The surgery department at Kaweah Delta Medical Center has voted against using nurses to provide anesthesia in operating rooms.


The vote Thursday was 15-2, with two surgeons abstaining. The number who voted represents about 30 percent of the 55 general surgeons who operate at the Visalia hospital.


Kaweah Delta administrators say it's hospital policy to honor the request of a surgeon or patient on whether to use an anesthesiologist, who is a medical doctor, or a nurse anesthetist (CRNA).


Provisions are already in place for wary doctors and patients, said Dr. Mark Garfield, vice president and chief medical officer.

"There will be enough anesthesiologists to accommodate these requests," he said.


On Sept. 20, the Medical Staff Organization's Medical Executive Committee decided to reserve the right to limit the number of CRNAs in the main operating room if they find a quality issue in the new program set to take effect Dec. 13.


The Kaweah Delta board of directors awarded Somnia Anesthesia an exclusive agreement to provide anesthesiology services beginning Dec. 13. The agreement provides that Somnia may use CRNA-certified nurses to administer anesthesia.


Somnia replaces Visalia Anesthesia Medical Associates, which provided anesthesia services using MDs in Kaweah Delta operating rooms for the last 16 years.


Dr. Walter Walters, chief of VAMA, said that one anesthesiologist per patient is warranted for patients at Kaweah Delta because of this area's poor population and high number of very sick patients.


Vote taken as recommendation
The surgeons' vote Thursday will not have any immediate effect, said Dr. Mark Wiseman, chief of staff at Kaweah Delta.


The vote was taken as a recommendation from the department of surgery.


"The decision of using CRNAs has a process that is to be followed and goes through the medical executive committee and then is taken to the board," he said.


Board to meet Dec. 12
The soonest the hospital trustees would take up the recommendation from the surgery department would be at their Dec. 12 board meeting, Wiseman said. The trustees meet in the Blue Room in the basement of the hospital. The public is welcome to attend board meetings.


However, the decision to use Somnia Anesthesia is a done deal, said Lindsay Mann, chief executive officer.


"Somnia will certainly be the provider of anesthesia service at Kaweah Delta on Dec. 13," he said. "We are prepared to work with them under any scenario."