Vol. XXV
No. 2
December, 2000

The Connecticut State Society
of Anesthesiologists

President: Kathryn McGoldrick, M.D.
Vice President: Mark Gerber, M.D.
Secretary: Franklin Rosenberg, M.D.
Treasurer: Jeffrey Gross, M.D.
Director, ASA District 3: Jan Ehrenwerth, M.D.
Alternate Directors: Jonathan Katz, M.D
Richard Browning, M.D.
Delegates to the ASA: William Conrad, M.D.
Jeffrey Gross, M.D.
John Muller, MD
Stanley Rosenbaum, M.D.
Alternate Delegates: John Satterfield, M.D.
Leonard Kulicki, M.D.
Craig Dennen, M.D.
Zeev Kain, M.D>
Program Chairman: David Mancini, M.D.
Newsletter Editors: Richard Kemp, M.D.
Craig Dennen, M.D.
CSSA Website: Ken Gutierrez, M.D.
Placement Committee: Zeev Kain, M.D..
Executive Secretary: Jill Fuggi
Legislative Consultants: Sullivan & LeShane, Inc.

Looking Forward

Mark Gerber, MD

These are the best of times-these are the worst of times. Hardly an original concept, but never more appropriate in medicine than at the beginning of this new century. Despite the greatest accumulation of knowledge and technological advancement in medicine that mankind has witnessed, there are those forces which seek to undermine these achievements. While it would be easy for physicians to throw up their hands and surrender to those that would erase this progress, we must resist that temptation. As physicians grow tired of advocating for our patients against a seemingly endless array of assaults we must redouble our efforts to ensure our patients receive the highest level of health care this country has to offer.

It is under this atmosphere that I will outline my agenda for our society for the next two years. First, we must remain true to the original goals of the society-the advancement of our specialty as a whole as well as the educational advancement of each member. By pooling our resources with the 2 residency programs in the state, the CSSA will be able to invite nationally renown speakers to address the membership. Dr. Dave Mancini, program chairman, has begun to work with the residency directors of both Yale and UCONN to implement this plan. In addition, the CSSA resident component will be conducting seminars to meet the specific needs of our resident members.

Second, the society will keep membership informed of developments in the managed care and Medicare arenas. To accomplish this the chairs of the committees on third party payers Dr. Frank Rosenberg and Medicare liaison Dr. Ken Stone, will provide the membership with quarterly reports at each CSSA meeting. Their ongoing dialogue with insurance company executives and Medicare administrators will be a forum in which we can advocate for the proper treatment of our patients.

Third, the CSSA needs to maintain a well coordinated grassroots political organization which will express our views to Connecticut’s elected officials. Dr. Tony Peluso, chair of the legislative committee, will require the efforts of many members throughout the state if we are to be successful. We must remember that public (medical) policy is developed at the capitol. If we are to influence those policies we must stay involved.

Finally, yet perhaps most importantly, is increasing membership involvement in the affairs of the society. Nothing less than the future of our practices is at stake. We can NOT allow all we have studied for and trained for, all we have worked so hard to achieve for our patients, to be washed away by a flood of self serving interests. There are no excuses which would justify that outcome. I look forward to seeing all of you at our next meeting.

New Job Placement Service

Dr. Zeev Kain, Chair of the CSSA Placement Committee is redesigning the job posting section of the CSSA website (CTANES.ORG). Each practice chief will soon receive information on how to submit to this site. In the meantime, anyone wishing further information can contact Dr. Kain at (203)785-6747 or email him at zeev.kain@yale.edu.

Office-Based Anesthesia:

The Good, the Bad, and the Ugly

Kathryn E. McGoldrick, M.D.

Before 1980, in developed countries, nearly all surgical procedures were conducted in the hospital. In the United States in the early 1980s approximately 80% of all surgical operations were conducted on inpatients; of the 20% that were ambulatory procedures, only 1% were in freestanding facilities and 1% were in physicians’ offices. By 1990 approximately 1.2 million surgical procedures were office-based. Today almost 75% of all operations are performed in the ambulatory setting, with 17% conducted in freestanding ambulatory surgical centers and 14% (approximately 8.6 million procedures) in offices. By the year 2005, it is projected that 82% of total surgical volume in the United States will be in an ambulatory venue, and 24% of these procedures will be performed in physicians’ offices.¹

