping all of my ASA obligations. I will travel to visit component societies and to represent our interests in Washington, D.C., at various AMA meetings and at one or two international conferences. The ASA President usually spends about 150 days away from home, in whole or in part. I am already committed to about 140 days, and the obligations continue to grow. The Barry M. Glazer, M.D. President-Elect and First Vice-President, combined, usually travel even more than the President. Collectively, our 11 ASA officers will liaison with every state, as will members of the Committee on Governmental Affairs. We wish to assure close cooperation between state societies and ASA. Our most important activity will be to assist states in which the governor may consider opting out of the recently retained federal requirement that nurse anesthetists be supervised by a physician. Your vigorous assistance and support for your state leaders is essential to our success in this effort. Your national officers cannot conduct these state-level activities. State governments see any attempts at outsider participation as an intrusion. This obligation falls squarely on anesthesiologists in each state, although ASA will provide vigorous support. We are working with the rest of organized medicine to support S and H.R. 3351, congressional bills to stop the onerous 5.4-percent reduction in Medicare payments to all physicians in 2002, and we are working to correct Medicare s persistent underpayment for anesthesiology services as compared to the rest of medicine. Your continued support of our political action committee and your involvement in the political process at the state and federal level remain as important in the support of all these efforts as they were in support of our extended and successful efforts to retain the federal supervision rule. I think we are off to a good start, and with the support of you, our members, we will have a great year! 2 American Society of Anesthesiologists NEWSLETTER

4 WASHINGTON REPORT Medicare Fee Schedule Update Bill Gains Wide Sponsorship, But Congress Fails to Act Before Recess Michael Scott, J.D., Director Governmental and Legal Affairs By December 20, more than 60 Senators and 280 Representatives had joined in sponsorship of S. 1707/H.R. 3351, companion bills under which the percent negative update in the Medicare conversion factor would be limited to 0.9 percent. Congress recessed for the year, however, without taking actions on the bills. Under the terms of the companion bills, a one-year adjustment in the effect of the Medicare update formula the so-called Sustainable Growth Rate (SGR) formula would be imposed for 2002, and the Medicare Payment Advisory Commission (MedPAC) would be required to report to Congress early next year with recommendations as to how the SGR should be changed. Congress did include this reporting requirement in the report on the Labor-HHS appropriations bill. MedPAC, a nonpartisan advisory body authorized by Congress, has already stated its view that the formula, particularly in its reliance on changes in the Gross Domestic Product as a limiting factor, is flawed and should be changed. Estimated one-year cost of limiting the negative update for 2002 would have been $1.25 billion. Under federal budget rules approved by Congress, there is no room for this additional Medicare expenditure unless an offsetting reduction is found elsewhere. Ways and Means Committee Chair William M. Thomas (R- CA) had expressed pessimism that these savings could be found and had also expressed the view that any adjusting legislation should be postponed until next year. Note should be taken of the fact that the current scheduled adjustment in the national anesthesiology conversion factor is a negative 6.89 percent, rather than 5.4 percent, due to the continued phase-in of negative adjustments in practice expense values determined in Adjustments for individual Medicare payment areas were reported in the December issue of the NEWSLETTER and will go into effect on January 1, ASA s Washington Office and outside legislative representatives have been among the most active in gaining sponsors for the companion bills among both Democrats and Republicans. House Unanimously Passes Medicare Reform Legislation On December 4, the House unanimously approved the Medicare Regulatory and Contracting Reform Act of 2001 (H.R. 3391), designed principally to reduce provider paperwork and introduce greater due process protection into the procedures for resolving disputes as to the appropriate level of reimbursement. The bill represents an amalgamation of regulatory reform bills adopted in November by the House Ways and Means Committee and Energy and Commerce Committee. Passage of the bill represents a significant step forward for organized medicine, which has lobbied intensively for many provisions of the bill in the current Congress. It includes the requirement that the Secretary of Health and Human Services establish an appeals mechanism for providers in claims disputes that includes judicial review and prohibits the Secretary from issuing regulations with retroactive effect. The bill would also prohibit sanctions against providers who act in accordance with erroneous written advisories from Medicare carriers and impose procedural standards on the issuance of new regulations by the Department. A somewhat similar Senate bill (S. 1738) was introduced in late November by the leadership of the Senate Finance Committee. Although it is theoretically still possible for the Senate and House bills to be reconciled and passed by Congress in 2001, the more likely result is that the Senate will take up S next year. Supervision Opt-Out Proposals Initiated in Handful of States By mid-december, gubernatorial offices in a limited number of states had indicated interest in considering an opt-out from Medicare nurse anesthetist supervision requirements, as permitted by Centers for Medicare & Medicaid Services November 13 final rule. Under the rule, a governor is permitted to opt institutions out of the federal requirement if such action is consistent with state law and if, after consulting with the state boards of medicine and nursing, the governor finds that such action is in the best interest of the citizens of the state. To date, we are aware of nurse anesthetist efforts to seek an opt-out in Idaho, Montana, North Dakota and Washington State. The component societies in these states are vigorously responding to these initiatives on Continued on page 7 ASA Washington Office 1101 Vermont Ave., N.W., Suite 606 Washington, DC (202) mail@asawash.org January 2002 Volume 66 Number 1 3

5 Controlled Substance Prohibition Reaffirmed Appearing below is a letter received by ASA from Attorney General John Ashcroft, reaffirming the Drug Enforcement Administration (DEA) prohibition against the use of federally controlled substances in connection with assisted suicide. The letter expressly notes that there will be no increase in DEA scrutiny of physicians prescription of controlled substances as a result of this reaffirmation of federal policy. Mr. Glenn W. Johnson Executive Director American Society of Anesthesiologists Headquarters Office 520 N. Northwest Highway Park Ridge, IL November 6, 2001 Dear Mr. Johnson: I am today restoring a judgement originally made by the Drug Enforcement Administration (DEA) that narcotics and other dangerous drugs controlled by federal law may not legally be used to assist suicide or for euthanasia in any part of our nation. This decision will be applied prospectively only. The American Society of Anesthesiologists has long taken the position that physician-assisted suicide is not a legitimate medical practice. At the same time, the American Society of Anesthesiologists has been rightly concerned to ensure that efforts to prevent the misuse of controlled substances to assist suicide do not deter physicians from prescribing controlled substances to alleviate pain. I want the nation s doctors to know that under this decision they will have no reason to fear that prescription of controlled substances to control pain will lead to increased scrutiny by the DEA, even when high doses of painkilling drugs are necessary and even when dosages needed to control pain may increase the risk of death. My decision today makes no change in the current standards and practices of the DEA in any state other than Oregon. Former Attorney General Janet Reno s June 5, 1998, letter emphasized that action to revoke the DEA registrations of physicians who dispense federally controlled substances to assist suicides may be warranted where a physician assists in a suicide in a state that has not authorized the practice under any conditions. Today s decision does not portend an increase in investigative or enforcement activity in any part of the nation outside of Oregon. Even in Oregon, enforcement of today s decision will not increase DEA scrutiny of physicians prescription of controlled substances for pain relief. Under Oregon law, a report that identifies the precise drugs used in every case of assisted suicide must be made to state authorities. The DEA has statutory authority to obtain these reports. Thus, it should be possible to identify the cases in which federally controlled substances are used to assist suicide in Oregon in compliance with Oregon law by obtaining reports from the Oregon State Registrar without having to review patient medical records or otherwise investigate doctors. Accordingly, implementation of this directive in oregon should not change the DEA s current practices with regard to enforcing the Controlled Substances Act so as materially to increase monitoring or investigation of physicians or other health care providers or to increase review of physicians prescribing patterns of controlled substances used for pain relief. I am therefore requesting that the American Society of Anesthesiologists take all appropriate measures to inform and reassure its membership and other physicians that there will be no increase in DEA scrutiny of physicians prescription of controlled substances to control pain in any state, including Oregon, as a consequence of today s decision. Consequently, physicians throughout the country should feel confident that they may prescribe federally controlled drugs to the full extent desirable to relieve pain without any fear that their prescriptions will be questioned or investigated as a result of today s action. Sincerely, 4 John Ashcroft Attorney General

6 2001 Annual Meeting House of Delegates Summary The House of Delegates of the American Society of Anesthesiologists met during the Society s Annual Meeting in New Orleans, Louisiana, October 13-17, Included in the significant actions of the House of Delegates were the following: Officer Elections Elections were held and the following officers will serve during 2002: President Barry M. Glazer, M.D. President-Elect James E. Cottrell, M.D. Immediate Past President Neil Swissman, M.D. First Vice-President Roger W. Litwiller, M.D. Vice-President for Scientific Affairs Bruce F. Cullen, M.D. Secretary Thomas H. Cromwell, M.D. Treasurer Orin F. Guidry, M.D. Assistant Secretary Peter L. Hendricks, M.D. Assistant Treasurer Roger A. Moore, M.D. Speaker of House of Delegates Eugene P. Sinclair, M.D. Vice-Speaker of House of Delegates Candace E. Keller, M.D. Special Awards Alan D. Sessler, M.D., of the Mayo Clinic, Rochester, Minnesota, was named as the recipient of the 2001 Distinguished Service Award. David C. Warltier, M.D., Ph.D., Medical College of Wisconsin, was presented with the 2001 Award for Excellence in Research. Rhonda Rowland, producer at CNN television and Betsy McCaughey, Ph.D., a writer for America Outlook magazine, were announced as recipients of the 2001 Media Awards. Membership for Anesthesiologist Assistants Ratified the Board of Directors previous action approving a new category of Educational Membership for the purpose of making educational opportunities available to anesthesiologist assistant members of the anesthesia care team. Budget Approved the 2002 Budget, which includes a total income of $19,541,500 and expenses of $19,241,100. Dues The following 2002 membership dues were approved: President Bush Addresses ASA s Delegates Members of the ASA House of Delegates watch a videotaped message from President George W. Bush during the opening session on October 14. Referring to the outpouring of public support in the aftermath of the September 11 attacks, the President told the delegates: I want to thank all of you in the American Society of Anesthesiologists for doing your part during the difficult past few days. Whether it was the doctors who worked overtime to help victims in New York and Washington or those who gave money and offered prayers, our nation is blessed by so many dedicated health care professionals. (Photography by Chad Evans Wyatt) January 2002 Volume 66 Number 1 5

7 Active members $450 Affiliate members $225 Educational members $225 Resident members $25 Medical Student members $10 Again in 2002, dues may be charged to members VISA and MasterCard accounts. In addition, members may pay their dues online. [You can access this feature on the ASA Web site < by clicking on Professional Information and going to Members Only Login. ] Appearing on the 2002 dues statement and membership card will be an acknowledgement that membership in good standing of ASA requires adherence to the ASA Guidelines for the Ethical Practice of Anesthesiology. By previous action of the Board of Directors and House of Delegates, 2002 dues payments will again include support for the Wood Library-Museum of Anesthesiology, the Foundation for Anesthesia Education and Research and the Anesthesia Patient Safety Foundation. Political Action Committee Received information that 4,509 ASA members contributed to the ASAPAC in 2001, with total contributions amounting to $947,862. Practice Parameters Approved the Practice Advisory for Preanesthesia Evaluation and Practice Guidelines for Postanesthetic Care. Also approved the updated practice parameter Practice Guidelines for Sedation and Analgesia by Non- Anesthesiologists. These practice parameters will be published in the journal Anesthesiology in spring 2002, and copies are currently available from the ASA Executive Office. Guidelines and Statements Ratified the Board of Directors previous approval of the newly revised American Medical Association (AMA) Principles of Medical Ethics to replace the current AMA principles appearing in the ASA document Guidelines for the Ethical Practice of Anesthesiology. Ratified the Board of Directors previous approval of revisions to the statement The Anesthesia Care Team and Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders or Other Directives that Limit Treatment and the new Statement of Support for Respiratory Therapists. Also approved revisions in Guidelines for Patient Care in Anesthesiology and approved a new document Statement of Principles: Critical Care and Trauma Medical Services. Task Force on Graduate Medical Education Ratified the Board of Directors previous approval of several recommendations from the Task Force on Graduate Medical Education, including that ASA contract with a consultant to assist in collecting various supply/demand data that could be used as a reference when the total number of residency positions is considered. Also approved recommendations that the ASA Committee on Governmental Affairs and the ASA Washington Office study the issue of reimbursement of practice-employed residents and the cap on the number of funded residency positions. Approved that these issues be pursued with federal government agencies if it appears achievable and politically appropriate. In addition, referred to a committee of the President s choice was the consideration of developing a program that would allow debt forgiveness of graduating residents in exchange for a limited commitment to academic medicine. Task Force on Structure and Governance Ratified the Board of Directors previous approval of a number of recommendations of the Task Force on Structure and Governance, including the establishment of a new position of Vice-President for Professional Affairs. Also approved a revision in ASA s organizational structure calling for the establishment of new sections on Administration, Professional Standards, Professional Practice and Society Subspecialties. These and other recommendations were referred to the Committee on Bylaws for implementation in October Referred to a committee of the President s choice a recommendation to study the size and composition of the Board of Directors and the Administrative Council. Relative Value Guide Ratified the Board of Directors previous approval of a number of additions and revisions to the 2002 Relative Value Guide. (Copies of the 2002 Relative Value Guide will be available in February 2002 through the ASA Executive Office.) Also ratified the Board of Directors previous approval of a new Statement on Transesophageal Echocardiography (TEE), which is intended to address funding issues and is not a detailed clinical or scientific treatise concerning TEE. 6 American Society of Anesthesiologists NEWSLETTER

8 Bylaws Approved Bylaws language for the establishment of a standing Committee on Rural Access to Anesthesia Care. Also approved new Bylaws language governing oversight of the Society s reserve funds. In addition, new language was approved to allow ASA s Board of Directors to participate in a meeting by way of conference telephone or similar equipment. Continuing Medical Education Approved a recommendation from the Section on Education and Research for the development of an educational product for the purpose of providing information to supervising surgeons regarding perioperative medical management. There was further consensus that the course material should be available in a variety of formats and that ASA should define the curriculum but should avoid certifying medical direction. Section on Fiscal Affairs Approved a recommendation that a committee of the President s choice give consideration to alteration of the dues structure for anesthesiologists financially affected by the war on terrorism. Web Site Editorial Board Ratified the Board of Directors previous approval of the establishment of a new Web Site Editorial Board to consist of one member each from the committees on Communications, Newsletter, Outreach Education and Electronic Media and Information Technology. Robert M. Wallace (left), ASA Member Services Manager, helps visitors at the ASA Resource Center to learn more about ASA's continuing medical education programs and other the benefits of membership. Board of Directors Following adjournment of the House of Delegates on October 17, 2001, the Board of Directors met in New Orleans, Louisiana. Board members were elected to serve on the Board of Directors committees on Administrative Affairs, Finance, Legislative Review and Scientific Affairs. Washington Report: Supervision Opt-Out Proposals Initiated in Handful of States Continued from page 3 patient safety grounds and, in this respect, are supported by the relevant state medical associations. At its semiannual meeting in early December, the American Medical Association adopted a resolution calling for continued support of the federal physician supervision standard. January 2002 Volume 66 Number 1 7

9 2001: We Did This Together Neil Swissman, M.D., 2001 President This report was presented by the 2001 ASA President, Neil Swissman, M.D., to the ASA House of Delegates on October 14, 2001, in New Orleans, Louisiana. The 2001 ASA presidency has been like a roller coaster ride twists, turns, steep climbs and rapid descents have characterized this year. In spite of the turbulence, our motivation has steadfastly been patient safety. It was mid-january when the Clinton Administration, yielding to outrageous political pressure, published its rule. That rule would have allowed anesthesia nurses to practice without physician supervision. Trying to remedy that wrong and protect our nation s seniors occupied the majority of my time this year. With the help of staff, skilled lobbyists, our public relations consultants and advertising experts, we were able to convince President Bush and his administration to review the ill-considered Clinton rule. They postponed the implementation of that rule twice and have now proposed a new rule. The new rule will maintain physician supervision or anesthesiologist direction of anesthesia care for Medicaid and Medicare patients. However, a governor may opt out of this requirement if it is consistent with state law and if other requirements have been fulfilled. The rule also proposes an outcome study to determine the safety of alternate forms of anesthesia delivery. In an effort to derail the proposed new rule and prevent its publication, the American Association of Nurse Anesthetists (AANA) continues to twist facts. Half-truths, personal attacks and distortions are still the methods they use to try to achieve their goal. Whatever that goal is, it is not patient safety! If it were patient safety, they would support the study before changing the system. ASA has never resorted to personal attacks on their profession or their leadership. We have never used anecdotal cases to prove our point. We know that access (rural or Neil Swissman, M.D., is a private practitioner in Las Vegas, Nevada, and Associate Professor of Anesthesiology, University of Nevada-Reno College Medical School, Reno, Nevada. Almost all of the nation s physicians and the nation s seniors want physicians involved in their anesthesia care, and they support the new proposed rule. The bottom line is no excuse to diminish the quality of health care. There is no alternative to patient safety. Patient safety is our oath and our motto. urban) is not the issue, and we know that anesthesia nurses do not, as AANA claims, deliver 65 percent of the nation s anesthetics alone. They do participate in anesthesia care. We know they are not better trained than anesthesiologists and we know they are not safer anesthesia providers. Anesthesiology is the practice of medicine not the practice of nursing. Almost all of the nation s physicians and the nation s seniors want physicians involved in their anesthesia care, and they support the new proposed rule. The bottom line is no excuse to diminish the quality of health care. There is no alternative to patient safety. Patient safety is our oath and our motto. Over the past year, I have been involved in a number of public affairs, public education and communication opportunities to favorably affect the perception and opinion of our specialty. This includes the public and the media along with federal and state legislators. The decision by the Bush administration to reverse the Clinton supervision rule was obviously affected by the overwhelming public affairs and lobbying campaign organized by the ASA Washington office, communications department and outside consultants. Two major supporters who delivered our message of patient safety to people nationwide were the public/political advocacy groups of e- advocates and The Seniors Coalition. Earlier this year, their combined Web-based and direct-mail efforts generated more than 125,000 letters, faxes, postcards and 8 American Society of Anesthesiologists NEWSLETTER

