es to qualify, they would have to have the endorsement of two ASA members, and would be required to sign the association's statements of ethics and the anesthesia care team, which advocates having an anesthesiologist in charge of all medical direction of all participants in the anesthesia team. The primary goal is to improve the education and safety. However, the certified registered nurse anesthetists (CRNAs) doubted they could improve their education via this affiliation. For example, the hospital at Broken Bow, Nebraska , which cannot afford to have an anesthesiologist on staff, has had an experienced nurse anesthetist on staff for about 15 years and have found him to be just as competent as any anesthesiologist (Bagby, 1999, 16).
The American Medical Association played a key role in opposing the Health Care Financing Administrations (HCFA) proposal to allow nurse anesthetists to provide anesthesia services without physician supervision to Medicare and Medicaid patients (Organized, 2000, 3170). The AMA, ASA, all 50 state medical societies and
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