Since the inception of surgical anesthesia more than 150 years ago, the focus of care has progressed from merely rendering the patient senseless during surgical manipulation to providing appropriate preoperative evaluation and patient selection criteria, extremely safe intraoperative care, and superb, safe postoperative analgesia in an efficient, cost-effective, highly professional manner. Indeed, progress in these areas has been nothing less than awe-inspiring. Little more than one decade ago estimated anesthesia-related mortality was said to be 1 in 10,000 anesthetics. Today, it is cited as 1 in 250,000 anesthetics, and the national rate for anesthesia-related deaths for outpatient (hospital-based or freestanding ambulatory surgery centers) anesthesia is quoted at 1 in 400,000. These previously unimaginably low mortality risks are said to approach the enviable "six sigma" level.² Yet, the death rate for office-based surgery in Florida was recently estimated at 1 in 8,500!³ And a recent issue of the Journal of Plastic and Reconstructive Surgery, incorporating data from an independent survey, disclosed approximately one death for every 5,000 liposuction procedures performed in a physician’s office.⁴

Why the disparity in safety based on venue? A host of factors may be operative. In recent years, surgical anesthesia increasingly has been provided by highly trained professionals who typically practice in hospitals or ambulatory surgery centers that are carefully scrutinized by accrediting agencies. Moreover, these skilled professionals have swift access to an armamentarium of the most modern drugs and sophisticated equipment, as well as to other superbly trained specialists who provide depth and breadth of "backup".

In a private office, by contrast, all bets are off in an environment that is devoid of the typical checks and balances that are enmeshed in the fabric of hospital-based or surgery center practice. Currently, office-based facilities are under little or no regulation, oversight, or control from federal, state, or local laws. (Isn’t it ironic that government regulations apply to lab tests conducted in an office, but not to anesthesia or surgery?) Indeed, office-based anesthesia is largely as unregulated as office-based surgery. In some cases, surgeons with no credentialing in anesthesiology are the anesthetists for their own cases. Patients may not be monitored at all or they may be inadequately monitored by clerical staff who are also assigned to provide care during postanesthetic recovery! In some instances, qualified anesthesiologists are called upon to administer anesthesia in a suboptimal environment that would not meet the standards established for hospital or ambulatory care centers. And, if a bad outcome occurs, no process is in place to assure a proper review and to protect patients who erroneously assume that "someone" is responsible for the quality of anesthesia and surgical care to which they submit themselves.

When deaths and injuries began to surface in states as the result of office-based anesthesia, concerned anesthesiologists joined with representatives from the Boards of Medicine in those states to define standards for office-based anesthesia. Today, regulations governing office-based anesthesia are in place in New Jersey, California, Florida, and Texas. Similar regulations are under consideration in New York and Rhode Island. Areas of concern may be divided into four broad categories: patient care issues, general practice issues, administrative concerns, and environment of care issues. The New Jersey experience, and its regulations, serve as a template to foster safer patient care. The New Jersey law states that if a physician is to administer general anesthesia, the physician must be credentialed "by a hospital or the Board"⁵ to provide general anesthesia services. If a CRNA is to administer general anesthesia, regional anesthesia, or conscious sedation, the CRNA must be supervised by a physician who meets the above requirements. (I was recently told that the latter portion of the bill is currently being challenged.) Moreover, only patients classified as ASA physical status I or II can receive general anesthesia in the office setting. Class III patients are restricted to conscious sedation only.

At the annual meeting of the American Society of Anesthesiologists in October 1999, the ASA House of Delegates adopted "Guidelines for Office-Based Anesthesia" and a "Statement on Qualifications of Anesthesia Providers in the Office-Based Setting".⁶ These guidelines state unequivocally that the standards currently used by anesthesiologists in hospitals apply to office-based anesthesia as well. The ASA underscores that wherever and whenever anesthesia is administered, there should be appropriate anesthesia equipment to allow monitoring consistent with ASA standards, and regular preventive maintenance on this equipment as recommended by the manufacturer must be clearly documented.