10 messages that went to the White House, Centers for Medicare & Medicaid Services (CMS) and Congress protesting the Clinton rule. A more recent effort to raise public support for the Bush rule that reinstates supervision garnered another 13,000-plus responses. These efforts were synchronized with ASA-sponsored radio and television advertising in Washington, D.C. Our message also was delivered to legislators and regulators through large diorama signs in the Ronald Reagan National Airport promoting anesthesiology and ASA with the message: Keeping You Safe for Surgery: Our Concern, Your Life. Numerous high-profile editorials and news stories appeared in the media. An editorial in the Milwaukee Journal stressed the need for a patients outcome study. This editorial was published the day before I met with former Wisconsin Governor and Health and Human Services Secretary Tommy Thompson. Also present at the meeting was Milwaukee anesthesiologist and former nurse anesthetist Catherine M. Drexler, M.D. National media outlets also showcased anesthesiology this past year, including the Cable News Network (CNN), NBC News and the New York Times. The women s publication Self magazine wrote about the benefits of physician involvement in anesthesia care following a face-to-face meeting with editors and Galveston anesthesiologist S. Lynn Knox, M.D., who is also a former nurse anesthetist. The medical diversity of our profession was highlighted through numerous media opportunities coordinated by the Committee on Communications. I was proud to be part of the ASA video and radio news releases on pain medicine produced and distributed this spring. The releases featured Boston anesthesiologist Carol A. Warfield, M.D., and reached more than 6 million people. While we await approval and implementation of the final rule to retain physician involvement in the anesthesia care of Medicare/Medicaid patients, we know that our message of patient safety was heard coast to coast and, we hope, will be heeded. Committees All ASA committees have met and carried out their respective tasks. Their annual reports are in this handbook. In particular, I urge you to read the annual reports of the committees on Quality Management and Departmental Administration (429-3) and Outreach Education (534-1). These committees are helping ASA answer the request of the American College of Surgeons for assistance in developing educational programs for their members. These programs are to provide them with appropriate knowledge to medically manage a patient when a nonphysician provides or administers anesthesia. I urge your support of this activity. I want to thank each chair and the members of all ASA committees for their dedication and service. Task Forces There are many task force reports in this year s handbook. These task forces were asked to consider new issues facing ASA and have provided us with meaningful evaluations of those issues. The report from the Task Force on Structure and Governance (400-3) is far-reaching. I have appointed a special Reference Committee to receive testimony on only that report. Please consider that report carefully. It is not necessary to adopt it in its entirety. Many of its recommendations may require further study. Please refer any item that you are not absolutely convinced is appropriate to President-Elect Barry M. Glazer, M.D. I urge adoption of the recommends from the Task Force on Educational Affiliate Membership (414-1). We have already offered our support to anesthesiologist assistants. They are a valuable part of the anesthesia care team and committed to that mode of practice. I also urge your support of the Task Force on Graduate Medical Education (400-5) report. The problems addressed in that report are critical to the training of new anesthesiologists and to the survival of our specialty. We must support academic anesthesiology. I want to personally thank each task force chair and the members of those task forces for their service to ASA. ASA Political Action Committee (ASAPAC) ASAPAC continues to be an important part of our political presence in Washington. In the year 2000, contributions were received from 24 percent of ASA s members. This year, contributions are running at a disappointing 12 percent. Our needs have not diminished, and we must strengthen our resolve. Please support ASAPAC. More anesthesiologists must participate! This is the last year of service to the PAC Board for Rodney C. Osborn, M.D. Thank you for your service and untiring efforts on our behalf. Foundations Every ASA foundation continues to thrive as witnessed by their reports. They remain a source of pride to our Soci- January 2002 Volume 66 Number 1 9

11 ety and vital to our future. I urge continued support of these foundations. Sections All the sections of our Society continue to function well and provide leadership in their respective areas. Membership Those naysayers who predicted a drop in ASA membership were wrong! Our membership continues to grow, and we represent almost all of our country s anesthesiologists. Finances While the economy has changed and our ASA expenses have soared, we continue to remain financially healthy. My special thanks to ASA Treasurer Orin F. Guidry, M.D., Assistant Treasurer Roger A. Moore, M.D., and the Section on Fiscal Affairs for guiding us through these times. Please read my progress report (411-3) for a further update of this year s ASA activities. Gratitudes There are so many to thank for this spectacular year and our successes. The Administrative Council has provided me with all the time I needed from them, sometimes at less than 24-hour s notice. Their advice, dedication to ASA, friendship and support have been more than could be expected. They have been a constant source of strength. ASA President-Elect Barry M. Glazer, M.D., and First Vice-President James E. Cottrell, M.D., have been at my side every step of the way. Their advice and involvement have been invaluable. When I was not available, without question, they carried the baton for ASA. With their wisdom and leadership, the future of ASA is secured. This year, ASA discovered a new medical condition Siamese triplets. Glenn Johnson, Mike Scott and Neil Swissman were a seamless unit. At all hours of the day or night and at any location, they were there to brainstorm, debate and plan. We shared each victory and each sorrow. The wisdom they bring to ASA is beyond description, and all of us are fortunate to have them as part of the ASA team. They are dedicated to our Society, our specialty and our patients. They are very much a part of anesthesia care in this country. A simple thanks to them is no measure of their value or what they mean to me. We are equally fortunate to have outstanding colleagues in Park Ridge, Illinois and Washington. Their tireless energies and professional skills played a vital role in our success. On behalf of every ASA member, I extent the most sincere thanks to Ron, Frank, Sue, Dee, Janice, Phil, Diane, Karin, Manuel and the rest of the staff. You cared not because it was ASA but because it was right. No other organization has a better or more loyal team. My partners at Summit Anesthesia Consultants deserve special thanks. They tolerated my prolonged and often unplanned absences without ever missing a beat. I must acknowledge the encouragement and support the Nevada State Society of Anesthesiologists has given me for many years. I am proud of my component society and its political activities. My family has been a tower of strength. When I had to miss family functions, they filled in for me. They understood the obligation. They take great pride in what ASA stood for and that I had the privilege of representing the nation s anesthesiologists. Now, I must give special recognition to my best friend and wife of 31 years. I can honestly say I have never before subjected her to the stresses we shared this year as the scope-of-practice issue evolved. Without question, she accepted my responsibility. Her advice was always appreciated and appropriate. She always gave me a shoulder to lean on at the most trying times. She truly deserves the title First Lady of Anesthesiology! Debbie, all of ASA thanks you for the sacrifices you have made this year. I love you very much. The privileges of being your President, a member of ASA and an anesthesiologist have been great honors. I am so proud to be part of this specialty and this Society. I would do it all over again in a heart beat. Casey D. Blitt, M.D., Director of ASA District Number 21, told me there are three times in a man s life youth, middle age and boy you look good! I hope I have looked good to you and represented you well. Thank you for this extraordinary honor! 10 American Society of Anesthesiologists NEWSLETTER

12 2002: How Much Will You Contribute? Barry M. Glazer, M.D., 2001 President-Elect This address was delivered by the 2001 President-Elect Barry M. Glazer, M.D., to the ASA House of Delegates on October 14, 2001, in New Orleans, Louisiana. For decades, the most important activities of this Society have been those dealing with education. The issues most debated by the House of Delegates have dealt with scope of practice, reimbursement and the public image of the anesthesiologist. Adequacy of personnel to provide anesthesia services throughout the country and expanding the role of the anesthesiologist to be a more complete physician have been discussed. The present is so much like the past that we would be foolish to think that the immediate future will be greatly different. While ASA may never provide a final solution for any of these matters, I believe that we have taken actions, year after year, to address those issues that are important to anesthesiology, and I believe that we have made great progress to improve our specialty. I am committed to lead this Society in continuing that progress. Scope-of-Practice Issues If the rule published by the Centers for Medicare & Medicaid Services (CMS) on July 5 becomes final, we will have a challenge before us, a challenge to work in every state to educate our governors about the importance of physician involvement in the care of every patient who receives an anesthetic. Our federal activities for the last four years have provided an unexpected benefit: Anesthesiologists around the country have become more united than ever before and better prepared than at any time in our history to be involved in legislative and governmental activities and to advocate effectively for patient safety. ASA has committed additional resources, both in money and personnel, to assist the states in their advocacy efforts. But every state must immediately increase its readiness and its involvement as there is absolutely nothing that ASA can do to substitute for the involvement of anesthesiologists at the state level. Without local involvement, there will be local episodes where our efforts do not succeed. Medicare Reimbursement Our Committee on Economics is one of our hardest working and most effective committees. They have expertly presented the case for increased reimbursement to the American Medical Association s (AMA s) Relative Value Update Committee (RUC). The RUC has not met its responsibility this past year, which is to honestly accept the results of the surveys that we have conducted repeatedly, to their standards, and to act on those results to recommend an appropriate increase in reimbursement. Anesthesiology remains grossly undervalued in the Medicare system. ASA is committed to using all its resources to pressure the RUC to present appropriate recommendations for updates to the anesthesiology conversion factor. If those efforts fail, we will continue to advocate directly to CMS for appropriate increases in reimbursement. And please be assured, we are also already advocating, and will continue to do so, for appropriate reimbursement for pain management and critical care as well. It is my goal that ASA will be able to return the dues dollars of its members to them, hopefully many times over, in increased reimbursement from Medicare alone. Advocacy and ASAPAC Both on scope-of-practice issues and on reimbursement issues, our advocacy efforts are a large portion of the activity of ASA. In return for the efforts of ASA, each of you is obliged to support the political process. Such support can most easily be expressed in a broad base of substantial contributions to our Political Action Committee (ASAPAC). Many physicians do not like the political process and do not like political action committees, campaign contributions or politicians. I am not asking our members to change what they like. But I am asking every anesthesiologist to recognize the realities of the world in which we live, including the need to be involved in politics in order to achieve successes and avoid failures in the political arena, which affects our lives every day. Education The educational activities of ASA are the foundation of our existence. Even in years such as those we have recent- Barry M. Glazer, M.D., is Staff Anesthesiologist, Department of Anesthesiology, Saint Francis Hospital, Beech Grove, Indiana. January 2002 Volume 66 Number 1 11

13 ly experienced, education remains the primary function of this Society. ASA continues to conduct the largest and best anesthesiology meeting in the world and publishes one of the best journals in the world of medicine. Because their efforts are so successful, we often fail to recognize the thousands of anesthesiologists who are responsible for the educational activities of ASA. I thank you and ASA thanks every one of you who has contributed to our outstanding educational programming. Structure and Governance The latest iteration of the Task Force on Structure and Governance has worked hard for two years to produce a very thoughtful report, which I know the House of Delegates will give appropriate consideration. In particular, I strongly support the recommendations that will formalize the interaction of ASA leadership with the leadership of the subspecialty societies and the academic societies within our specialty and that will formalize the process for soliciting input for committee and leadership appointments by the President-Elect. The appointment process is a difficult one, which I believe every President- Elect takes very seriously; extensive input can only improve the information available to assist in these important decisions. The State of the Specialty and the Society I am proud to be an anesthesiologist, and I am proud of our specialty and its health. In spite of the challenges that we and all of medicine face daily, the membership of ASA continues to reach new highs. Although we encountered difficulties (many of them due to bad information) in recruiting anesthesiologists in the past, it appears that we have turned the corner and that we are attracting more and better physicians into our residency programs. Nevertheless, we have challenges to address as the academic community struggles to recruit and retain high-quality faculty for the education and research that will assure our continued success and growth. The Task Force on Graduate Medical Education has provided several recommendations for ways that ASA can help, and I support the report of the task force. We are obliged to continue to support our past, present and future, as embodied in our foundations. I am proud that I rarely hear objection to such continued support. Our planned giving program for support of the foundations is under way, and I urge your support of this activity as an additional, long-term source of funds for the foundations. We have a shortage of personnel to provide all the anesthesia services that are necessary as surgical volume and complexity continues to grow. For this reason, the anesthesia care team is a reality for the foreseeable future. Anesthesiologist assistants are committed to the anesthesiologist-led care team, and I urge you to adopt the recommendations that will allow them to be educational members of ASA. We continue to be fiscally sound, although with reduced reserves compared to recent years. Historically, our budgetary process has not been well thought out. The Section on Fiscal Affairs has recommended procedural changes for that process, which will make our fiscal decisions more deliberative and sound. I support their recommendations, as amended by the Board. We are four years away from the 100th anniversary of organized anesthesiology. I encourage adoption of the recommendation of the Committee on Communications, forming a committee to begin plans for the centennial celebration. We have strong alliances with the rest of organized medicine. AMA, every state medical society and a multitude of national medical specialty societies have supported our efforts at the federal level. AMA has repeatedly recognized our successes and our contributions; our AMA delegation is well-respected. I urge each of you to support your state medical associations and AMA with your membership dues. We are blessed with a plethora of volunteers, and virtually all the work that needs to be done finds multiple members willing to serve. Each committee has several members well-qualified and willing to serve as a future chair, and there is an abundance of committee chairs prepared to accept greater responsibilities. Delegates are available to become directors, directors to become officers and officers to become future presidents of the Society. Our future is secure. Appreciation Glenn W. Johnson is an exemplary Executive Director who leads a lean and efficient ASA staff. Michael Scott is as dedicated and effective as Director of Governmental Affairs as anyone could possibly wish for. These two leaders and the entire ASA staff in Park Ridge, Illinois, and Washington D.C., make up a remarkable team that is as dedicated to the cause of anesthesiology as our own members. Without the dedicated staff of ASA, your officers would accomplish little. 12 American Society of Anesthesiologists NEWSLETTER

14 Every one of our officers not only performs his or her specific duties in an outstanding manner while looking for ways that their office can make ASA better, but they also are routinely concerned with every aspect of ASA and its welfare. They will constitute a cabinet for me in the coming year who will work hard and advise me wisely. The two Presidents with whom I have worked most closely, my immediate predecessors, Neil Swissman, M.D., and Ronald A. MacKenzie, D.O., have left me with the opportunity to move ASA forward and have given me the greatest guidance in how to do so. There are no messes to clean up, and for that I am most grateful. On Wednesday, when I become President of ASA, my wife, Jan, and I will celebrate our 30th anniversary. Her birthday is four days later. In the past 20 years, we have usually spent either our anniversary or her birthday, and sometimes both, in elegant cities during the ASA Annual Meeting, but usually in the company of a room full of other anesthesiologists. She reminds me to be humble, that I am only the custodian of an office that I am honored to hold for a year and will then pass on to the next leader. Thank you to every member of this Society who has made a contribution. I have been in organizations with no member support, and good leaders are not able to make them great. Without the support and contributions of the membership, we would not have this wonderful specialty and this strong professional Society. Every one of you contributes to ASA s greatness, and I once again pledge to try to honor you as much as you have honored me. Ventilations: Anesthesiology s Aphorisms Chapter Four Continued from page 1 Be wary of patients whose risk exceeds their ejection fraction. Treat the patient, not the monitor. Never trust a naked baby! We live a life of choice not chance. People respond to appreciation. Leadership by example works. I received a note from Stephen J. Prevoznik, M.D., who served for many years at the University of Pennsylvania as the clinical director and vice-chair and was the mentor for hundreds of anesthesiologists. As a teaching aid, he composed a list of laws for practicing safe anesthesia. These collected aphorisms are timeless and are reprinted for you. Prevoznik s Laws of Anesthesia Never anesthetize a patient who isn t there. The more effective the case, the more selective your evaluation. Compromise, though not desirable, is permissible with all but patient safety. Chance of survival drops precipitously as the BUN exceeds the body weight. The more the ECG resembles the EEG, the sicker the heart. Regarding open-heart surgery: If not on bypass by the end of page 1, expect a long case. If not on bypass by the end of page 2, survival odds drop. Death can be deferred but not defeated. Never block pain that isn t there. It is much easier to add (drugs) then to subtract (them). Never argue with success just because you can t explain it. No block ever fails, some just have to be supplemented more than others. Fifteen minutes spent preoperatively with a patient is worth 15 mg of morphine as a premedicant. I would like to thank the following physicians for submitting material to this column: John S. Carson, M.D., Doris K. Cope, M.D., Kenneth R. DeVoe, M.D., Philip S. Gibbs, M.D., Stephen J. Prevoznik, M.D., Hector A. Rodriguez, M.D., Myer H. Rosenthal, M.D., Joseph L. Seltzer, M.D., Joseph F. Talarico, M.D., Peter M. Winter, M.D., Howard L. Zauder, M.D., and John S. Zorab, M.D. M.J.L. Editor s Note: Please send your aphorisms, witticisms, Berra-isms, oxymorons and dueling aphorisms to me for the next Aphorisms installment. January 2002 Volume 66 Number 1 13

