OR technicians protest proposal saying only RNs may circulate

The Association of Surgical Technolo- gists (AST) filed a formal protest Feb 25 against the Health Care Financing Administra- tion’s (HCFA) handling of the new proposed Medicare regulations. The proposed rules, pub- lished Jan 4 in the Federal Register, state that only a registered nurse may perform circulat- ing duties in the operating room, and the OR must be supervised by an experienced RN. The comment period ended March 7.

AST has petitioned for: 0 an extension of time for comment on the

regulations 0 the opportunity to make an oral presenta-

tion of HCFA officials 0 the disqualification of Carolyne Davis,

RN, administrator of HCFA, from further involvement in issues directly affecting RNs vs surgical technologists, claiming she is biased toward RNs.

HFCA officials met with AST representatives March 11.

Joseph Radzius, the Chicago attorney rep- resenting AORN for this issue, has filed a brief on behalf of the Association supporting the proposed regulations. Radzius also included the 600-page brief he filed for AORN in 1980. We are satisfied that HCFA has sufficient in- formation from AORN on this issue at this time.

AORN Headquarters wil l continue to monitor the progress of the regulations and keep members informed. It is expected to be some time before the government sifts through the some 30,000 comments received on all the

Medicare rules. Until final action is taken on the proposed rules, hospitals are still covered by the original rule that only a registered nurse may circulate in the operating room.

W Ethylene oxide (EO) exposure would be limited to one part per million (ppm) under a strict new rule proposed April 15 by the Occu- pational Safety and Health Administration. The government agency was ordered to expedite a new rule by an appeals court decision handed down in March.

The current exposure limit is 50 ppm aver- aged over an eight-hour period. The Public Citizen Health Research Group and a labor union had sued OSHA saying this level was too high. Studies have shown a relationship between EO exposure and cancer in humans and animals. The union has also said the new proposed limit is too high; one-half ppm would be more acceptable to them.

The American Hospital Association, on the other hand, expressed concern that many hospitals might not be able to comply with the proposed standard. This could jeopardize the sterilization of items that can only be pro- cessed with EO. AORN has expressed similar concerns.

Hearings on the proposed new standard are scheduled for July. An OSHA official said he expected a final standard in about a year.

W Chemical disinfectants and sterilants used to prepare instruments for surgery will no longer receive independent testing by the government. The Environmental Protection Agency (EPA) has closed the only national laboratory testing the effectiveness of hospital disinfectants.

You will now have to rely primarily on tests

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from companies in determining whether a sterilant or disinfectant is safe. Three states -Florida, North Carolina, and Virginia-have their own testing procedures, but the other states do not.

James G Touhey, EPA director of benefits and field studies, told the Washington Post the lab was being closed so lab employees could be assigned to other agency projects that have a backlog. About 20 employees will be reas- signed.

rn A federal judge in April overturned the government‘s so-called “Baby Doe rule.” The regulation required hospitals receiving federal funds to post a notice saying it was illegal not to feed and care for handicapped infants. On the poster was to appear a hotline number to be used by anyone knowing about the denial of “customary medical care” to such infants.

“The regulation purports to set up an en- forcement mechanism without defining the vio- lation,” the judge said.

He added that the government “did not ap- pear to give the slightest consideration to the advantages and disadvantages of relying on the wishes of the parents, who, knowing the setting in which the child may be raised, in many ways are in the best position to evaluate the infant’s best interests.” In addition, he said the government violated the Administrative Procedures Act by not allowing enough time for public comment.

The government said it would appeal. In the meantime, the rule is not in effect. President Reagan called for the rule last year after he learned of a case in which an infant known as “Baby Doe,” born with Down’s syndrome, died after food and medical treatment were with- held. The rule came from the US Department of Health and Human Services (HHS).

The judge said the new rule did not reflect the “caution and sensitivity” the government should use in intervening in complex medical and moral decisions. He said he did not believe the rule would improve treatment for newborn infants.

The suit was filed by the American Academy of Pediatrics, the National Association of Chil- dren’s Hospitals, and Children’s Hospital Na- tional Medical Center, Washington, DC. A va- riety of other health organizations, including the American Nurses’ Association, joined the

academy in writing to HHS Secretary Margaret Heckler about their concern.

Requiring second opinions of Medicare and Medicaid patients having elective surgery could save $157.7 million annually, the gov- ernment‘s inspector general Richard P Kus- serow estimated in a March report. He encour- aged the US Department of Health and Human Services to reconsider its policy of only en- couraging voluntary second opinions.

The government has been promoting sec- ond opinions since 1977, the report said, but the voluntary program has not significantly re- duced the number of elective operations. The principal reason is that most people decide not to get asecond opinion, perhaps because they worry about offending their physician by hav- ing his or her decision questioned.

On the other hand, mandatory programs in some states have shown money can be saved, the report indicated. Studies in the three states have shown 20% to 35% reductions in elective surgeries. In the Medicare program, second opinions might be most effective in reducing the numbers of prostate surgeries, cholecys- tectomies, joint replacements, and hernia re- pairs.

The inspector general called on HHS to seek changes in the Social Security Act requiring mandatory second opinions for Medicaid and Medicare patients.

Patricia Patterson Associate editor

1408 AORN Journal, June 1983, Vol37, No 7