The cavalier attitude that heretofore permeated certain office-based anesthesia practices is a sad commentary on some of the darker aspects of human nature. Clearly, greed has been one of many motivating forces in the march toward office-based surgery. Given the fact that many office-based procedures are cosmetic in nature, it is almost as if nobody is too ill or too old to be beautiful! And, since cosmetic surgery is not covered by third party payers, we cannot blame the usual suspect, the managed care nemesis! Yes, the entrepreneurs are alive and well in America, and not just in the form of surgeons, anesthesiologists, nurses, and healthcare payers. On the unregulated internet, sites are being developed where patients and surgeons can match needs and services, fostering a virtual bidding war.¹

Sunlight is a very powerful disinfectant. Now that an all-too real problem has been recognized, let us work together to ensure that adherence to guidelines and standards will enhance patient safety. It is imperative that patients are assured the same level of safety in the office as in the hospital environment. Our patients should accept no less, and we must adamantly refuse to lower our standards of excellence based on venue, revenue, or any other "consideration".

Now, who in the CSSA will volunteer to work with the appropriate regulatory or legislative agencies in Connecticut to ensure proper oversight in our own backyard?

REFERENCES

1. Wetchler BV. Online shopping for ambulatory surgery: let the buyer beware! (editorial). Ambulatory Surgery 2000: 8:111.

2. Bodenheimer T. The movement for improved quality in health care. N Engl J Med 1999; 340:488-92.

3. Toughen in-office surgery rules (editorial). St. Petersburg Times; October 8, 1999.

4. Grazer FM, deJong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg 2000; 105:436-46.

5. New Jersey Register. June 15, 1998. §13:35-4A.6.

6. American Society of Anesthesiologists. 2000 Directory of Members. Park Ridge, Illinois: ASA; 2000:480-510.

ASA House of Delegates: 2000

Jonathan D. Katz, MD

The House of Delegates of the American Society of Anesthesiologists convened on October 14 and October 18, 2000.

The first order of business, and arguably the most important function of the House was the election of a slate of officers to guide us through the promises and challenges of the coming year and beyond. It is interesting to note that there seem to be fewer and fewer contested positions each year. Consistent with that observation, there was only ONE contested office this year, that being First Vice President which was won in a close race by James Cottrell from NY. Jim was aided in his candidacy by the tireless support and a superb nominating speech from our own Director Jan Ehrenwerth. The other officers are: President- Neil Swissman, Vice President for Scientific Affairs- Bruce Cullen, Secretary- Thomas Cromwell, Assistant Secretary- Peter Hendricks, Treasurer- Orin F. Guidry, Assistant Treasurer- Roger Moore, Speaker of the House- Eugene Sinclair, Vice Speaker- Candace Keller. Another election of significance was for next year’s ASA Distinguished Service Award- which will go to previous ASA President Betty Stephenson.

Among the myriad of "Resolves", "Recommends" and "For information only" that inhabit the 7 pound "Delegate’s" workbook that we all carry around for 5 days- 4 proved to be the most controversial. The first, the entire issue of HCFA’s revised ruling on CRNA supervision for Medicare cases remains unresolved as of this writing. A number of bills have been initiated in Congress in support of ASA’s commitment to continued involvement of an anesthesiologist in all anesthetics. The most recent, a Weldon- Green bill (H.R. 5286), is yet another attempt to achieve a fair and safe compromise. As of this writing, the bill has not been pushed through for a formal vote, and it appears unlikely that it will do so in the waning hours of this Congressional session. The leadership of the ASA has considered each of the possible outcomes and have in place plans to deal with any result of HCFA’s proposed ruling. As an aside, if the HCFA ruling proceeds as currently proposed, we in Connecticut can expect a new wave of challenges to the very core values of our practices. This will be a serious problem for the C.S.S.A. and for each and every anesthesiologist in Connecticut.

Several of the other contentious issues were dispatched in the time – honored tradition of most deliberative bodies- they were punted back to "a committee of the President’s choice". Included in this category was a proposal that would create a new category of membership in the ASA, entitled an "Educational Affiliate Membership". There are a number of ramifications of this initiative and many members were concerned, among other things, about the potential impact of a large number of non- physicians on the activities of the ASA.

A second, but related, issue that was also referred back to committee for additional study was whether and how to support the development of the profession of Anesthesia Assistants. This concept shows up in a number of reports and resolutions and seems to be on a relative fast track towards substantive ASA support.