15 ASA Art Show: Down by the Riverside Triumphs in Wake of September 11 Tragedy Jerry J. Berger, M.D., Chair Committee on Art Exhibits The 34th annual ASA Art Exhibit, Down by the Riverside shone as one of the best exhibits that the ASA has ever displayed, despite the tragic events of September 11, Braving long air traffic delays, canceled flights and slow overland travel, the artists persevered and managed to deliver works showcasing their talents to the exhibit hall. There were 145 entries, about the same as most yearly exhibits, and the literature entries numbered 12. It was the first year that digital photography was an entry category. A set of photographs of the World Trade Center by Alan W. Grogono, M.D., was assembled on short notice and was featured prominently in the exhibit hall as a tribute to all those brave people who lost their lives in the September 11 attack. Judging of the art entries took place on Saturday afternoon, October 13, and was overseen by Sam and Diane Losavio, who examined and re-examined the art over a five-hour period before making their final award decisions. Literature was judged by Shelley Mickle, a prominent author and columnist. The winners of each category should be proud and know that well-credentialed professionals awarded them prizes. Best of Show was awarded to Govind P. Garg, M.D., for his color photograph Morning Prayer. The winners in all the other categories are listed below: Best of Show Govind P. Garg, M.D., Morning Prayer Viewers Choice Medge D. Owen, M.D., Croak-quette Anyone? Junior Exhibitor 1st Tanvi Shah for oil painting Foothills in Italy 2nd James L. Patterson, M.D., for color photography Sunset at 21:00 Jerry J. Berger, M.D., is Associate Professor of Anesthesiology, University of Florida, Gainesville, Florida. Govind P. Garg, M.D., won Best of Show for his Morning Prayer photograph, but the biggest victory was the positive member turnout during a tragic time. Theme: Down by the Riverside 1st William B. Strong, Jr., M.D., for digital photography View of Ocean Springs over Watermelon 2nd Laszlo Gyermek, M.D., Ph.D., for oil painting Sailboat at Zuiderzee 3rd Anne E. Dickison, M.D., for color photography Stealth Glider Honorable Mention Karen Furman, M.D., and group Altered Book Painting: oil and acrylics 1st Mary A. Cheng, M.D., Sikou 2nd Saroj M. Shah, M.D., Standing Vigil 3rd Maria Anderson Irene of Mykonos Painting: watercolor, tempera and gouache 1st Medge D. Owen, M.D., Croak-quette Anyone 2nd Ezzat I. Abouleish, M.D., Ali-Baba 3rd Ann Gessner Peony 14 American Society of Anesthesiologists NEWSLETTER

16 Photography: color 1st Govind P. Garg, M.D., Morning Prayer 2nd Douglas J. Reinhart, M.D., Navigating the Bergs 3rd Govind P. Garg, M.D., Smokies at Dawn Honorable Mention: Jacquelin K. Kewalramani, M.D., Divine Light Photography: black and white 1st Gregory M. Janelle, M.D., Beach Trip 2nd William L Johnson, M.D., Morada Eternal Photography: digital 1st William B. Strong, Jr., M.D., Antique Shop 2nd Jessie A. Leak, M.D., Water Lilies 3rd Alan W. Grogono, M.D. In Memoriam Honorable Mention: Jerry A. Cohen, M.D., Sedona Sunrise Graphic works on paper: drawings, prints and pastels 1st George M. Wahab, M.D., Beside the Flowers 2nd Druscilla A. DeFalque Dreams II 3rd Suada N. Spirtovic, M.D., Confusion Honorable Mention: Jessie A. Leak, M.D. Fisherman Sculpture: including found objects 1st Jose S. Sison, M.D., Daddy Long Legs 2nd Jerry J. Berger, M.D. Second Life Crafts: including needlework, weaving, pottery, stained glass, jewelry 1st Karen Furman, M.D., When in Disgrace (crafts) 2nd Gulen F. Tangoren, M.D., Scottish Tissles (needlework) 3rd Hema Mehta Blue River (pottery) Honorable Mention Patti Hetrick William s Choice (quilting) This was my first year as Chair of the Committee on Art Exhibits, and things went smoothly, largely because of the tireless help of committee members and Kelly Spaulding, our wonderful coordinator. The theme for next year in Orlando, Florida, will be Fountain of Youths, in recognition of our Florida location and its association with both water and as a center for children s vacation activities. Rev up your minds and imaginations and start creating next year s entries! Guidelines for art and literature entries are being modified slightly to improve the exhibit, so please access the ASA Web site in the near future and note the changes. I look forward to seeing everyone in Orlando next year and to enjoying the wonderful artistic creations. As chair of the Committee on Art Exhibits, Jerry J. Berger, M.D., far right, announces the top winners of the 34th annual ASA Art Exhibit during a reception on October 14. January 2002 Volume 66 Number 1 15

17 2002 ASA Scientific Papers: Call for Abstracts The submission procedure for the 2002 ASA Annual Meeting scientific papers will be very similar to that used in For 2002, ASA has once again partnered with Marathon Multimedia, which specializes in online paper submissions. This year, the abstract submission program will be accessible through ASA s Web site < AnnMtg/> and clicking on the Scientific Papers link. All accepted abstracts will be published in their entirety in electronic format, and the summary of the abstract will be published in the 2002 Annual Meeting program book. Submission instructions are available on the ASA Web site and will not be mailed to authors. It will not be necessary to request a packet of abstract submission material. The following outlines the 2002 Scientific Papers submission process: The submission Web site will be available on January 7, The deadline for submitting all abstracts is Sunday, April 1, 2002, at 11:59 p.m. Central Standard Time. Abstract submission will require a computer, an Internet connection and a Web browser (version 4.0 or higher). If you do not have access to these items, you may find out about alternate submission methods from the ASA Executive Office. All submission instructions will be available on the ASA Web site and accessible from any point during the submission process. No separate submission packet will be mailed. Authors may input and revise submissions until deadline or until the abstract is officially submitted by clicking the Submit button. Entries will be checked automatically for completeness once officially submitted. After the closing deadline, entries that are not in compliance with all of the submission requirements will be assumed to be in draft format and will not be considered by the graders. A brief summary of the study must be included with the submission and, for abstracts that are accepted, will be published in the 2002 Annual Meeting program book. The summary will not be considered when the abstracts are graded. The September supplement to Anesthesiology will consist of a CD-ROM containing the full text and graphics of all accepted abstracts. The use of scientific characters and common style elements such as bold, italic and underline will be permitted. Font specification, with some limitations, will be available. The ASA Web site will contain more complete information regarding the process for submitting abstracts. Nominations Sought for Award for Excellence in Research The annual ASA Award for Excellence in Research recognizes an individual for outstanding achievement in research that has or is likely to have an important impact on the practice of anesthesiology. The individual s work must represent a body of original, mature and sustained contribution to the advancement of the science of anesthesiology. The nominee need not be a physician, an anesthesiologist or a member of ASA but must be presently engaged in research related to anesthesiology. In 2001, the award was presented to David C. Warltier, M.D., Ph.D., at the ASA Annual Meeting in New Orleans, Louisiana, on Monday, October 15, 2001, immediately preceding the Emery A. Rovenstine Memorial Lecture. Dr. Warltier is Professor in the Departments of Anesthesiology, Medicine (Cardiovascular Division) and Pharmacology & Toxicology; Vice-Chair for Research, Department of Anesthesiology; and Director, Medical Scientist Training Program at the Medical College of Wisconsin, Milwaukee, Wisconsin. The deadline for nominations for the 2002 Award for Excellence in Research is March 30, Guidelines for nominations are available from the ASA Executive Office, 520 N. Northwest Highway, Park Ridge, IL American Society of Anesthesiologists NEWSLETTER

18 Residents Invited to Enter Research Essay Contest Resident members of ASA are reminded that April 1, 2002, is the deadline for receipt of entries in the ASA Residents Research Essay Contest. Three prize-winners will be invited to present their papers at the ASA Annual Meeting in Orlando, Florida, in October The rules for entry are: Eligibility 1. The entrant or co-entrant(s) must be a member of ASA at the time of submission. 2. The work reported should have been completed during residency or research fellowship training in an Accreditation Council for Graduate Medical Education-accredited program in anesthesiology. Research performed as a student may be considered. 3. Papers should be submitted while in training or within one year after completion of training. Submission of Entry 1. A letter from the residency program director confirming eligibility must accompany each submission. 2. Concurrent submission of an abstract of the work for presentation as a regular scientific paper at the ASA meeting is required. That submission should be prepared using the ASA abstract submission material in accordance with the rules and deadlines for submission of regular ASA scientific abstracts and submitted independently of the essay contest application. 3. Manuscripts should follow the format provided in the Guide for Authors of the journal Anesthesiology. The work should not have been presented, published or submitted to any other meeting, journal or residents essay contest prior to this submission. A limit of 25 doublespaced pages, including all figures, tables and references, will be enforced; manuscripts that exceed the page limit will not be reviewed. The original and 21 copies of the manuscript must be received by April 1, 2002, by the office of the Chair of the Committee on Research, Michael K. Cahalan, M.D., Anesthesia Department, University of California-San Francisco, 521 Parnassus Ave., San Francisco, CA Complete guidelines for application are available from residency program directors or from the ASA Executive Office, 520 N. Northwest Highway, Park Ridge, IL Guidelines for the submission of ASA Annual Meeting scientific papers are also available from the ASA Executive Office and the ASA Web site. The Guide for Authors for the journal Anesthesiology can be found in the January issue of the journal PBLD Program Open Call for Case Submissions Meg A. Rosenblatt, M.D., Chair Committee on Problem-Based Learning Discussions The 10th year of the Problem-Based Learning Discussion (PBLD) Program at the ASA Annual Meeting included many new cases chosen from the open selection process. In an effort to maintain the vitality and relevance of the PBLD program, the Committee on Problem-Based Learning Discussions again wishes to solicit new cases for possible inclusion in the 2002 program. Any member of ASA is invited to submit a PBLD case to the committee for review and possible selection for the 2002 ASA Annual Meeting in Orlando, Florida. We are looking for controversial topics, compelling true cases and areas where there are content gaps in the current program. For the 2002 program, all cases both new and old will be reviewed by the committee for their relevance, enigma, content, conformity to guidelines and clarity of presentation. This year, for the first time, all cases must be submitted online. All submissions must conform to the guidelines for PBLD cases as described in the 2001 Problem-Based Learning Discussion CD- ROM and on the ASA Web site < AnnMtg/PBLD>. These include: title, objectives, case, model case discussion and references. Deadline for submission of PBLD cases is February 15, January 2002 Volume 66 Number 1 17

19 Nominations for Distinguished Service Award The House of Delegates has established policies governing the selection of a recipient for the ASA s Distinguished Service Award. Procedures for the submission of nominations and selection of a candidate for 2002 will be as follows: 1. Any member of ASA or a component society may submit the names of individuals for consideration for this award. name of no more than one candidate. Selection of a candidate shall require a two-thirds vote of the full committee. 6. No officer of ASA shall be eligible for selection. 7. Should the committee select a candidate to enter into nomination in the House of Delegates, the name of the candidate shall not be disclosed until placed in nomination before the House of Delegates. 2. Nominations must be submitted on the nomination forms, which may be obtained from the ASA Executive Office, together with a current curriculum vitae. 3. Nomination forms should be submitted to: Neil Swissman, M.D W. Sahara Ave., Suite #340 Las Vegas, NV Final selection of the recipient of the Distinguished Service Award shall be made by the House of Delegates by secret ballot and shall require a two-thirds vote of those seated in the House of Delegates. 4. Nomination forms must bear a postal mailing date on or before August 1, The committee will review the names of nominees submitted and recommend to the House of Delegates the 28th National In-Training Exam Set for July 13, 2002 The ABA-ASA Joint Council on In-Training Examinations encourages all trainees in anesthesiology to participate in the 28th National In-Training Examination to be given July 13, The examination last year was challenging and stimulating to trainees and rewarding to program directors. The 2001 examination will be identical in format. Keyword feedback will be supplied to examinees and program directors, and scores will be provided to enable the examinees to compare their performances to that of all other residents at the same training level and to track their own growth in knowledge. Each program director will receive a summary of the performance of all trainees in that program, including every year each trainee has participated. Application forms have been sent to all program directors, and residents in training are urged to obtain the form from their program director and to complete it as soon as possible. Canadian trainees have been invited to participate again this year. Applications can be submitted only by the program director and must be received at the ASA Executive Office on or before May 1, The examination will cost $85 per examinee. Application information relating to the In-Training Examination is available to program directors from the ASA Executive Office, 520 N. Northwest Highway, Park Ridge, IL ; or contact <J.Jacobson@ ASAhq.org>. Any other questions may be directed to Raymond C. Roy, M.D., Wake Forest University Medical Center, Department of Anesthesiology, Medical Center Blvd., Winston-Salem, NC ; <rroy@wfubmc.edu>. 18 American Society of Anesthesiologists NEWSLETTER

20 SPOTLIGHT ON September 11, 2001: When Our World Was Changed Roy A. Winkler ASA Communications Assistant Photographs by Kenneth M. Sutin, M.D. Change begets change. Nothing propagates so fast. If a man habituated to a narrow circle of cares and pleasures, out of which he seldom travels, steps beyond it, though for never so brief a space, his departure from the monotonous scene on which he has been an actor of importance would seem to be the signal for instant confusion The mine which Time has slowly dug beneath familiar objects is sprung in an instant; and what was rock before, becomes but sand and dust. Charles Dickens (1844) Few could argue that before September 11, 2001, each and every one of us was not habituated to our own narrow circle of cares and pleasures. As much as mass media saturation, instantaneous electronic communication and rapid means of travel have made ours a global culture, we Americans, for the most part, remain communal beings. In general, we tend only to worry about what goes on in our own backyards the times are rare that we have a need to worry about anything more. But on the morning of September 11, 2001, the narrow circle of our individual cares and pleasures was forever altered. As we watched the tragedies unfold in New York City, Washington, D.C., and southwestern Pennsylvania, Americans collectively understood that a monumental and unprecedented change had taken place. Certainly it was important that these events represented the only direct attacks on American soil since Pearl Harbor more than 60 years ago. More important, however, and perhaps more devastating, were the symbolic consequences. In a span of two hours, an as yet unnameable and invisible foe had reduced to rubble and ash the mammoth twin symbols of American commerce and prosperity in New York and had infiltrated the very brain trust of our military might in the Pentagon. As the ruins of the World Trade Center and the damaged Pentagon smoldered, as dismay and horror turned to speculation and rage, we began to realize the most insidious truth about these unprecedented events. We realized that our highest ideals, our most cherished institutions, and our belief and faith in human goodness had been used against us. Soon after that fateful morning, we were dramatically confronted with an enemy that we were to learn hated us for our ideals and beliefs. They hated our values and they hated our lifestyles. We were shocked into confronting what we had collectively become: fragmented and isolated, despite the fact that television and the Internet had supposedly made us so connected. We were still communal, but our communities were within ourselves. We cherished such ideals of January 2002 Volume 66 Number 1 19

21 freedom, goodness and tolerance, but we also had reached a point where we largely took them for granted. On September 11, 2001, that all changed. In mere minutes, we watched our symbols of prosperity and cultural tolerance crumble to the ground. We realized then that everything that we have held dear up until that point had been challenged. The collective reaction, for a culture so supposedly complacent and jaded, might have been as astonishing as the grisly images on that morning of September 11. The evil of that day was met with an equal amount of solidarity and compassion from Americans and from people the world over. The terrifying acts of September 11 initially achieved their intended effects Americans were shocked, frightened and confused. But just as quickly as those acts of terror reduced the World Trade Center to rubble, they galvanized the collective American spirit of unity and pride. Americans from all ethnic backgrounds donated their time, their services, their money, their blood. The most culturally diverse melting pot of citizens in the world had become one again. The Damage Done In the midst of the chaos in lower Manhattan and the vicinity of the Pentagon, firefighters, police officers and ordinary citizens scrambled to help those in need. Hospital and emergency medical staff were also preparing for the worst. J. David Roccaforte, M.D., an assistant professor of anesthesiology at New York University and co-director of the surgical intensive care unit at Bellevue Hospital in Manhattan, was preparing an elective oral surgery case on the morning of September 11. Around 8:50 a.m., he and his associates received word that an explosion had taken place at the World Trade Center. Looking out the windows of the Bellevue intensive care unit, they saw billowing smoke from the towers. Many in the ICU there saw the second plane hit the south tower. It did not take long for the hospital staff to realize how badly they would be needed. We proceeded to the emergency department and began setting up for mass casualties, Dr. Roccaforte said. Elective cases were completed, ICUs were triaged and cleared, and operating rooms were placed on standby. Within an hour, we were fully prepared to accept and treat injured patients up to our capacity. In the ensuing hours, Dr. Roccaforte and his co-workers treated about a dozen critical trauma patients, and the emergency department processed and treated around 200 minor casualties. When the trade center towers collapsed, however, they understood that minor casualties would probably be minimal from that point on. While Dr. Roccaforte and countless others struggled amid the chaos in New York City, more tragedy was occurring in the nation s capital. At 9:43 a.m., American Airlines Flight 77 crashed into the Pentagon. Evacuation began immediately, but lost in the great plumes of smoke and scattered rubble was an objective appreciation of the damage done. Once again, like in New York, area hospitals and trauma units were rushed into action. More Dead Than Wounded Grant Lynde, M.D., an Army captain and CA-3 resident at Walter Reed Army Medical Center in Washington, D.C., was in the operating room when he and his co-workers were informed of the attacks on the World Trade Center. While he watched television news coverage of the New York attacks, Dr. Lynde learned that the Pentagon had been attacked as well. The hospital was put on alert, and they prepared for the worst. All of the staff in the emergency room were separated into trauma teams consisting of a surgeon, an anesthesiologist, two R.N.s and two L.P.N.s, Dr. Lynde said. We distributed equipment and waited. My team was third up for a patient. Like so many who were involved in the chaotic atmospheres soon after the attacks, Dr. Lynde understandably felt a mixture of confusion, sadness, horror and rage while he watched and listened to the chaos so close to him. Adding to his own personal distress was the knowledge that his fiancée frequently visited the Pentagon through her job as an economist. Not knowing her whereabouts, he tried frantically to call her. As was so frequently reported at the time, however, cellular phone infrastructure failed, and he spent a hellish three hours until he was finally able to contact her and learn that she was safe. During those tension-filled hours of waiting, the first of three patients arrived. He had substantial burns and required intubation due to his injuries, Dr. Lynde said. Because of the edema from the burns and overall poor airway morphology, intubation was extremely difficult and ultimately required an emergent tracheostomy. A second patient came to the surgical intensive care unit and was intubated after developing respiratory distress. A third acute trauma patient died before reaching the ICU. Dr. Lynde was on call that night and so was asked to 20 American Society of Anesthesiologists NEWSLETTER