A very difficult issue was raised within the Annual Report of the Committee on Obstetrical Anesthesia in a document entitled, "Optimal Goals for Anesthesia Care in Obstetrics". This is a joint statement between ASA and the American College of Obstetricians and Gynecologists (ACOG) that has been under consideration by our House of Delegates since 1997. The document deals with tricky issues such as availability of personnel, facilities, and equipment in defined circumstances, (for example in cases of VBAC or to start a cesarean delivery) and the qualifications of anesthesia and obstetrical personnel. An important clause tightens up the requirement so that a "qualified physician with obstetrical privileges to perform operative vaginal or cesarean delivery" is available during administration of anesthesia (i.e. epidural analgesia). This document, and its sister guideline, "Guidelines for Regional Anesthesia" spell out in detail what is expected of anesthesiologists who provide services to an obstetrical unit. Like them or not, they define the standards to which we are all held. I urge all to obtain a copy (ASA website) and read them.

A potentially controversial issue that ultimately proved to have almost unanimous support was a recommendation from then- President Elect (now President) Swissman for a dues increase- to $450/ year for Active Members, $225 for Affiliate Members. The ASA has not had a dues increase in 10 years. The House of Delegates recognized the increased activities of the ASA, especially in the political and public education arenas where our expenses skyrocketed from $650,000 to $3.2 million this year. In the absence of a dues increase we were facing a $3 million operating deficit.

A large number of committee and district director reports were passed without much debate or controversy. One personally gratifying announcement came from the Committee on Annual Meeting Review that, as of the 2000 meeting, all exhibitors for the technical exhibit program will be prohibited from using latex products in their displays. This decision was the result of urging from the Task Force on Latex Sensitivity, which I chair. This decision will be of great benefit to the 10- 17% of anesthesiologists who are sensitized to latex, half of whom experience clinical symptoms when exposed.

The final meeting, held on October 18, was completed in 2 1/2 hours, which belies the magnitude and the complexity of the materials considered. The speed and efficiency of the meeting does speak well of the organizational structure of the Society, specifically its commitment to the democratic process and its reliance on regional caucuses and the Reference Committee system. It is also a testimonial to the commitment and competence of your elected officers and ASA staff. I urge anyone who attends next year’s ASA national meeting to take a few minutes to observe and participate in the process. I guarantee that you will not be disappointed.

CSSA Political Agenda

Anthony Peluso, MD

As of this writing, the proposed HCFA rule change regarding nurse anesthetist supervision is still being reviewed by the Office of Management and Budget. In the meantime it has become painfully clear that the passage of the Safe Seniors Assurance Study Act (H.R.632 and S.818) is unlikely to pass during the 106th Congress without modification. In September Rep. Dave Weldon, (R-FL), author of H.R. 632 prepared a compromise proposal regarding the supervision issue. This compromise proposal still requires an outcome study. However, the proposal would allow carefully defined collaborative arrangements assuring physician participation as well as the current supervision requirement. ASA has endorsed this compromise and there are efforts being expended to attach this modification to a Medicare bill being authored by House Republicans. I think most of us realized as time passed that the Safe Seniors Assurance Study Act would probably never get to a vote in either chamber of Congress. This codification contains the word "collaboration". As those physicians that have battled independent nurse practice initiatives at the state level can attest, nurses love the word "collaboration". It is a seductive, feel good term that ought to be avoided when dealing with supervision issues. Webster's dictionary defines collaborate as," to cooperate or work with another person". This implies working shoulder to shoulder with another individual. Period. No one is supervising anyone else. We must never confuse medical direction with collaboration. Although some may feel that medical direction and collaboration are not mutually exclusive, we must be sure that the latter never supplants the former. So much for word play. Compromise is part of politics and Weldon's amended bill still provides a safety net for patient
protection.

As most of you know, the Quality Health Care Coalition Act, authored by Rep. Campbell(R-CA) passed the House in June. Unfortunately, this antitrust relief bill will not pass the Senate since there is no Senate counterpart bill. The conference committee continues to work on the patient bill of rights.

I am proud to report that Connecticut's contribution to the ASAPAC has risen dramatically compared to last year. Last year we were ranked 17th in the nation when ranking all states by percentage of component society members who contributed to ASAPAC. This year we leaped to 6th place with 38% of CSSA members contributing. This is an auspicious start toward reaching a ranking of number one.I will continue to solicit innovative ways from the membership as to how to increase contributions to both ASAPAC and the PASPAC. Please let me know if you are interested in participating on the political action committee. A major issue this coming session will be focusing on the abysmally low Medicaid reimbursement rates in this state and the options available to improve this fee schedule. We will be working very closely with the CSMS on this issue.

Medicare Update

Kenneth Stone, M.D.

Change of Part B Medicare Carrier in Connecticut

I am happy to be able to submit this first report to the Society’s membership since my appointment to be the CSSA’s representative to the Connecticut Medicare carrier’s Carrier Advisory Committee. In this communication, I would like to report on the recent change of Medicare carriers in the State.

As most of you now know, First Coast Service Options has replaced United HealthCare as the Medicare Part B carrier in Connecticut. The new carrier (known by the acronym FCSO: best pronounced "fik-so") is a for-profit, wholly-owned, subsidiary of Blue Cross/Blue Shield of Florida with headquarters in Jacksonville. The name ‘First Coast’ reflects a local designation of that region of Florida.

What follows is a summary of information presented by First Coast in an introductory meeting held June 19, 2000. The meeting was attended by physicians from around the State. First Coast was represented by its CEO, Curtis Lord, Dr. Sidney Sewell, Medical Director, and other officers and representatives of the home office.

FCSO is a large corporation with 1300 employees in Florida, Maryland and Connecticut. The company has been a Medicare contractor since the program’s inception in 1966 and is one of the largest Medicare claims processors. FCSO acts as a Part A (hospital) intermediary and provides processing for other Medicare intermediaries. They are also the Part B carrier for Florida. Recently, they have been awarded contracts to handle Part B services in Maryland and Connecticut.

Regarding the transition in Connecticut from UHG, FCSO states that it will accomplish this as seamlessly as possible. They will hire all qualified UHG personnel and maintain the same offices and facilities. Initially, all operational processes will be the same and there will be no noticeable difference in claims submission. Furthermore, as of June of this year, they were committed to hiring the UHG Medical Directors: Drs. Mary Jean Ahern and Arif Toor.

At the introductory meeting, the staff of FCSO put on a thorough presentation of its corporate structure and mission. The senior officers made an effort to reach out and convey the sense that they are personable, available and truly concerned about the company’s handling of this venture. I believe that most physicians in the audience viewed the presentation in a positive fashion. However, there was also a sense of caution that we all must wait and see how they actually carry out this service. One physician commented that interactions with UHG had generally been favorable, and he hoped that FCSO would carry on in that same fashion.

One of my concerns was whether FCSO would make any changes in the policies and procedures that have been established, and which we are all used to following, under UHG. When asked this question, Mr. Lord replied that the established policies for Connecticut will remain in force. Furthermore, he stated that FCSO did not plan to unify policies among the States for which it is a Part B carrier. Therefore, any policies and understandings regarding aspects of reimbursement will continue as in the past. Any changes to this policy will go through the usual Local Medical Review Process (LMRP) and the Carrier Advisory Committee (CAC).

FCSO states that their transition team will be available to answer questions from physicians regarding the changeover. There will be seminars for both physicians and patients covering special transition issues as well as primers for physicians and their office staff. FCSO’s web site can be reached at www.Connecticut Medicare.com.

Minutes of the Executive Board & Business Meeting

Connecticut State Society of Anesthesiologists

September 13, 2000

New Haven Lawn and Tennis Club

Members Present:

The meeting was called to order by Dr. Mark Gerber.

President’s Report:

Dr. McGoldrick/Dr. Gerber

Streamlining of the Executive Board and Business Meeting was emphasized. The Vice-President, Secretary, Treasurer, Legislative and Committee Reports will be discussed during the Business Meeting. (Unless there are specific issues to be discussed prior to the meeting).

The contract with our lobbyist group LeShane and Sullivan is up for renewal. Dr. McGoldrick and P.A.C. chairperson (Dr. Peluso) will discuss renegotiating the contract with LeShane and Sullivan. They have been lobbying for the CSSA for six years. Each contract has been on a two year basis.

Dr. Peluso will look into the feasibility of using credit cards for PAS/PAC Contributions.

The importance of attending and supporting fund-raisers was discussed. To obtain dates and times you can contact Dr. Peluso or LeShane and Sullivan.

To enhance CSSA meeting attendance, several options including a change of speaker venue and or CSSA meeting sites were discussed.

Dr. McGoldrick presented nominations for:

President M. Gerber
Vice-President J. Gross
Treasurer J. Satterfield
Secretary F. Rosenberg
Delegates: A. Peluso
S. Rosenbaum
J. Muller
J. Gross

Alternate Delegates:

Z. Kain
K. Gutierrez
K. Stone
D. Mancini

All present members of the CSSA voted for the proposed state of officers and delegates. Dr. McGoldrick was presented with a plaque and thanked for her outstanding leadership during difficult times. Dr. Gerber would like to have the CSSA membership more involved and an increase in meeting attendance.