22 provide anesthesia for the second patient who had developed compartment syndrome. Because the Walter Reed Army Medical Center is not a trauma center, the patient s severe burns presented added challenges for Dr. Lynde and his co-workers. When the patient was successfully intubated and sedated, however, Dr. Lynde found a brief amount of time to contemplate. Three things struck me pretty deeply during the case, he said. First, the patient was about my age, and I started to think about all the people I knew in the Pentagon prior patients and a childhood friend. It was difficult for me to not be incredibly sad and angry at the atrocity brought upon us by a yet unknown enemy. Second, I was overwhelmed by the odor of burnt flesh and the non-textbook-like hyperdynamic nature of the patient, as if all the fentanyl in the world couldn t ease his pain. And third, I was impressed by the amazing crystalloid requirements such a patient had. He was not to witness much more of the same, however. The rush of casualties that Dr. Lynde and his fellow staff members prepared for never came. The reason was obvious: There would be more dead than wounded. Waiting to Do Anything Useful An attending anesthesiologist at nearby Alexandria Hospital in Alexandria, Virginia, R. David Zurowski, M.D., experienced the same letdown as Dr. Lynde while he waited for incoming wounded from the Pentagon. We all sat around in the operating room waiting, but no one came, he said. He later learned that the military took strict control over matters concerning the treatment of any who were injured in the attack. As an Arlington County Medical Examiner, however, Dr. Zurowski found himself amid the damaged Pentagon site. It was just like something you d see in a movie, he said. There were three or four perimeters of fences, and it seemed everybody had loaded automatic weapons. Dr. Zurowski expressed amazement at the relatively small number of people actually partaking in the rescue process. He estimated that there were perhaps six or seven people from all manner of governmental agencies on the scene for every one rescue worker, but he did not know who they were or why they were there. Dr. Zurowski was close enough to witness the attempts at reclamation of bodies and any salvageable items of evidence. They would pull out huge chunks or rubble, dump it into trucks and take it to a different side of the Pentagon. Then they would dump it, hose it down and pick through everything. Because the military s control over all aspects of the attack s aftermath, not even the funeral directors with whom Dr. Zurowski worked so closely were called upon despite the anticipated high death toll. All in all, for civilian medical staff in the Washington, D.C., area, the hours and days following the Pentagon attack were frustratingly uneventful. There seemed to be one concurrent feeling experienced by Dr. Lynde, Dr. Roccoforte, Dr. Zurowski and the thousands of others who were called upon to assist in helping those in need following the attacks: a yawning helplessness. As the police, military and the media began to piece together the events of September 11, the situation became more clear and more disturbing. These terrorist attacks were soon to be recognized as the worst the world had ever seen. They had been calculated by a faceless enemy to take as many lives as quickly as possible. As the medical community was learning, they succeeded in dramatic fashion. Several of our physicians returned from a New York downtown hospital to report that their casualties were lower than expected, Page 19: Taken on September 13, Manhattan skyline looking south. Page 20: Taken on September 13, shows damage to buildings of the World Financial Center, approximately 100 yards from the World Trade Center. Page 21: A passerby studies one of several walls near the New York Medical Examiner s Office, where families and friends hoped to learn of their loved ones fates. January 2002 Volume 66 Number 1 21

23 Memorials in the dust. This column in front of World Financial Center building number 2, just east of the World Trade Center, was transformed into one of many impromptu tributes that sprang up around the city. or missing. Eerily, he observed a wondrous contrast to the nightmare on the city streets. The wind shifted and the sun broke through, it was an otherwise innocent late summer day. Welcome to this brave new world, he lamented. Regaining an Air of Normalcy Dr. Roccaforte reported. We were asked to equip and staff a field hospital triage site at Chelsea Piers. Our reports from physicians there were also of few if any seriously injured survivors. The afternoon was spent in frustration, waiting to do anything useful. Brave New World At St. Vincent s Manhattan Hospital, where the majority of casualties from the trade center attacks would have gone, the same frustration permeated the medical ranks there. George G. Neuman, M.D., chief anesthesiologist at St. Vincent s, reported a pressing helplessness at being within walking distance of ground zero, but not being able to get to the victims. Anesthesiologist Steven Stern, M.D., also of St. Vincent s, echoed that statement and said that after treating dozens of burn victims during the initial wave, the expected deluge never came. Around 2 a.m. the next morning, after hours of agonized waiting, Dr. Roccaforte s team realized that no more casualties would be coming into his Chelsea Piers triage site. They dismantled, and he made his way home through the now surreal, ash-clogged streets that just half a day before hummed with vitality and optimism. About the casualty situation, Dr. Roccaforte commented that this was nothing we wouldn t be able to handle even under ordinary circumstances. I don t think the disaster response was in any way lacking. By the time the dust settled and the fires were controlled, the golden hour was long gone. By then, all that was left was the walking wounded and the dead. All in all, a frustrating endeavor. The next morning, Dr. Roccaforte played witness to frantic scenes on the city s streets. Everyone here was trying to track down anyone they know who might have been in the buildings or the area and sorting out if they are safe Change has a considerable psychological impact on the human mind. To the fearful, it is threatening because it means that things may get worse. To the hopeful, it is encouraging because things may get better. To the confident, it is inspiring because the challenge exists to make things better. King Whitney, Jr., President of Personnel Laboratory, Inc. Eight weeks after the attack on the Pentagon, Dr. Zurowski is amazed at how sterile it now looks. The rubble has been removed, the damaged sections cleaned up and the workers on scaffolds give the impression that only simple, routine maintenance is being performed. Although the devastation was greater in New York City, ground zero too is slowly regaining an air of normalcy. What remains of the World Trade Center will eventually be whisked away, damaged buildings nearby will be repaired, city planners and construction workers will no doubt retransform the area, and it will take on a new life of its own. Buildings can be replaced. Landmarks come and go. The effects of September 11, however, were more powerful than the World Trade Center was tall. You look at things more closely now, Dr. Zurowski said. Little things creep into your life. Things that people used to take for granted, they don t take for granted anymore. For Dr. Lynde, many of the memories of September 11 will never go away. Since that day, a lot has changed in my life, he said. Some of my friends, attendings and colleagues are no longer here. I still here the sounds, see the people and smell the burnt flesh as if it was yesterday. His fiancée was personally unscathed from the Pentagon attacks, but she lost four coworkers there. All Americans lost something that day, indeed anyone in the world who cherishes liberty and goodness lost something that day. A relatively small few gave the ultimate Continued on page American Society of Anesthesiologists NEWSLETTER

24 PRACTICE MANAGEMENT There are some significant changes to the Current Procedural Terminology (CPT) codes for anesthesia services for Interventional radiologic procedures and obstetric anesthesia in particular have been revamped. The new obstetrical anesthesia and analgesia coding system was the subject of companion articles by Alexander A. Hannenberg, M.D., and James P. McMichael, M.D., in the December 2001 NEWSLETTER. The section on Anesthesia for Radiological Procedures has eight new codes, eight deleted codes and one revised code. Many anesthesiologists will be pleased to know that code (anesthesia for myelography, diskography, vertebroplasty) is included in the 2002 CPT book and will therefore be recognized by those payers who do not accept a code until it is in CPT. Codes for anesthesia for therapeutic interventional radiologic procedures for the arterial system (three codes) and the venous/lymphatic system (four codes) have also been added to CPT, but with code numbers differing from those listed in the 2001 ASA Relative Value Guide (RVG). The 2002 RVG will use the code numbers as assigned by CPT. In most cases, CMS base values match those assigned by ASA; the exceptions are noted in Table 1. Please refer to Table 2 for a summary of anesthesia codes that a r e new/deleted/revised/renumbered for The two codes for anesthesia for diagnostic or therapeutic blocks and injections (when the block or injection is performed by a different provider) have been assigned new numbers in the 2002 RVG. These and other codes in the RVG but not the 2002 CPT are listed in Table 3. Questions regarding the changes should go to Sharon Merrick, ASA Coding and Reimbursement Analyst at <s.merrick@asawash.org>. Ms. Merrick compiled the information for this article. Coding Changes for 2002 Karin Bierstein, J.D. Assistant Director of Governmental Affairs (Regulatory) Table 1: New CPT Codes With ASA and CMS Base Value Differences Code Description ASA CMS Base Value Base Value Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; NOS carotid or coronary intracranial, intracardiac or aortic Anesthesia for therapeutic interventional radiologic procedures involving the venous/ lymphatic system (not to include access to the central circulation); intrathoracic or jugular intracranial Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure)(use in conjunction with code 01967) 3 2 January 2002 Volume 66 Number 1 23

25 Table 2: Anesthesia Code Changes for 2002 New Codes ASA Base Units **00326 Anesthesia for all procedures on the larynx and trachea in children less than 1 year of age THIS CODE IS NOT IN THE 2002 CPT TM Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity TM **00834 Anesthesia for hernia repairs in lower abdomen; under 1 year of age THIS CODE IS NOT IN THE 2002 CPT TM **00836 Anesthesia for hernia repairs in lower abdomen; infants less than 37 weeks gestational age at birth and less than 50 weeks gestational age at time of surgery THIS CODE IS NOT IN THE 2002 CPT TM Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection TM Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; vasectomy, unilateral/bilateral TM Anesthesia for myelography, diskography, vertebroplasty TM Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; not otherwise specified TM carotid or coronary TM intracranial, intracardiac, or aortic TM Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); not otherwise specified TM intrahepatic or portal circulation (eg, transcutaneous porto-caval shunt (TIPS)) TM intrathoracic or jugular TM intracranial TM Anesthesia for: vaginal delivery only TM cesarean delivery only TM urgent hysterectomy following delivery TM cesarean hysterectomy without any labor analgesia/anesthesia care TM abortion procedures TM Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor) Report time for neuraxial labor analgesia according to local standards TM Cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure) (Use in conjunction with code 01967) Time units reported as for surgical anesthesia services TM Cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure) (Use in conjunction with code 01967) Time units reported as for surgical anesthesia services TM (Continued) 24 American Society of Anesthesiologists NEWSLETTER

26 Table 2: Anesthesia Code Changes for 2002 (continued) Deleted Codes Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; cesarean section (to report, use 01961) cesarean hysterectomy (to report, use 01963) Neuraxial analgesia/anesthesia for labor ending in a cesarean delivery (includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor) (to report, see 01968, 01969) Anesthesia for procedures on major lower abdominal vessels; transvenous umbrella insertion (to report, use 01930) Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal delivery (to report, use 01960) Neuraxial analgesia/anesthesia for labor ending in a vaginal delivery (includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor) (to report, use 01967) Anesthesia for injection procedure for pneumoencephalography (to report, use 01905) Anesthesia for injection procedure for myelography; lumbar (to report, use 01905) cervical (to report, use 01905) posterior fossa (to report, use 01905) Anesthesia for injection procedure for diskography; lumbar (to report, use cervical (to report, use 01905) Anesthesia for arteriograms, needle; retrograde, brachial or femoral (to report, use 01916) Anesthesia for angioplasty (to report, see ) Revised Codes Anesthesia for diagnostic arteriography/venography arteriograms, needle; carotid or vertebral Anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; less than one four percent total body surface area one percent to nine between four and nine percent of total body surface area Renumbered Codes **02100 Anesthesia for diagnostic or therapeutic nerve blocks and injections; when block or injection is performed by a different provider (3 + TM) THIS CODE IS NOT IN THE 2002 CPT **02101 Anesthesia for diagnostic or therapeutic nerve blocks and injections - patient in the prone position; when block of injection is performed (5 + TM) by a different provider) THIS CODE IS NOT IN THE 2002 CPT January 2002 Volume 66 Number 1 25

27 Table 3: New ASA RVG codes The RVG still contains some codes that are not included in CPT, although fewer than in the past. Payers who recognize a code based upon its inclusion in the RVG should accept these new ASA RVG codes Anesthesia for all procedures on the larynx and trachea in children less than 1 year of age TM Anesthesia for hernia repairs in lower abdomen; under 1 year of age TM Anesthesia for hernia repairs in lower abdomen; infants less than 37 weeks gestational age at birth and less than 50 weeks gestational age at time of surgery TM The two codes for anesthesia for diagnostic or therapeutic blocks and injections (when the block or injection is performed by a different provider) have been assigned new numbers in the 2002 RVG. THESE CODES ARE NOT IN THE 2002 CPT Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider TM Anesthesia for diagnostic or therapeutic nerve blocks and injections - patient in the prone position (when block or injection is performed by a different provider TM JCAHO Compliance Toolkit Answers Your Questions Online The ASA Web site now features an interactive program that answers anesthesiologists questions about complying with various policies, guidelines and standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Designed to assist ASA members responsible for their departments compliance with JCAHO requirements, the Toolkit consists of: links to relevant JCAHO standards and intents ASA standards, guidelines and statements sample policy and procedure statements educational materials for nonanesthesiologists, including slide shows and streaming video presentations Frequently asked questions (FAQs) related links The Toolkit, which contains links between and within the above information sets, was created by Robert S. Lagasse, M.D., of the Committee on Quality Management and Departmental Administration (QMDA) and two staff members, Janice L. Plack, Director of Information Services, and Anita Abbatacola, Web Site Administrator. The Committees on Electronic Media and Information Technology and on Information Management contributed their expertise. Dr. Lagasse was previously involved with a similar toolkit developed by the New York State Society of Anesthesiologists teamed with the Healthcare Association of New York State. The three-year project was funded by the New York State Department of Health and began as an effort to examine the effectiveness of various dissemination strategies for clinical practice guidelines. The FAQs section of the Toolkit is a particularly helpful feature. The committee and its members who also serve as ASA s representatives to the JCAHO s Professional and Technical Advisory Committees (PTACs) devote considerable time and thoughtfulness to answering members questions and to keeping the Toolkit up to date. Besides the JCAHO and ASA standards, the Toolkit content comes from various members of the QMDA Committee, and as such, it represents personal suggestions and opinions rather than ASA policy. All ASA members who have material that they have found valuable in complying with JCAHO and other accreditation requirements and that they would like to have considered for inclusion in the Toolkit, are invited to submit the material to <webmaster@asahq.org>. 26 American Society of Anesthesiologists NEWSLETTER

28 STATE BEAT Managing the Opt-Out Process S. Diane Turpin, J.D. Assistant Director of Governmental Affairs (State) Several state component societies are addressing the issue of state governors seeking an opt-out from the Medicare requirement for physician supervision of nurse anesthetists. Iowa s governor was the first to opt out last month. Component societies are accustomed to the traditional legislative and regulatory processes whereby time typically marches slowly, giving all interested parties an opportunity to weigh in on an issue. That was not the case in Iowa, nor should component societies expect an opt-out request to be a drawn-out process. The opt-out process is vastly different and requires component societies to behave in a different manner. The opt-out process is very simple. The governor must consult with the state s boards of medicine and nursing regarding access to and quality of anesthesia services in the state. The governor must determine that opting out is consistent with state law and is in the best interests of the citizens of the state. The governor then submits a letter to the Centers for Medicare & Medicaid Services (CMS) requesting an opt-out. The opt-out is effective upon CMS receipt of the letter. It cannot be stressed enough that an opt-out could conceivably occur before a component society even knows it has been requested. In two cases, we received approximately 24 hours notice of a board of medicine meeting on this issue. By now, all component societies should have contacted the governor s office and the board of medicine and asked that it be advised if the governor is interested in seeking an opt-out. Although it is hard to fathom that a governor would seek an opt-out without discussing the issue with both physicians and nurses, component societies should not rely upon the governor s staff to initiate the dialogue. In Iowa, repeated efforts were made to schedule a meeting with the governor s staff, to no avail. Once a governor decides to initiate the process, a decision can be made very quickly. Before opting out, the governor must determine that it is consistent with state law. Simply put, if the state laws and/or regulations require physician supervision of nurse anesthetists, an opt-out would not be consistent with state law. The difficulty lies in determining what state law requires. The American Association of Nurse Anesthetists relies primarily on the Nurse Practice Act and Board of Nursing regulations, ignoring other laws and regulations that impact on the scope of practice of nurse anesthetists. For example, in Montana, nurse anesthetists have asked the governor to opt out of the physician supervision requirement. Montana hospital regulations require that nurse anesthetists practicing in hospitals must be under the supervision of the operating practitioner or an anesthesiologist who is immediately available if needed. (See MONT. ADMIN. R [1]). These regulations actually incorporate the Medicare Anesthesia Conditions of Participation as published in As such, an opt-out would be inconsistent with state law. Component societies must understand the laws of their respective states. If an opt-out is inconsistent with state law, the component society must be able to explain why. Regardless of the governor s view on this issue, no governor wants to act on incorrect or incomplete information. The governor also must determine that opting out is in the best interests of the citizens of the state. One must wonder how a governor could make such a determination without considerable public debate on this issue. Nevertheless, CMS is not going to query the governor on what steps he or she took to determine the best interests of the public. Component societies must seek to ensure that the public is advised and has an opportunity to weigh in on this issue. Office-Based Anesthesia One Step Forward, One Step Back New Jersey The board of medical examiners has proposed regulations to establish a mechanism by which physicians who do not hold hospital privileges can become privileged by the board to administer and supervise anesthesia or perform surgery or special procedures in the office setting. Upon final adoption of the proposed rule, a physician who does not hold hospital privileges must apply for board privileges no later than one year after the effective date of the rule. The physician may continue to practice in the office until such time as the board acts upon the application. This alternative privileging process sets forth a number of requirements a physician must meet to be approved by the board, and the requirements vary depending upon the type of anesthesia to be provided or supervised by the physician. A physician (whether privileged by a hospital or the board) who administers or supervises the administration of general anesthesia services must, during every consecutive three-year period, complete at least 60 category 1 hours of continuing medical education (CME) in anesthesia. A physician privileged by a hospital or the board to Continued on page 31 January 2002 Volume 66 Number 1 27

29 RESIDENTS REVIEW A Review of the Annual Resident Component Meeting Carlos L. Moreno, M.D., Chair Resident Component Governing Council The ASA Resident Component meeting was held in October 2001 during the ASA Annual Meeting in New Orleans, Louisiana. It was an exciting meeting, and it was a pleasure to meet so many energized anesthesiology residents. We covered a lot of ground during the Leadership Training/Grassroots Advocacy Program, the Resident Component House of Delegates and the Annual Residents Forum. While many residents turned out and participated in these sessions, I would like to review the highlights in this article for those who did not make it. Moreover, I want to reiterate the importance of sharing this information with all anesthesiology residents so as to increase awareness and perhaps fuel interest in getting involved in your ASA. We must remember that we are only as strong as our active membership, and communication is the key for keeping our resident members in the loop. If any anesthesiology resident has questions regarding the work of ASA, he or she can contact any member of the Resident Component Governing Council (see < for contact information). Congratulations to the newest members of the Resident Component Governing Council: Bracken J. DeWitt, M.D., Ph.D., Chair-Elect; Sherri Y. Burton, D.O., Alternate Delegate; and James F. Weller, M.D., Secretary. Lastly, I want to thank all residents who ran for national offices and were not elected; I encourage you to stay involved, as there are many leadership opportunities at local, state and national levels. Anyone with further questions can direct them to me at <clmoreno@umich.edu>. The following items were discussed during each of these resident sessions. Leadership Training/Grassroots Advocacy This is a forum held on the Friday evening preceding the ASA Annual Meeting. A panel of ASA Political Action Carlos L. Moreno, M.D., is a CA-3 resident at the University of Michigan, Ann Arbor, Michigan. Chair Carlos L. Moreno, M.D., Chair-Elect Bracken J. DeWitt, M.D., Ph.D. Secretary James F. Weller, M.D. Delegate Jason T. Vigue, M.D. Alternate Delegate Sherri Y. Burton, D.O. Resident Component Governing Council Officers for 2002 Ann Arbor, Michigan Owings Mills, Maryland Baltimore, Maryland Durham, North Carolina Chapel Hill, North Carolina Committee (ASAPAC) board members, representatives from our ASA Washington Office and legal counsel for ASA update residents on medical and legal as well as political issues involving anesthesiologists nationwide. This year s update concerned the nurse anesthetist/physician supervision ruling. A lively reception for all residents in attendance followed this session. ASA Resident Component House of Delegates This session was held on the Saturday afternoon of the ASA Annual Meeting. The meeting began with three guest speakers addressing a variety of anesthesia-related topics. ASA President-Elect [for 2001], Barry M. Glazer, M.D., spoke on reimbursement and scope-of-practice issues. Rodney C. Osborn, M.D., now past Chair of ASAPAC, updated the Resident Component House on scope-of-practice issues as well as reviewing the guidelines for delivery of safe office-based anesthesia. Lastly, Ronald L. Harter, M.D., Chair of the Committee on Young Physicians, explained the role of the Committee on Young Physicians and encouraged residents to join state component societies. Special recognition was given to both Ronald A. Mackenzie, D.O., Immediate Past President, for his commitment to medical student and resident education, and Thomas B. Bralliar, M.D., Chair of the Committee on Residents and Medical Students, for his outstanding work and support of the American Medical Student Association (AMSA) Airway Workshops. The Resident Component House of Delegates, in addition to 28 American Society of Anesthesiologists NEWSLETTER

30 electing new members to the Resident Component Governing Council [Table 1], discussed and passed seven resolutions: Resolution 1 called for the integration of advanced trauma life support into the core curriculum of anesthesiology residency programs. Resolution 2 asked that the Resident Component encourage the American Board of Anesthesiology (ABA) to establish a system that facilitates the ability for residents to pursue elective rotations outside their residency program. Resolution 3 asked that the Resident Component encourage the Committee on Communications to include resident nominees for the anesthesia recognition award. Resolution 4 asked ASA to consider expanding the AMSA Airway Management Teaching Program to include regional resident scientific meetings. Resolution 5 asked the chair of the Resident Component to write a letter to every program director asking that preference be given to residents to provide regional anesthesia in those cases involving regional anesthesia. Resolution 6 called for ABA to change the Pain Management subspecialty name to Pain Medicine. Resolution 7 asked the chair of the Resident Component to write a letter to the Society for Education in Anesthesia and the Association of Anesthesiology Program Directors encouraging the incorporation of didactics as well as transesophageal echocardiography in their curricula. Resolutions requiring letters from the chair of the Resident Component will be submitted to the appropriate individuals and their responses will be posted in a future Chair s Page update at < Residents Forum This residents-only forum was held on Sunday morning. Items discussed included: bringing new fellows and attendings into the Resident Forum to discuss job opportunities in academics and private practice, increasing residency program interest in ASAPAC, creating Web links from the Resident Component page to career development Web sites (for example, < < < and instructions and review of how to apply for reimbursement of Federal Insurance Contributions Act taxes for residents (see < Committee Appointments Deadline for committee requests was December 31, To all residents who have already submitted materials, I have not forgotten about you. Selection of committee members will not be completed until May 1, I would like to announce the appointment of the two new Resident Co-Editors for the ASA NEWSLETTER: Jill M. Mhyre, M.D., and Carlos O. Viesca, M.D. These two individuals will be the contacts for anyone wishing to submit an article for the ASA NEWSLETTER. Their contact information will be posted on the ASA resident Web page at < Airway Management Workshops ASA will be conducting its Annual Airway Workshop at the AMSA National Meeting. This year s meeting will be March 6-10, 2002, at the Hyatt Regency in downtown Houston, Texas. I am looking for anesthesiology residents from the local programs to help conduct these airway management workshops, which are designed to introduce medical students to the basics of airway management. We also will begin coordinating with regional resident scientific meetings to conduct additional airway workshops for residents (and students) attending these meetings. Anyone interested in participating in the workshop should contact Carlos L. Moreno, M.D., for more information. Legislative Conference The ASA Legislative Conference is scheduled to take place in Washington, D.C., on April 29-May 1, Attending this conference provides a unique way to get involved with the political branch of ASA. Past activities include briefings on health care issues being discussed on Capitol Hill and speeches by members of Congress as well as opportunities to participate in lobbying efforts. Interested residents should contact their state component societies for further details. I would once again like to take the opportunity to graciously thank Tripti C. Kataria, M.D., Fran Thayer, M.D., and John D. Cabral, M.D., for their leadership and outstanding service to the Resident Component. A special thanks goes out to Christine A. Doyle, M.D., our Webmaster, for her outstanding work on the Resident Component homepage. May the future bring all of you happiness, health and good fortune. If any resident member has questions, concerns or issues related to his or her anesthesia training, please feel free to contact me. I look forward to working with all of you over the next year. January 2002 Volume 66 Number 1 29

31 NEWS 2002 Meeting Dates for ASA Governing Bodies ASA President Barry M. Glazer, M.D., has announced that the Interim Meeting of the Board of Directors will be held in the Chicago area on March 2-3, The Annual Meeting of the Board of Directors also will be held in the Chicago area on August 17-18, The first meeting of the House of Delegates will be held in Orlando, Florida, on Sunday, October 13. The following deadlines have been established for filing reports to be considered by the House of Delegates. Reports Due Reports Mailed *September 6 September 3 September 24 (5 p.m.) *As requested by the 1983 House of Delegates, this distribution will consist of all reports acted upon by the Board of Directors at its previous meetings, the minutes of those meetings and reports from the Speaker concerning conduct of the House of Delegates. All Board of Directors actions will be footnoted on those reports previously considered. The Speaker of the House of Delegates has provided regulations in the Rules of Order to provide that all reports and resolutions for the House of Delegates must be in the hands of the Executive Director no later than 5 p.m. Tuesday, September 3. When possible, all individuals are requested to submit their reports by August 30 to provide sufficient time for the Executive Office to prepare the reports for distribution. The 2002 House of Delegates will not, therefore, consider reports or resolutions received after 5 p.m. Tuesday, September 3, Calendars and More Coming to Your Mailbox Soon The twice-a-year envelope mailing of new booklets, brochures and meeting information for ASA members is now sent separately from the January and July NEWSLETTER due to postal regulations governing periodical mailings. This change was implemented in January You will receive your January envelope mailing within the next few weeks, containing important up-todate information, including: ASA Calendars for Meetings, January 2002 edition (This will be the last printed issue. All meetings are now posted at < ASA Publications and Services Catalogue Information on the 2002 Self- Education and Evaluation (SEE) program Doctors Day 2002 information and poster Office-Based Surgery and Anesthesia patient education brochure, new for 2002 Sedation Analgesia patient education brochure, new for Single copies of the above publications are mailed to ASA members free of charge. Additional copies may be obtained from the ASA Publications Department ( 847) ; <publications@asahq.org>. ABA Announces ASA Solicits ABA Directorate Nominations The American Board of Anesthesiology (ABA) has announced that the Directorates now held by Steven C. Hall, M.D., and Mark A. Warner, M.D., end with the Annual Meeting of the Board in the fall of Drs. Hall and Warner are eligible to serve another term. In accordance with the policy established by the ASA representatives to the Joint Committee at the ASA Annual Meeting on October 20, 1961, the component society secretaries and district directors of ASA have been notified regarding the procedure to be followed in submitting the name(s) of a candidate or candidates for the guidance of the ASA representatives to the Joint Committee. These names must be mailed to the ASA Executive Office, 520 N. Northwest Highway, Park Ridge, IL , with a postal mailing date prior to March 1, American Society of Anesthesiologists NEWSLETTER

32 September 11, 2001: When Our World Was Changed Continued from page 22 sacrifice, and the lives of their loved ones will never completely whole again, but all of us will remember the images and feel the shock of that day. An enemy attacked us and awakened emotions and feelings that most of us do our best to avoid or ignore. But along with the collective awakening of our fear, horror and vengeance came an awakening of a collective sense of pride and unity, a pride and unity that comes from being an American. An enemy destroyed the World Trade Center, damaged the Pentagon and took thousands of innocent lives above the ground and on the ground, but that same enemy did more damage to itself than it could ever do to our country. They awakened our slumbering sense of unity. They united the melting pot of individuals who are here to find a life of freedom and tolerance. Americans, as should be clear by now, work best under pressure. Americans do not just welcome change, Americans are change. We were full of fear and reticence that day and for the days that followed, but we pulled together. We proved our system works. I ve been in contact with some family members who lost loved ones in the Pentagon, and I can t begin to describe the cathartic feelings they as family members and I as a caregiver have felt as we have shared our stories, Dr. Lynde said upon recounting his efforts to save lives on September 11. I d like to think that the families feel a bit better knowing that someone cared enough to help ease some victim s pain someone just like their loved one and I know I feel better knowing that people appreciated all of our efforts. On September 11 and during the days that followed, it was not important that we were surgeons or lawyers or construction workers or anesthesiologists. It was important that we were Americans. Like so many times before, we pooled our talents, and we became one again. We were forever changed on that day, but change, to Americans, is just another name for growth. We grew, and as the efforts of Drs. Zurowski, Roccafortte, Lynde and countless others can attest to, no enemy will ever halt that growth. State Beat: Office-Based Anesthesia One Step Forward, One Step Back Continued from page 27 administer or supervise regional anesthesia must, during every consecutive three-year period, complete at least eight category 1 hours of CME in anesthesia exclusively or as it relates to the physician s field of practice. A physician privileged by a hospital or the board to administer or supervise conscious sedation must, during every consecutive three-year period, complete at least eight category 1 hours of CME in any anesthesia services, including conscious sedation exclusively or in anesthesia as it relates to the physician s field of practice. A nurse anesthetist must be supervised by one of the above-referenced physicians. Minor conduction blocks, with the exception of retrobulbar blocks, shall be administered only by a physician or podiatrist, nurse anesthetist, certified nurse midwife, advanced practice nurse or physician assistant who has training and experience in the administration of minor conduction blocks. Retrobulbar blocks shall be administered only by a physician. The proposed rule also provides for board-approved privileges for physicians and podiatrists who perform surgery or special procedures in the office. New York In a lawsuit brought by the New York State Association of Nurse Anesthetists, a New York Court ruled that the Clinical Guidelines for Office-Based Surgery, adopted by the State Department of Health (DOH), are null and void and of no force and effect and prohibited DOH from publishing, distributing or enforcing the guidelines. The court s ruling does not address the merits of the guidelines. The court held that DOH did not have legal authority to adopt guidelines which, by DOH s admission, were intended to be standards to be applied in physician disciplinary proceedings and would be evidence of local community medical standards in medical malpractice actions. At this writing, no decision has been made regarding an appeal. January 2002 Volume 66 Number 1 31

33 2001 Subject Index 2001 NEWSLETTER Subject Index Subject Vol. Month:Page Administrative Update April in Paris February 65 4:2 Anesthetic Drug Shortages: What s Going On? 65 5:2 Cloudy Forecast Revisited; Partly Sunny With Higher Temps 65 6:2 Help Me to Communicate With You! 65 1:2 Mother ASA 65 10:2 Naysayers Beware the Indomitable Human Spirit 65 1:2 Our Patient Safety Record Is in Grave Danger 65 3:2 Our Place in American Medicine and the Public Consciousness 65 4:3 Purpose and Passion 65 9:2 Volunteer Members Make the Difference 65 12:2 Voting Process and Safeguards in the House of Delegates 65 7:2 We Say That We Matter Let s Make Sure We Keep It That Way 65 11:2 Who Can Our Patients Trust Now? 65 2:2 Who Is Responsible for the Future? 65 8:2 American Board of Anesthesiology 27th National In-Training Exam Set for July 14, :16 ABA, ASA and ACGME: Collaboration, Clarification and Less Confusion 65 3:23 ASA Solicits ABA Directorate Nominations 65 1:28 ABA Announces 2001 Meeting Dates for ASA Governing Bodies 65 1:28 ABA Announces ABA Recertification Examination Dates 65 5:39 ABA Announces ABA Recertification Examination Dates 65 6:35 ABA Announces Critical Care Medicine Examination for Certification and Recertification 65 8: :32 ABA Announces New Council Seeks At-Large Nominees 65 9:40 ABA Announces Pain Management Examination for Certification and Recertification 65 9: :32 American Medical Association AMA Meeting to Include Issues for Section Council 65 6:35 AMA Section Council Requests House of Delegate Attendee Names 65 11:36 What s New In Organized Medicine: Do We Need AMA? 65 5:30 American Society of Anesthesiologists 2001 Meeting Dates for ASA Governing Bodies 65 1: Officers Profiles: The Leaders of Our Society 65 2: RVG and CROSSWALK Available in Print and on Disk 65 2: Membership Dues Announced 65 12:38 Announcement of Candidates for Elected Office 65 4:32 ASA New Partner for Lung Cancer Awareness Month 65 10:32 ASA Placement Services Become Web-Based, Expand Options 65 12:35 ASA at a Glance 65 6:20 Board of Directors Annual Meeting Summary 65 10:17 Board of Directors Interim Meeting Summary 65 5:17 Calendars and More Coming to Your Mailbox Soon 65 1:29 Eight Candidates Announce for Elected Office 65 9:40 Update Your Member Information and Pay Dues Online 65 9: :38 Anesthesia Patient Safety Foundation APSF Offers 11 Web-Based Videotapes 65 8:20 APSF Retreats, Returns With Report on Perianesthetic Data Management 65 2:7 APSF Task Force Reports on Legal Issues of Data Collection and Analysis Systems 65 2:9 NPSF Awards $5,000 to APSF in Honor of Ellison C. Pierce, Jr., M.D. 65 8: Annual Meeting 2000 Annual Meeting House of Delegates Summary 65 1: Annual Meeting Highlights Erratum 65 1: Art Exhibit Award Winners Earn Their Writes 65 3: FACES Shine at ASA Art Exhibit in San Francisco 65 1:17 Please Prepare for Landing 65 1:8 Raison d etre 65 1: Annual Meeting 1,375 Reasons to Attend the Annual Meeting 65 7: Annual Meeting in New Orleans Full of Surprises 65 12: Annual Meeting Schedule 65 7: Art Exhibit Down by the Riverside 65 7: ASA Scientific Papers: Call for Abstracts 65 1:14 Annual Meeting Placement Service 65 7:17 Betty P. Stephenson, M.D., Receives Distinguished Service Award 65 9:28 Breakfast Panels: Nutrition and Knowledge 65 7:18 Clinical Forum Program Offers Diversity 65 7:19 David C. Warltier, M.D., Ph.D., to Receive 2001 Excellence in Research Award 65 8:13 Emery A. Rovenstine Memorial Lecture: Glenn W. Johnson, ASA Executive Director, to Present 32 American Society of Anesthesiologists NEWSLETTER