Secretary’s Report:

Franklin Rosenberg, M.D.

Minutes from the last meeting were approved as printed in the last CSSA newsletter.

District Director’s Report:

J. Ehrenwerth, M.D.

The text of this report has been circulated independently to the membership and is available for review at the CSSA Website.

Committee Reports

Insurance Committee:

F. Rosenberg, MD

Many insurance companies are using a proprietary system for calculating anesthesia reimbursement called Claim Check. This system often bundles procedures that are done in conjunction with an anesthetic. Recently BC/BS CT discontinued payments to anesthesia providers for Procedure Code 93503 Pulmonary Artery Catheter insertion. After discussion with the Medical Director, a letter of justification was sent, BC/BS CT reversed it’s decision and will pay for this procedure. Many of these for-profit managed care companies continue to find ways to decrease anesthesia reimbursement.

We are reminded that placement of arterial, central venous and pulmonary artery catheters and use of transesophageal echocardiography are NOT included in the basic unit value.

The Connecticut State Medical Society is exploring options for increasing Medicaid reimbursement.

Political Action Committee:

A. Peluso, MD

Continued support of all CSSA members is needed to ensure adequate funds for the PAS/PAC. Two Federal Legislature Bills that need to be mentioned are the:

Quality Healthcare Coalition Act, by Rep. Tom Campbell and The Patient Bill of Rights (Senate and House versions), by Rep. Norwood -Dingell; presently in conference committee.

The A.S.A. Legislative meeting in Washington, D.C. is April 29-May 2, 2001. Those interested in attending should contact Jill Fuggi.

Medicare Committee:

K. Stone, MD

Medicare Part B will be contracted through First Coast Service Options, Inc. In Florida in September 2000. United Healthcare will no longer be the Part B carrier. The new carrier states there will be no disruption in service or reimbursement. Local medical policy will still prevail.

Placement Committee:

M. Gerber, MD

Anesthesia groups who have anesthesiology positions available are encouraged to call Z. Kain, MD at Yale University. Z. Kain, MD is the new chairperson of the placement committee.

Education Committee:

D. Mancini, MD

The next meeting is December 6th. Dr. Barry Glazer will present our annual ASA update in his capacity as the ASA’s President Elect.

Southern New England Anesthesia Conference;

J. Muller, MD

The next meeting will be June 2 and 3, 2001 in Boston, Mass. The theme will be "Nightmares in Anesthesia."

Other Business

Dr. R. Kemp discussed the Connecticut Certificate of Need process as well as ambulatory, free-standing surgical and office centers. A number of patient deaths in plastic surgical offices has caused a renewed interest in anesthesia safety and care outside the traditional operating room settings. The office of Health Care Accent is presently reviewing guidelines for office based anesthetics. Dr. M. Gerber emphasized that the main purpose of the CSSA is the education of its members.

Bylaw Changes:

The CSSA Bylaws were formally amended as follows:

"On an annual basis, an independent CPA will do a compilation of financial statements and prepare any necessary tax returns. Upon a majority vote of the board of directors or of the general membership, the accounts of the treasurer shall be audited by an independent CPA at least one month prior to the termination of his elected term in office. Upon majority vote of the board of directors, the treasurer shall be bonded by the Society in an amount approximately equivalent to the financial assets of the Society. "

There being no further old or new business; the business meeting was adjourned to hear a presentation by Lee Fleisher, MD, "Cost Containment in Perioperative Medicine, Fact or Fiction."

Respectfully Submitted,

Franklin Rosenberg, MD

CSSA membership changes:

Active

Michelle Bouyea, MD Rockville General Hospital
Ellen Whalen, MD Danbury Hospital
Richard Frank, MD Midstate Medical
Francis Kors, MD Stamford Hospital
Emy Lu, MD Stamford Hospital
Sara Rogers, MD Yale-New Haven
Haleh Saadat, MD Yale-New Haven
Terry Horbal, MD Stamford Hospital
Neeraj Mangla, MD Bristol Hospital