34 2001 Subject Index Subject Vol. Month:Page ASA: Education, Science and Advocacy Past, Present and Future 65 7:7 FAER Honorary Research Lecture: Debra A. Schwinn, M.D., to Give Inaugural FAER Lecture on 21st Century Research 65 7:9 From Hard Science to Software 65 7:20 House of Delegates to Convene October 14, :29 Lewis H. Wright Memorial Lecture: Dale C. Smith, Ph.D., to Discuss Anaesthetists: Arguments, Attainments and Authority, :8 New Orleans: You ll Be Swamped With Things to Do 65 7:5 Nominations Sought for Award for Excellence in Research 65 1:15 Nominations for Distinguished Service Award 65 1:16 Panels and Workshops Cover Issues From A to Z 65 7:16 PBLD Program Takes Active Stance on Learning 65 7:21 Plans Under Way for 2001 ASA Annual Meeting in New Orleans 65 4:22 Resource Center at Annual Meeting 65 9:30 Refresher Course, Clinical Update and Basic Science Review Program 65 7:14 Regulations Governing Assignment of Tickets 65 7:24 Residents Invited to Enter Research Essay Contest 65 1:15 Special Airline Arrangements, Car Rentals Offered 65 7:24 Technical Exhibit Program 65 7:15 The City That Time Won t Forget 65 4: Annual Meeting 2002 PBLD Program Open Call for Case Submissions 65 12:28 ASAPAC ASAPAC 2000 An Unprecedented Year Erratum 65 1:14 Calendars for Meetings Calendars and More Coming to Your Mailbox Soon 65 1:29 Calendars for Meetings Booklet Entries Invited 65 4:33 Calendars for Meetings on the Web 65 5: : :36 New Enhancement to Calendars for Meetings on ASA Web Site 65 7:36 Cardiovascular Anesthesiology Anesthesia for Mechanical Replacement Hearts 65 10:10 Cardiac Anesthesia Timeline 65 10:5 Recent Advances in Anesthesia for Congenital Heart Disease 65 10:12 SCA: The Heart of Cardiovascular Anesthesiology 65 10:29 Chemical Dependence Addiction in Your Private Practice: Prepare for It 65 6:16 Anesthesiologists: Addicted to the Drugs They Administer 65 5:14 Chemical Dependence in Anesthesiologists: What Is Being Done About It? 65 5:9 Chemical Dependency in Anesthesiologists 65 5:6 Curriculum on Substance Abuse Now Available 65 5:15 My Story: A Spouse Relives the Nightmare 65 6:17 Primary Prevention for Anesthesiologists 65 5:11 Time to Take Action on Chemical Dependence 65 5:5 Communications Learn About Online Solutions for Your Practice 65 9:30 Medem Creates Web Sites for 700 Members 65 6:19 Spotlight On Maybe You? 65 9:33 Compliance Corner 65 1: : : :26 Component Society News Fourth $500,000 IARS Frontiers in Anesthesia Research Award 65 7:36 National Leadership Award From the Federation of State Medical Boards 65 7:36 NYSSA s DSA Award Winner Announced 65 3:28 NYSSA Elects Officers for :33 Continuing Medical Education Calendars and More Coming to Your Mailbox Soon 65 1:29 Calendars for Meetings Booklet Entries Invited 65 4:33 Calendars for Meetings on the Web 65 5: : :36 New Enhancement to Calendars for Meetings on ASA Web Site 65 7:36 Online Workshop on Regional Anesthesia and Pain Medicine Techniques Offered 65 8:33 Society for Education in Anesthesia: Losing None at SEA 65 7:26 Workshop on Regional Anesthesia and Pain Medicine Techniques 65 5:39 Workshop on Transesophageal Echocardiography Planned 65 3: :33 Critical Care Medicine Critical Care and Private Practice: It s the Right Thing to Do 65 8:11 Critical Care: The Times They Are a Changin! 65 8:9 January 2002 Volume 66 Number 1 33

35 2001 Subject Index Subject Vol. Month:Page The Future of Anesthesiology in Critical Care 65 8:31 Let s Restake Our Claim to Critical Care Medicine 65 8:4 Pulmonary Artery Catheter Education Program: A New Collaborative Educational Tool 65 8:6 Data Management Any Reporting System Needs Postoperative Outcomes and Data Collection 65 2:14 APSF Retreats, Returns 65 2:7 APSF Task Force Reports 65 2:9 Doctors Day 2001 Doctors Day 2001: Tooting Your Horn About Advancing Pain Management and Reducing Medical Errors 65 2:4 Plan Now to Celebrate Doctors Day :5 Electronic Media Backward or Forward, M-e-d-e-m and A-S-A Make a Great Team 65 3:18 Study Supports Importance of Physician Web Sites 65 4:28 What s New In Best Practices: Risk Management on the Internet 65 6:23 Ethics A Code of Conduct 65 3:6 Are We Overlooking Fetal Pain and Suffering During Abortion? 65 10:24 Informed Consent for the Patient With an Existing DNR Order 65 3:13 Prospective Planning for Interventions in Patients Near the End of Life 65 3:11 Specialty-Specific Ethical Issues for the Anesthesiologist 65 3:5 When Should Anesthesiologists Restrain Uncooperative Patients? 65 3:8 FAER A FAER Representation of Anesthesiology s Brightest 65 1:40 A FAER Representation of Anesthesiology s Brightest Part Two 65 2:44 A FAER Representation of Anesthesiology s Brightest Part Three 65 3:36 Anesthesiologists Need to Stay in School 65 6:38 Announcement of Recent Recipients 65 8:39 Announcement of Recent Recipients, Part II 65 10:40 Announcement of Recent Recipients, Part III 65 11:39 Annual Meeting a Boon for FAER Resident Scholars 65 12:44 Building Momentum for Research, Endowment and Partnerships 65 3:35 FAER Activities at the ASA Annual Meeting 65 9:44 FAER: For the Future of the Practicing Anesthesiologist! 65 4:36 FAER Partners With Anesthesiology Societies 65 5:44 FAER Partners With Anesthesiology Societies, Part II 65 7:40 FAER Welcomes New Director; Ups the Ante on Grants 65 11:39 Funding Changes Allow New Opportunities for Academic Anesthesiologists 65 6:40 Summary of New Grant Programs 65 8:39 Governmental Affairs 2001: Not Shoes, Nor Ships, Nor Sealing Wax 65 12:5 Changing Local Medicare Policies: TEE and Endoscopy 65 12:9 Governmental Affairs: It s a Team Sport! 65 12:4 How to Prepare for a Joint Commission Survey 65 5:25 Member Generosity Places ASAPAC on Political Map 65 12:12 Summary of 2001 State Legislative and Regulatory Activities 65 12:16 History of Anesthesia A Focus on History 65 9:25 Cardiac Anesthesia Timeline 65 10:5 Information for Authors 65 12:42 In Memoriam 65 1: : : : : : : :36 Letters to the Editor A Gas Price We Cannot Afford 65 7:38 A Genesis of Religious Opinions? 65 12:40 A Misunderstanding is Born 65 2:40 A T-Shirt Suits Some Just Fine 65 5:42 Addiction Cure Dependent Upon Awareness 65 10:37 An Anesthesiologist-Eat- Anesthesiologist World 65 10:38 A(N) Place to Begin 65 10:37 An Unconscionable Decision About Conscious Sedation 65 8:38 Anesthesiologists Left on Curb 65 3:31 The Ant and the Grasshopper: A Parable for :42 Are Drs. Falwell and Lema on Same Page? 65 12:41 Article Bombs History Lesson on Fire Hazards 65 2:39 Attired and Loving It 65 5:42 Better Living Through Preparation 65 8:35 Beyond Armageddon 65 3:31 Clothes Do Make the Wo(man) 65 2:43 Code Wars 65 8:36 Correcting a Correction! 65 10:38 Correcting a PC Problem 65 6:36 Cracking the Code: Ms. Bierstein Responds 65 8:36 The Cyclical Nature of Dress 65 2:43 34 American Society of Anesthesiologists NEWSLETTER

36 2001 Subject Index Subject Vol. Month:Page Death in a Droplet Averted With an Ounce of Prevention 65 6:36 Death Not the Enemy in End-of-Life Care Issues 65 2:38 Don t Come as You Are 65 3:32 Doulas: Delivering Life, Changing Lives 65 2:41 Dress for the Rest 65 3:32 Editor s Religious Claims in Need of Disclaimer 65 12:40 Erudite Editor Lauded: In Other Words, Good Work! 65 2:40 Every Mom s Crazy Bout a Sharp Dressed Physician 65 3:31 Fifth Vital Sign? Not Yet 65 2:43 Finding Time for Subspecialty Care 65 11:37 General Anesthesia vs. Major Apathy 65 3:30 Give Me Liberty, Then Give Me Dress 65 3:33 The Global Village Is Weary, and There s No Rest in Sight 65 2:42 God Will Heal Our Nation 65 12:40 The Golden Rule: Get Out of School? 65 7:38 Have We Bitten the Hands That Feed Us? 65 7:39 Image Is Everything 65 8:37 Impressing an Image on the Public 65 10:36 It s a Peasant Place to Visit 65 5:42 It s All in the Translation 65 2:39 January PC Article Does Not Compute 65 4:35 JCAHO Needs Real World Lesson 65 12:39 Kudos for Compassionate Care of Charles 65 2:38 Locked Carts Open Pandora s Box 65 9:43 Locked Cart Rule Unrealistic 65 12:39 Mickey Mouse, Alexis de Toqueville Reap Benefits of Supermarket Bonus Card 65 11:38 Mind Your P s and Q s and PA s 65 8:35 The Mirror Doesn t Lie 65 8:38 Most Abused Drug Most Ignored 65 10:37 NEWSLETTER No Place fo God 65 12:41 Nix Executions From Medicine 65 9:43 No Shortage of Workforce Shortage Opinions 65 10:39 PAs Held to Same Standard as M.D.s 65 10:36 Please Don t Let Me Be Misunderstood: Dr. McMichael Responds 65 2:40 Private Practice Physician Gives an Academic Lesson 65 6:37 Procedural Sedation, Not Conscious Sedation 65 9:42 Raising Better Consciousness About Conscious Sedation Guidelines 65 11:37 Reader Likes the Way Editor Tells It 65 8:38 Res Ipsa Loquitor! 65 6:36 Reconsidering Spinal Anesthe sia in Orthopedic Surgery 65 2:38 Resident at Ground Zero Says NEWSLETTER on Shaky Ground 65 12:39 San Francisco Niners Question Residency Match Numbers 65 9:43 Sharks Among Us 65 7:39 Show Me the Money 65 9:43 Slob nobbing in the World of Medicine 65 3:34 Social Skills 101: Do You Have a Passing Grade? 65 3:34 Sounding Out on the PA System 65 3:30 Thanks to Those Who Scripted Our Success 65 11:38 To Do or Not to Do 65 9:42 Ventilations a Revelation to Reader 65 12:41 Ventilations Make Me Happy 65 4:35 Vital Sign of the Times 65 7:38 We re Just Keeping PACe: Mr. Bonilla Responds 65 5:43 Where Have All the Academicians Gone? 65 2:41 Where Is ASA PAC king My Money? 65 5:42 Who Asked You Anyway, Regarding Our Dress Code? 65 3:33 Whose God Will Win New War? 65 12:40 Workforce Prediction Predilections 65 8:37 Media Award Nominations Sought for Media Award 65 4:32 Nonanesthesiologist Practitioners Anesthesiologists Assistants: Being a (Care) Team Player 65 3:16 Obstetric Anesthesia Code New : Changes Improve OB Coding and Billing 65 12:23 Epidural PCA During Labor 65 11:16 SOAP Working Hard to Resolve Labor Issues 65 11:34 Toward Fair and Reasonable Fees in Obstetrical Anesthesia 65 12:21 Occupational Health Infection Control Recommendations: Their Importance to the Practice of Anesthesiology 65 3:15 New Federal Legislation: Needlestick Safety and Prevention Act 65 1:12 Stress Management: Finding Your Purpose on the Ark 65 11:27 The Anesthesiologist and Fatigue 65 2:11 Office-Based Anesthesia Office-Based Anesthesia: Lessons Learned From the Closed Claims Project 65 6:9 Update on Office-Based Anesthesia: Caveats on the Professional Finger-Pointing 65 8:17 January 2002 Volume 66 Number 1 35

37 2001 Subject Index Subject Vol. Month:Page Obituaries Nicholas G. DePiero, M.D., :37 Pain Medicine Alphabet Soup: ASIPP, ASRA and ASA Do We Need Them All? Who Best Takes Care of the Pain Management Anesthesiologist? 65 11:12 Are We Overlooking Fetal Pain and Suffering During Abortion? 65 10:24 ASA Posts Video News Release on Pain Medicine on Web 65 8:34 Continuing Medical Education on the Internet: ASA/ASRA Elec tronic Regional Anesthesia and Pain Medicine Techniques Workshop 65 11:14 Joint Statement on Prescription Pain Medications 65 11:11 Liability Arising From Anesthe siology-based Pain Management in the Nonoperative Setting 65 6:12 Medicare Coverage and Compliance in Pain Management 65 11:8 Outcomes Measures in Pain Medicine 65 11:5 What s the Fuss Over Oxy Contin and Other Long-Acting Opioids? 65 11:10 Patient Safety Anesthesia Patient Safety Foundation 65 2:31 The Anesthesiologist and Fatigue 65 2:11 Simulation Saves Lives 65 10:15 Physician Demographics The Age Wave : America s Tsunami of the Future? 65 10:20 ASA at a Glance 65 6:20 Estimating Staffing Requirements: How Many Anesthesia Providers Does Our Group Need? 65 8:14 Surviving the Perfect Storm 65 2:22 Where Have All the Anesthesi ologists Gone? Analysis of the National Anesthesia Worker Shortage 65 4:16 What s New In Anesthesiology Demographics: Woman Physi cians Changing Specialty Choices and Implications for Anesthesiology s Workforce Shortage 65 8:22 Practice Management Column Benchmarking Productivity 65 9:35 Beware the Aggressive Advice of Billing Consultants 65 11:29 Conference on Practice Management Scheduled 65 10:27 Criminal Conviction for Practicing Medicine With a Nurse s License 65 7:30 CROSSWALK Update 65 7:31 Epidural PCA During Labor 65 11:16 Epidurography and Fluoroscopy Billing 65 4:26 Errata 65 8:27 Evaluating a New Ambulatory Surgical Center Opportunity 65 5:32 Fees Paid for Anesthesia Services: 2001 Survey Results 65 9:34 Hip Joint Procedures: Correction and Explanation 65 3:20 HIPAA Fundamentals for Anesthesiologists 65 10:26 Hospital Contracts, Four Years Later 65 8:25 How Much Is Medicare Spending on Anesthesia Services? 65 7:28 If Medicare Has Rejected Your Claims for Sacroiliac Joint Injec tion + Fluoroscopy, Resubmit 65 10:28 Interventional Pain Study Researchers Meet With ASA Representatives 65 10:27 Labor Epidurals and Billing Methods 65 3:19 Medicare Approves New Anes thesia Codes and Base Units 65 1:20 Medicare Clarifies When You May Bill for Preoperative Visits and Tests 65 9:36 Medicare Cuts Physician Pay ments for :31 New Member Service: The e-pm Letter 65 8:27 Online Workshop on Regional Anesthesia and Pain Medicine Techniques Offered 65 8:33 Questions and Answers From the Committee on Quality Management and Departmen tal Administration (QMDA) 65 9:37 Real 2001 National Medicare Conversion Factor: $17.83, Up From $ :26 Top Medicare Billing Risks for Anesthesiologists in :24 Upcoming Practice Management Conferences 65 3:20 What Pain Doctors Should Know About Evaluation and Manage ment Codes 65 6:24 Workshop on Regional Anesthesia and Pain Medicine Techniques 65 5:39 Practice Parameters 2 Open Forums Set to Revisit PA Catheterization Guidelines and Discuss Recovery Room Discharge Criteria 65 2:35 Task Forces Offer More Open Forums, Updates to Practice Guidelines 65 3:27 Task Force for Conscious Seda tion to Hold Open Forums 65 4:32 What s New In Practice Parameters 65 2:30 Problem-Based Learning Discussions 2000 PBLD Books Still Available 65 2:15 Professional Liability High-Severity Injuries Associated With Regional Anesthesia in the 1990s 65 6:6 36 American Society of Anesthesiologists NEWSLETTER

38 2001 Subject Index Subject Vol. Month:Page Liability Arising From Anesthesiology- Based Pain Management in the Nonoperative Setting 65 6:12 Office-Based Anesthesia: Lessons Learned From the Closed Claims Project 65 6:9 Regional Anesthesia ASRA Offers 2 New Educational Opportunities in Spring :30 High-Severity Injuries Associated With Regional Anesthesia in the 1990s 65 6:6 Lower Extremity Nerve Blocks An Update 65 4:13 Online Workshop on Regional Anesthesia and Pain Medicine Techniques Offered 65 8:33 Outpatient Applications of Continuous Local Anesthetic Infusions 65 4:8 Regional Anesthesia for Office- Based Surgery 65 4:11 Should Regional Blockade Be Performed on Anesthetized Patients? 65 4:5 Residents Issues National Residency Matching Program Results for 2001: Another Increase This Year 65 5:19 Residency Composition and Numbers Graduating from Residencies and Nurse Anesthesia Schools 65 11:19 Residents Invited to Enter Research Essay Contest 65 1:15 Residents Research Award Recipients Honored 65 8:21 Surviving the Perfect Storm: Challenges Faced by Our Training Programs 65 2:22 Residents Review Column A Call for Residents to Serve on ASA Committees 65 9:39 A Permanent Residency in ASA 65 1:25 An Update on Resident Member Activities 65 6:31 ASAPAC What Does That Have to Do With Residents? 65 12:37 Call for a New Residents Review Editor 65 10:30 Call for Resident Component Governing Council Candidates 65 8:30 Ever Wished You Had Input on What s Printed Here You Could Be the Next Editor! Fair Winds and Following Seas 65 2:33 Greetings From Your New Residents Review Editor 65 3:25 Keeping Anesthesiology Research Alive 65 7:34 Neurologic Surgery: A Logical Choice for Anesthesiologists 65 5:37 Preparing for the ABA Written Examination In Search of the Most Efficient Approach 65 4:29 Residents Review Erratum 65 3:22 What Is ACGME and What Is Its Role in Residency Education? 65 11:32 SEE Program 2001 SEE Program Strives for Excellence 65 6: SEE Program Provides Lifelong Learning Opportunity 65 11:24 State Beat ASA on the Road 65 10:31 Component Societies Prepare to Advance Standards for Office-Based Anesthesia 65 6:30 Florida Office-Based Surgery Rules: The Fight for Patient Safety Continues 65 1:23 New York Issues Office-Based Surgery Guidelines: Nurse Anesthetists Sue 65 3:21 Nurse Anesthetists Challenge Rhode Island Office Surgery Regulations 65 2:28 State Legislative Report: AL, CT, MD, NM, RI, SC 65 4:27 State Legislative Report: AL, GA, IL, LA, MD, MI, NM, NY, PA, WA 65: 5:35 State Legislative Report: CT, IL, LA, NM, NY, RI, SC 65 7:32 States Address Issues of Anesthesiologist Assistants, Office-Based Anesthesia 65 8:29 Subspecialty News ABA, ASA and ACGME: Collaboration, Clarification and Less Confusion 65 3:23 ASRA Offers 2 New Educational Opportunities in Spring :30 Anesthesia Patient Safety Foundation 65 2:31 SCA: The Heart of Cardiovascular Anesthesiology 65 10:29 SOAP Working Hard to Resolve Labor Issues 65 11:34 Society for Education in Anesthesia: Losing None at SEA 65 7:26 Society for Ambulatory Anesthesia: Moving On in Good Health 65 12:36 Society for Pediatric Anesthesia: Growing Up Strong 65 9:38 The Future of Anesthesiology in Critical Care 65 8:31 Ventilations Algology The Next Medical Specialty? 65 6:1 An Eye for an Eye 65 7:1 An Unconscious Decision About Conscious Sedation 65 4:1 Anesthesiologists: Architects for Bridging the Quality Chasm 65 5:1 Aphorism Redux 65 1:1 Death in a Droplet 65 3:1 Flying Too Close to the Tree-tops 65 12:1 I m Changing My Name to Cash 65 9:1 In Case You Haven t Heard There Are No Available Anesthesia Providers 65 2:1 More Aphorisms, Please! 65 8:1 Now That We Have Your Attention 65 10:1 January 2002 Volume 66 Number 1 37

39 2001 Subject Index Subject Vol. Month:Page Service Is for Now and Research Is Forever 65 11:1 Washington Report 107th Congress Organizes; Key Medicare Chairs Named 65 2:3 AHRQ Issues Report on Cataract Anesthesia 65 1:4 ASA, AANA Present Opposite Viewpoints on Rollback of Medicare Supervision Rule 65 5:3 ASA Files Comments on Super vision Rule; Survey Shows Seniors Prefer Bush Plan, :3 ASA Increases Efforts to Overturn Clinton Midnight Supervision Rule 65 3:3 ASA Initiates Dialogue on Anesthetic Shortages 65 4:4 ASA Responds to AANA Objections 65 10:4 ASA Responds to HCFA Statement of Intent to Publish Supervision Rule 65 1:3 Bush Proposes Stop-Gap Indigent Drug Benefit Plan 65 3:3 Clinton Issues But Bush Suspends Supervision Rule 65 2:2 CMS Final Rule Retains Federal Requirement for Supervision 65 12:3 CMS Modifies CAH Rules for Pre-, Post-Op Exams 65 9:3 Conversion Factor Concerns Increase 65 11:18 Deadline Approaches for Finalization of Nurse Anesthetist Supervision Rule 65 11:4 HCFA Changes Its Name to CMS 65 7:3 HHS Issues Privacy Rules 65 2:3 HHS Issues Proposed Regulation Restoring Physician Supervision 65 8:3 HHS Proposes User Fee for Nonelectronic Claims 65 5:4 HHS Secretary Thompson Issues 60-Day Rule Suspension 65 4:4 HHS Secretary Thompson Receives Letter With Renewed Support From Doctors 65 3:4 HHS Seeks Comments on Patient Privacy Rule 65 5:4 HHS Under Clinton Sets Privacy Rules 65 3:3 House Committees Draft Reg ulatory Relief Bills 65 12:11 House Panels Considering Reg ulatory Relief Proposals 65 11:4 House Passes Patient Protection Bill, Sets Up Difficult Conference With Senate 65 9:3 Jeffords Defection Alters Dynamics of Senate Patient Protection Debate 65 7:3 Legislative Conference Partic ipants Focus on Supervision Issue 65 6:3 Medicare Fairness Act Filed to Curb Regulatory Abuses 65 4:4 Medicare Parts A and B Spending Up for First Eight Months of FY :19 Needlestick Standards to Increase on July :5 Negative MFS Update Limit Proposed by New Senate Bill S :3 Now is the Time! Please Write Letters Supporting New Rule 65 8:3 Opening Guns Sounded on Patients Rights Bill 65 3:3 Patient Protection Measure Readied for Introduction 65 5:3 Phoenix Rising 65 10:3 Scully Announces Medicare Reforms 65 7:4 Scully Nominated New HCFA Head 65 5:4 Senate Passes Patient Protection Bill; House Debate to Begin After Recess 65 8:19 Senators to Introduce Patient Protection Bill 65 6:5 Supervision Regulations to Be Drafted by CMS 65 7:4 Thompson Suspends Supervision Rule; Proposes Restrictions Outcomes Study 65 6:3 Waters, M.D., Ralph Milton Ralph M. Waters Legacy: The Establishment of Academic Anesthesia Centers by the Aqualumni 65 9:21 Ralph Milton Waters: His Influ ence on the World and Me 65 9:17 Ralph Waters Visit to Great Britain in :13 The Influence of Ralph Waters on Regional Anesthesia 65 9:10 The Investigator and His Uncompromising Scientific Honesty 65 9:7 The Political Career of Ralph M. Waters: This Is Your Society for the Future 65 9:19 Why Celebrate Ralph Milton Waters? 65 9:4 What s New In Academic Anesthesia Practice 65 3:22 Anesthesiology Demographics: Woman Physicians Changing Specialty Choices and Impli cations for Anesthesiology s Workforce Shortage 65 8:22 Best Practices: Risk Management on the Internet 65 6:23 Geriatric Anesthesia: Society for the Advancement of Geriatric Anesthesia Is New Kid on the Block 65 10:25 Operating Room Management: The Quest for Information 65 12:29 Organized Medicine: Do We Need AMA? 65 5:30 PC-Based Computers 65 1:19 Practice Parameters 65 2:30 The Wood Library-Museum of Anesthesiology: WLM Dedicates Curator s Room in John Lundy s Honor 65 4:23 38 American Society of Anesthesiologists NEWSLETTER

40 2001 NEWSLETTER Author Index Abdelmalak, Basem M., Keeping Anesthesiology Research Alive, 65 7:34 Abouleish, Amr E., Estimating Staffing Requirements: How Many Anesthesia Providers Does Our Group Need?, 65 8:14 Allen, Gregory C., Where Is ASA PAC king My Money?, 65 5:42 Andropoulos, Dean B., Recent Advances in Anesthesia for Congenital Heart Disease, 65 10:12 Angres, Daniel H., Chemical Dependency in Anesthesiologists, 65 5:6 Arens, James F., What s New In Practice Parameters, 65 2:30 Arkoosh, Valerie A., SOAP Working Hard to Resolve Labor Issues, 65 11:34 Arnold, William P. III, Chemical Dependence in Anesthesiologists: What Is Being Done About It?, 65 5:9 Bacon, Douglas R., What s New In The Wood Library-Museum of Anesthesiology: WLM Dedicates Curator s Room in John Lundy s Honor, 65 4:23 Why Celebrate Ralph Milton Waters?, 65 9:4 Bailey, Peter L., 2001 SEE Program Strives for Excellence, 65 6: SEE Program Provides Lifelong Learning Opportunity, 65 11:24 Raising Better Consciousness About Sedation Guidelines, 65 11:37 Bastron, R. Dennis, A Code of Conduct, 65 3:6 Berger, Jerry J., 2000-FACES Shine at ASA Art Exhibit in San Francisco, 65 1: Art Exhibit Down by the Riverside, 65 7:22 Berry, Arnold J., New Federal Legislation: Needlestick Safety and Prevention Act, 65 1:12 Infection Control Recommendations: Their Importance to the Practice of Anesthesiology, 65 3:15 Time to Take Action on Chemical Dependence, 65 5:5 1,375 Reasons to Attend the Annual Meeting, 65 7:12 Bierstein, Karin, Practice Management, 65 1:20; 2:26; 3:19; 4:24; 5:32; 6:24; 7:28; 8:25; 9:34; 10:26; 11:29; 12:31 Changing Local Medicare Policies: TEE and Endoscopy, 65 12:9 Compliance Corner, 65 1:22; 2:29; 3:20; 4:26 Cracking the Code: Ms. Bierstein Responds, 65 8:36 Bogetz, Martin S., Locked Carts Open Pandora s Box, 65 9:43 Bonilla, Manuel E., Member Generosity Places ASAPAC on Political Map, 65 12:12 We re Just Keeping PACe: Mr. Bonilla Responds, 65 5:43 Boulton, Thomas B., Ralph Waters Visit to Great Britain in 1936, 65 9:13 Broadman, Lynn, ASRA Offers 2 New Educational Opportunities in Spring 2001, 65 4:30 What s the Fuss Over OxyContin and Other Long-Acting Opioids? 65 11:10 Brown, Richard L., Primary Prevention for Anesthesiologists, 65 5:11 Burkle, Christopher M., The Political Career of Ralph M. Waters: This Is Your Society for the Future, 65 9:19 Calmes, Selma H., What s New In Anesthesiology Demographics: Woman Physicians Changing Specialty Choices and Implications for Anesthesiology s Workforce Shortage, 65 8:22 Campagna, Jason A., Ventilations Make Me Happy, 65 4:35 Caplan, Robert A., Should Regional Blockade Be Performed on Anesthetized Patients?, 65 4:5 Carella, Patricia I., Clothes Do Make the Wo(man), 65 2:43 Carson, John S., Kudos for Compassionate Care of Charles, 65 2:38 Cheney, Frederick W., High-Severity Injuries Associated With Regional Anesthesia in the 1990s, 65 6:6 Cohen, Jerry A., How to Prepare for a Joint Commission Survey, 65 5:25 Cooley, John A. Jack, Fair Winds and Following Seas, 65 2:33 Cottrell, James E., April in Paris February, 65 4:2 Coursin, Douglas B., Critical Care and Private Practice: It s the Right Thing to Do, 65 8:11 Cromwell, Thomas H., Cloudy Forecast Revisited; Partly Sunny With Higher Temps, 65 6:2 Cullen, Bruce F., Anesthetic Drug Shortages: What s Going On?, 65 5:2 Curry, Saundra E., Thanks to Those Who Scripted Our Success, 65 11:38 D Angelo, Robert, Epidural PCA During Labor, 65 11:16 Davis, Peter J., Society for Pediatric Anesthesia: Growing Up Strong, 65 9:38 de Jong, Rudolph H., Better Living Through Preparation, 65 8:35 DeLeo, Bernard C., Every Mom s Crazy Bout a Sharp Dressed Physician, 65 3:31 Deem, Steven A. Show Me the Money, 65 9:43 De Miranda, Edward G., Social Skills 101: Do You Have a Passing Grade?, 65 3:34 Dhamee, Saeed M., Don t Come as You Are, 65 3:32 Ditzler, John W., Article Bombs History Lesson on Fire Hazards, 65 2:39 Domino, Karen B., Office-Based Anesthesia: Lessons Learned From the Closed Claims Project, 65 6:9 Donahue, Robert J., Have We Bitten the Hands That Feed Us?, 65 7:39 Dorman, Todd, Critical Care: The Times They Are a Changin!, 65 8:9 Douglas, David L., The Ant and the Grasshopper: A Parable for 2001, 65 2:42 Eckhout, Gifford, Where Have All the Anesthesiologists Gone? Analysis of the National Anesthesia Worker Shortage, 65 4:16 No Shortage of Workforce Shortage Opinions, 65 10: Author Index January 2002 Volume 66 Number 1 39

41 2001 Author Index Egbert, Lawrence D., Death in a Droplet Averted With an Ounce of Prevention, 65 6:36 Enneking, F. Kayser, Outpatient Applications of Continuous Local Anesthetic Infusions, 65 4:8 Erickson, James C. III, A Focus on History, 65 9:25 Escher, Allan R., Jr., Medicare Coverage and Compliance in Pain Management, 65 11:8 Esquivel, Michelle, Medem Creates Web Sites for 700 Members, 65 6:19 Fitzgibbon, Dermot R., Liability Arising From Anesthesiology-Based Pain Management in the Nonoperative Setting, 65 6:12 Fletcher, Peter R., Correcting a Correction!, 65 10:38 Fraifeld, Eddy, A T-Shirt Suits Some Just Fine, 65 5:42 Freedman, John M., Procedural Sedation, Not Conscious Sedation, 65 9:42 Gaba, David M., APSF Task Force Reports on Legal Issues of Data Collection and Analysis Systems, 65 2:9 Garman, J. Kent, What s New In PC- Based Computers, 65 1:19 Gelman, Simon, Surviving the Perfect Storm: Challenges Faced by Our Training Programs, 65 2:22 Giesecke, N. Martin, Anesthesia for Mechanical Replacement Hearts, 65 10:10 Gilbert, Timothy B., Reconsidering Spinal Anesthesia in Orthopedic Surgery, 65 2:38 Glazer, Barry M., Our Patient Safety Record Is in Grave Danger, 65 3:2 Glener, David M., NEWSLETTER No Place for God, 65 12:41 Gorfine, Lawrence S., Medicare Coverage and Compliance in Pain Management, 65 11:8 Gravenstein, J.S., APSF Retreats, Returns With Report on Perianesthetic Data Management, 65 2:7 Grogono, Alan W., National Residency Matching Program for 2001: Another Increase This Year, 65 5:19 Residency Composition and Numbers Graduating From Residencies and Nurse Anesthesia Schools, 65 11:19 Gross, Jeffrey B., Panels and Workshops Cover Issues From A to Z, 65 7:16 Groudine, Scott B., Anesthesiologists Assistants: Being A (Care) Team Player, 65 3:16 Guidry, Orin F., Who Is Responsible for the Future?, 65 8:2 Hadzic, Admir, Lower Extremity Nerve Blocks An Update, 65 4:13 Halaszynski, Thomas M., Where Have All the Academicians Gone?, 65 2:41 Hannenberg, Alexander A., Toward a Fair and Reasonable Fees in Obstetrical Anesthesia, 65 12:21 Hanson, C. William III, Pulmonary Artery Catheter Education Program: A New Collaborative Educational Tool, 65 8:6 Hassell, Dayne D., Erudite Editor Lauded: In Other Words, Good Work!, 65 2:40 Haufe, Scott M., Image Is Everything, 65 8:37 Hedberg, Eric B., Anesthesiologists: Addicted to the Drugs They Administer, 65 5:14 Hendricks, Peter L., We Say That We Matter Let s Make Sure We Keep It That Way, 65 11:2 Hensien, M.A., The Cyclical Nature of Dress, 65 2:43 Herlich, Andrew, Res Ipsa Loquitor!, 65 6:36 Hessel, Eugene A., III, Cardiac Anesthesia Timeline, 65 10:5 Hiern, Barrie, Correcting a PC Problem, 65 6:36 Hill, D. Ann, An Anesthesiologist-Eat- Anesthesiologist World, 65 10:38 Hines, Roberta L., Emery A. Rovenstine Memorial Lecture: Glenn W. Johnson, ASA Executive Director, to Present ASA: Education, Science and Advocacy Past, Present and Future, 65 7:7 Hoellerich, Vincent L., Critical Care and Private Practice: It s the Right Thing to Do, 65 8:11 Hogan, Kirk, It s a Peasant Place to Visit, 65 5:42 Horlocker, Terese T., Should Regional Blockade Be Performed on Anesthetized Patients?, 65 4:5 Howard, Steven K., The Anesthesiologist and Fatigue, 65 2:11 Hug, Carl C., Jr., Prospective Planning for Interventions in Patients Near the End of Life, 65 3:11 Anesthesiologists Need to Stay in School, 65 6:38 FAER Honorary Research Lecture: Debra A. Schwinn, M.D., to Give Inaugural FAER Lecture on 21st Century Research, 65 7:9 Hughes, Francis P., ABA, ASA and ACGME: Collaboration, Clarification and Less Confusion, 65 3:23 Hughes, Samuel C., New Federal Legislation: Needlestick Safety and Prevention Act, 65 1:12 Jackson, Stephen H., Specialty-Specific Ethical Issues for the Anesthesiologist, 65 3:5 James, Francis M. III, Addiction Cure Dependent Upon Awareness, 65 10:37 Johnson, Betty H., A Genesis of Religious Opinions?, 65 12:40 Johnson, Glenn W., Volunteer Members Make the Difference, 65 12:2 Johnston, Richard R., Organized Medicine: Do We Need AMA?, 65 5:30 Joseph, David M., Mickey Mouse, Alexis de Toqueville Reap Benefits of Supermarket Bonus Card, 65 11:38 Kampine, John P., David C. Warltier, M.D., Ph.D., to Receive 2001 Excellence in Research Award, 65 8:13 Karas, Paul B., An Unconscionable Decision About Conscious Sedation, 65 8:38 Kataria, Tripti C., A Permanent Residency in ASA, 65 1:25 40 American Society of Anesthesiologists NEWSLETTER