Resident

Kashif Abdul-Rahman, MD UCONN/Hartford
Bernd Dotzauer, MD UCONN/Hartford
Qassem Kishawim, MD UCONN/Hartford
Henry Korzeniow, Jr. DO UCONN/Hartford
Isaac Osei, MBCHB UCONN/Hartford
Marlene Santiago, MD UCONN/Hartford
Sandra Vella, MD UCONN/Hartford
Ponnamma Chenanda, MD Yale
Mamatha Punjala, MD Yale
Rima Aouad, MD Yale
Apolotan, Ana Maria Yale
Bose, Ruma Yale
Gendzel, Leonardo Yale
Haliburda, Angela Yale
Hoefner, Ernest Yale
Itani, Muhammad Yale
Khan, Humayon Yale
Koltchine, Vladimir Yale
Ryskin, Alexey Yale
Shaheen, Yasser Yale
Shi, Bing Yale
Srinivasan, Sheila Yale
Stein, David Yale
Tantawy, Hossam Yale
Tuxbury, Ann Yale
Whipple, Joy Yale
Yusufali, Taizoon Yale

Affiliate

John LaPurga, MD Groton Naval Hospital
Wagih Ouda, MD Yale
Aymen Awad, MD Yale

Retired

David Campbell, MD Waterbury Hospital
Teofilo Gutierrez, MD Midstate Medical
Arcadio Salgado, MD St. Francis

Medical Student

Severine Chavel Yale
Raymond Lynch Yale
Healther Shelsta Yale
Shannelle Campbell Yale
Anna Hallemeier Yale
Elizabeth Bird Yale
Meghan Brett UCONN
Michael Seldon UCONN
Neil Oliwa UCONN
Beth Natt UCONN
Kenneth Fraticelli UCONN
Jason Ferries UCONN
Donna Albanese-Funk UCONN
Jermy Astle UCONN

Out of State

Jeffrey Martin, MD Pensylvania
Khwaja Zakriya, MD Maryland
Cephas Swamidoss, MD New York
Armen Ketchedian, MD New York
Hakan Attaroglu, MD New York

CSSA Resident Component

Richard J. Juda, MD

I have recently returned from the ASA 2000 in San Francisco. This year resident House of Delegates presented many issues ranging from educational standards to the residents' political involvement in the ASA. One final aspect of the conference for residents allowed the delegates to express concerns within the Anesthesiology Residency educational venture over the three years of training. The House of Delegates was preceded by reports from the ASA committee on education. This focused on the ASA' s commitment to residency training programs and the educational process. The president elect of the ASA, Dr. Swissman addressed the delegates, assuring the secure future in the anesthesiology job market for new graduates. New officers for the ASA resident component were then chosen.

Dr. Roy Soto, Chair of the resident component addressed the delegation urging residents to become involved in the ASA and the State chapters. He also related that there would be a new curriculum that will be endorsed by the ASA for office based anesthesia. Other related areas of the ASA's involvement included an airway workshop, which was held at the AMSA national conference to promote the field of anesthesia among medical students. A representative for the Anesthesia Assistants presented an overview of their training and certification process for the delegates. It was related that the AA was required to have a BS degree in order to gain acceptance into a program. The total clinical hours which a AA received in their training was 2600, higher than a nurse anesthetist. Finally the AA is regulated by the board of medicine not the board of nursing; hence, there is no competition for independent practice as with nurse anesthetists. The final process for the House of Delegates included voting on various resolutions. The first resolution was the development of a delegate position and alternate position for the American society of Regional Anesthesia. Secondly, the development of an airway management teaching programs for medical students. Thirdly, discussion was held regarding the development of a difficulty airway national database. This was disregarded due to the legal questions of patient privacy. The fourth resolution passed was to develop a letter to the ABA to search for alternatives in the administration of the board exam. Alternatives included switching from a solely annual exam to possibly create more dates and/or a computerized system of administration. The final resolution, which did not pass, was the placement of substance abuse posters; pamphlets through out the hospital to assist residents with counseling. It was suggested that a national toll free phone number would be better suited for this purpose.

From the standpoint of the CSSA, I am hoping to schedule a resident brunch in February to include financial planner, information on job searches and legal consultant to advise on contract evaluation. This brunch event is in the planning stages and I welcome any suggestions. A guest lecturer will be present for the next CSSA meeting.

I thank you for all of your interest in the resident component. I look forward to seeing everyone at the next meeting. At any time residents may contact me at: Rjudamd @pol.com or (860) 659-8877.

Dr. Juda is President of the CSSA Resident Component.