42 2001 Author Index ASAPAC What Does That Have to Do With Residents? 65 12:37 Call for Resident Component Governing Council Candidates, 65 8:30 Keller, Candace E., Purpose and Passion, 65 9:2 Kerbs, Cindy, Doulas: Delivering Life, Changing Lives, 65 2:41 Khan, Mohammed A., Greetings From Your New Residents Review Editor, 65 3:25 Preparing for the ABA Written Examination In Search of the Most Efficient Approach, 65 4:29 Kincaide, Gail G., A Misunderstanding Is Born, 65 2:40 Lagman, Steven R., The Mirror Doesn t Lie, 65 8:38 Lake, Carol L., FAER: For the Future of the Practicing Anesthesiologist!, 65 4:36 LaPorta, Robert F., Locked Cart Rule Unrealistic, 65 12:39 Laubach, Bruce J., Death Not the Enemy in End-of-Life Care Issues, 65 2:38 Leak, Jessie A., Stress Management: Finding Your Purpose on the Ark, 65 11:27 Lichtor, J. Lance, Society for Ambulatory Anesthesia: Moving On in Good Health, 65 12:36 Lipson, Steve F., A(N) Place to Begin, 10:37 Lynde, Grant C., Resident at Ground Zero Says NEWSLETTER on Shaky Ground, 65 12:39 Maccioli, Gerald A., Critical Care and Private Practice: It s the Right Thing to Do, 65 8:11 MacKenzie, Ronald A., Raison d etre, 65 1:5 Our Place in American Medicine and the Public Consciousness, 65 4:3 Betty P. Stephenson, M.D., Receives Distinguished Service Award, 65 9:28 Mackey, David C., Dress for the Rest, 65 3:32 Mahla, Michael E., Neurologic Surgery: A Logical Choice for Anesthesiologists, 65 5:37 Manalaysay, Alvin R., JCAHO Needs Real World Lesson, 65 12:39 Marsh, Brian J., Ventilations a Revelation to Reader, 65 12:41 Martin, David P., Outcomes Measures in Pain Medicine, 65 11:5 Martin, Douglas J., Reader Likes the Way Editor Tells It, 65 8:38 May, Judith A., Most Abused Drug Most Ignored, 65 10:37 McAllister, Kathleen, Mind Your P s and Q s and PA s, 65 8:35 McGoldrick, Kathryn E., Lewis H. Wright Memorial Lecture: Dale C. Smith, Ph.D., to Discuss Anaesthetists: Arguments, Attainments and Authority, , 65 7:8 McMichael, James P., Code New : Changes Improve OB Coding and Billing 65 12:23 Please Don t Let Me Be Misunderstood: Dr. McMichael Responds, 65 2:40 McQuillan, Robert J., A Code of Conduct, 65 3:6 Milholland, Arthur V., The Global Village Is Weary, and There s No Rest in Sight, 65 2:42 Miller, Ronald D., San Francisco Niners Question Residency Match Numbers, 65 9:43 Miller, Sanford M., Whose God Will Win New War? 65 12:40 Misuraca, LeRoy, It s All in the Translation, 65 2:39 To Do or Not to Do, 65 9:42 Mitchell, Daniel C., God Will Heal Our Nation, 65 12:40 Monk, Terri G., Any Reporting System Needs Postoperative Outcomes and Data Collection, 65 2:14 Montgomery, William H., Pulmonary Artery Catheter Education Program: A New Collaborative Educational Tool, 65 8:6 Moore, Roger A., Mother ASA, 65 10:2 SCA: The Heart of Cardiovascular Anesthesiology, 65 10:29 Moreno, Carlos L., A Call for Residents to Serve on ASA Committees, 65 9:39 An Update on Resident Member Activities, 65 6:31 Annual Meeting a Boon for FAER Resident Scholars, 65 12:44 What Is ACGME and What Is Its Role in Residency Education? 65 11:32 Morris, Lucien E., Ralph M. Waters Legacy: The Establishment of Academic Anesthesia Centers by the Aqualumni, 65 9:21 Murray, Michael J., Let s Restake Our Claim to Critical Care Medicine, 65 8:4 Nicodemus, Honorato F., Fifth Vital Sign? Not Yet, 65 2:43 Oakes, Raymond C., January PC Article Does Not Compute, 65 4:35 O Connor, Michael S., A Gas Price We Cannot Afford, 65 7:38 Olympio, Michael A., Simulation Saves Lives, 65 10:15 Otto, Charles W., Breakfast Panels: Nutrition and Knowledge, 65 7:18 Ovassapian, Andranik, From Hard Science to Software, 65 7:20 Palmer, Anthony R., Take This Job and Shrug It, 65 2:41 Palmer, Susan K., When Should Anesthesiologists Restrain Uncooperative Patients? 65 3:8 Parsloe, Carlos P., Ralph Milton Waters: His Influence on the World and Me, 65 9:17 Phelps, McKinley Red, Jr., Attired and Loving It, 65 5:42 Philip, Beverly K., How to Prepare for a Joint Commission Survey, 65 5:25 Pierce, Ellison C., Jr., Anesthesia Patient Safety Foundation, 65 2:31 Polk, Susan L., Curriculum on Substance Abuse Now Available, 65 5:15 Poulton, Thomas J., Finding Time for Subspecialty Care, 65 11:37 Prough, Donald S., Refresher Course, Clinical Update and Basic Science Review Program, 65 7:14 January 2002 Volume 66 Number 1 41

43 2001 Author Index Ramsey, James A., Who Asked You Anyway, Regarding Our Dress Code?, 65 3:33 Rathmell, James P., What s the Fuss Over OxyContin and Other Long-Acting Opioids? 65 11:10 Continuing Medical Education on the Internet: ASA/ASRA Electronic Regional Anesthesia and Pain Medicine Techniques Workshop, 65 11:14 Robins, Berklee, Anesthesiologists Left on Curb, 65 3:31 Rooke, G. Alec, Geriatric Anesthesia: Society for the Advancement of Geriatric Anesthesia Is New Kid on the Block, 65 10:25 Rosenblatt, Meg A., 2002 PBLD Program Open Call for Case Submissions, 65 12:28 PBLD Program Takes Active Stance on Learning, 65 7:21 Rosenquist, Richard W., Regional Anesthesia for Office-Based Surgery, 65 4:11 Rubin, Burton, Beyond Amageddon, 65 3:31 Sands, Robert P., The Influence of Ralph Waters on Regional Anesthesia, 65 9:10 Schubert, Armin, Where Have All the Anesthesiologists Gone? Analysis of the National Anesthesia Worker Shortage, 65 4:16 No Shortage of Workforce Shortage Opinions, 65 10:39 Society for Education in Anesthesia: Losing None at SEA, 65 7:26 Scott, Michael, Washington Report, :3 2001: Not Shoes, Nor Ships, Nor Sealing Wax, 65 12:5 Sinclair, Eugene P., Voting Process and Safeguards in the House of Delegates, 65 7:2 House of Delegates to Convene October 14, 2001, 65 9:29 Sladen, Robert N., The Future of Anesthesiology in Critical Care, 65 8:31 Somerville, Gregory M., Private Practice Physician Gives Academic Lesson, 65 6:37 Soto, Roy G., What s New In Academic Anesthesia Practice, 65 3:22 Stayer, Stephen A., Recent Advances in Anesthesia for Congenital Heart Disease, 65 10:12 Steinhuas, John E., The Investigator and His Uncompromising Scientific Honesty, 65 9:7 Stemp, Leo I., Vital Sign of the Times, 65 7:38 Still, Ann C., Alphabet Soup: ASIPP, ASRA and ASA Do We Need Them All? Who Best Takes Care of the Pain Management Anesthesiologist? 65 11:12 Stock, M. Christine, Operating Room Management: The Quest for Information, 65 12:29 Stoelting, Robert K., NPSF Awards $5,000 to APSF in Honor of Ellison C. Pierce, Jr., M.D., 65 8:20 Stone, Shepard B., Sounding Out on the PA System, 65 3:30 PAs Held to Same Standard as M.D.s, 65 10:36 Sullivan, R. Lawrence, Jr., Doctors Day 2001: Tooting Your Horn About Advancing Pain Management and Reducing Medical Errors, 65 2:4 Summers, Frank W., Slob nobbing in the World of Medicine, 65 3:34 Swissman, Neil, Naysayers Beware the Indomitable Human Spirit, 65 1:2 Please Prepare for Landing, 65 1:8 Who Can Our Patients Trust Now?, 65 2:2 Tamburine, F. Todd, Editor s Religious Claims in Need of Disclaimer, 65 12:40 Thielmeier, Kenneth A., Anesthesia for Mechanical Replacement Hearts, 65 10:10 Tremper, Kevin K., Surviving the Perfect Storm: Challenges Faced by Our Training Programs, 65 2:22 Truog, Robert D., Informed Consent for the Patient With an Existing DNR Order, 65 3:13 Turpin, S. Diane, State Beat, 65 1:23; 2:28; 3:21; 4:27; 5:35; 6:30; 7:32; 8:29; 10:31 Summary of 2001 State Legislative and Regulatory Activities, 65 12:16 Twersky, Rebecca S., Update on Office- Based Anesthesia: Caveats on the Professional Finger-Pointing, 65 8:17 Unruh, Gregory K., Clinical Forum Program Offers Diversity, 65 7:19 Van Norman, Gail A., When Should Anesthesiologists Restrain Uncooperative Patients? 65 3:8 Vaughan, Robert W., Workforce Prediction Predilections, 65 8:37 The Age Wave : America s Tsunami of the Future?, 65 10:20 Vigue, Jason T., Developing a Culture of Safety, 65 5:36 Vloka, Jerry D., Lower Extremity Nerve Blocks An Update, 65 4:13 Waisel, David B., Informed Consent for the Patient With an Existing DNR Order, 65 3:13 Walther, Henry C., Give Me Liberty, Then Give Me Dress, 65 3:33 Ward, Clarence F., Addiction in Your Private Practice: Prepare for It, 65 6:16 Waun, James E., General Anesthesia vs. Major Apathy, 65 3:30 Webber, Terrence, Nix Executions From Medicine, 65 9:43 White, R. Frank, Are We Overlooking Fetal Pain and Suffering During Abortion? 65 10:24 Young, Steven R., Code Wars, 65 8:36 Yun, Steve C., The Golden Rule: Get Out of School? 65 7:38 Zerwas, John M., Governmental Affairs: It s a Team Sport! 65 12:4 Zornow, Mark H., Estimating Staffing Requirements: How Many Anesthesia Providers Does Our Group Need?, 65 8:14 42 American Society of Anesthesiologists NEWSLETTER

44 FAER REPORT New FAER President: We re All in This Together Myer Rosenthal, M.D., President Foundation for Anesthesia Education and Research As the Foundation for Anesthesia Education and Research (FAER) begins its 16th year, I have been given the honor of becoming its eighth President. Under the earlier leadership of William K. Hamilton, M.D., in 1986, and followed by Alan D. Sessler, M.D., Donald R. Stanski, M.D., Patricia A. Kapur, M.D., William D. Owens, M.D., Francis M. James III, M.D., and Carl C. Hug, Jr., M.D., FAER has established itself as the principle source of funding for academic anesthesiologists attempting to establish themselves in the scholarly areas of research and education. The continued support of the American Society of Anesthesiologists (ASA), anesthesia subspecialty societies, individual anesthesiologists and corporate sponsors has provided the means for FAER to increase its grant support and further the opportunities for new investigators to gain the mentor-guided expertise to pursue innovative and clinically relevant research and educational concepts. This support is essential for the continued growth in clinical and scientific excellence that provides the credibility for anesthesiology as a physician-led specialty of medicine. Since the American Board of Medical Specialties (ABMS) recognized anesthesiology as a primary specialty on February 16, 1941, we as anesthesiologists have often been called to defend our leadership of this specialty. Thus far we have been successful due in no small part to the demonstrated scientific accomplishments of so many of our physician colleagues. Neil Swissman, M.D., in addressing the Association of University Anesthesiologists (AUA) as the then President of ASA, at a time of concern over the future of physician-led anesthesiology practice, acknowledged the essential contribution of academic anesthesia in stating that the survival of anesthesia is dependent on the survival of academic anesthesia. The last 10 years have witnessed dramatic changes in our training and academic programs. Misconceptions as to staffing needs coupled with ominous economic predictions led to a profound drop in the number of CA-1 anesthesiology residents from a high of 1,904 in 1992 with 85 percent (1,609) from American medical schools to a low of 1,073 in 1996 with a further low of 40 percent (496) of CA-1s from American medical schools in Recognition of The need to develop increased interest in academic careers has rarely been as great as it is at present. The anesthesiologist practicing in our training programs is likely the first introduction medical students see of our specialty, and the impression gained by this interaction is often determinant of their career choices. the impact of faulty predictions and the increasing need for anesthesiologists in clinical practice has led to a resurgence of interest in anesthesiology as a specialty for our American graduates with 1,466 CA-1-filled positions in 2001 of which 980 (67 percent) came from American medical schools. Myer H. Rosenthal, M.D., is Professor of Anesthesiology, Stanford University, Stanford, California. January 2002 Volume 66 Number 1 43

45 Report (continued) These dramatic changes over such a brief period have also had a significant impact on our academic programs. The need to develop increased interest in academic careers has rarely been as great as it is at present. The anesthesiologist practicing in our training programs is likely the first introduction medical students see of our specialty, and the impression gained by this interaction is often determinant of their career choices. Encouraging our trainees to consider academic careers is a major challenge particularly as the marketplace for community anesthesia practice improves. We should not consider ourselves in competition for a limited resource but rather recognize that as we all developed dependent on the knowledge, ability and mentorship of faculties in our training programs, so too will the future clinicians, educators and scientists who are essential to continue the excellence and create the vision of the future of our specialty. There is much that we can do together to guarantee the future of what we have all worked so hard to further. First, we must all consider a vision of what we believe anesthesiology should be and must become in the future. Debra A. Schwinn, M.D., in presenting the First Annual FAER Honorary Research Lecture discussed the essential need to Think out of the box, a concept of which I have recently become acutely aware in my discussions with anesthesiologist and industry pioneer William New, Jr., M.D. Both Dr. Schwinn and Dr. New have convinced me that only through new and innovative approaches to our specialty can we hope to maintain and grow our role in both perioperative clinical care and contribute to the scientific knowledge necessary to lead our specialty into this new century. FAER plans to work hard to examine the role we can play in this most important endeavor. Second, FAER is in the process of developing a strategic plan to both encourage anesthesiology trainees and junior faculty to examine careers in research and education. The National Institutes of Health (NIH) and other sources of research dollars have been largely untapped in recent years by anesthesiology. We must increase the competitiveness of our anesthesiology research trainees to establish themselves in a position to succeed in gaining this support. This effort includes a rigorous application and review of proposals by a panel of research experts similar to that to be expected from the NIH and similar granting agencies. Also required of candidates for FAER awards is the identification and active participation of experienced research FAER will be making every effort to convince our potential supporters of the value of our effort and to assure our contributors that their support will be used in a manner to best achieve the goals of furthering the educational and research objectives of our specialty. investigators as continuing mentors in developing proposals and carrying out the investigation. Finally, none of this can be achieved without the economic support of our colleagues both in anesthesiology practice and industry. FAER will be making every effort to convince our potential supporters of the value of our effort and to assure our contributors that their support will be used in a manner to best achieve the goals of furthering the educational and research objectives of our specialty. The goal to create the future academic leaders in our specialty cannot be accomplished without this support. Academic departments of anesthesiology are increasingly faced with economic difficulty in decreasing clinical revenue as well as government and institutional support. Outside funding is therefore essential to allowing these programs to provide the means for the training and education of future scholars and scientists. We must all contribute in some manner to this effort, and with your help and support, FAER will continue to dedicate itself to this responsibility. 44 American Society of Anesthesiologists NEWSLETTER