Kathryn Glas, MD, MBA, FASE, Immediate Past Council Chair

Scott T. Reeves, MD, MBA, FACC, FASE, Council Chair

Webster’s dictionary defines an advocate as “a person who argues for a cause, supporter, or defender.” The secondary definition is “an intercessor.” Why is the COPE group discussing advocacy this month? It is because ASE recently took significant steps as an advocate for the patients of South Carolina and our specialty of echocardiography.

What exactly occurred in South Carolina? On Wednesday, February 1, the South Carolina Board of Medical Examiners (SCBME) reported that they were going to hear testimony from the South Carolina Board of Nursing about two issues critical to our patients on the following Monday morning. The first was a white paper proposing independent practice for all advance practice nurses in the State of South Carolina. The second was to add the placement of transesophageal echocardiography (TEE), image acquisition, and interpretation for surgical decision to the nursing scope of practice for Certified Registered Nurse Anesthetists (CRNAs). Both had been previously approved by the South Carolina Board of Nursing. On Wednesday evening, we notified the ASE leadership of the proposed changes to nursing scope of practice and the CRNA TEE issue. The ASE was appropriately concerned with the CRNAs “utilizing TEE for surgical decision making” given their total lack of training and the significant potential to compromise patient care. Within 16 hours of the initial request for assistance, the ASE leadership sent a broadcast email to all 222 ASE members in the state requesting that they write letters and call members of the SCBME. It did not end there! The ASE also sought help from the American College of Cardiology (ACC), and in only 8 additional hours the ACC sent a broadcast email to every member of their SC chapter requesting assistance.

On Monday, Dr. Reeves testified on both issues, representing the Medical University of South Carolina as Chairman of the Department of Anesthesia and Perioperative Medicine, as well as the ASE as chairman of COPE, a member of the Advance PTE Examination Writing Committee of the National Board of Echocardiography, and president-elect of the Society of Cardiovascular Anesthesiologists. The board was extremely polite, and individuals on both sides of the issues had an opportunity to express their viewpoints.

The SCBME then rendered their decisions:

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  The board voted unanimously against the expanded scope of practice document.

  
  
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  The board voted unananimously against the increase in scope of practice for CRNAs doing TEE and added, for the record, that the board considered the practice of TEE to be exclusively part of the practice of medicine.

The board concluded by asking the South Carolina Board of Nursing representatives if they would be willing to create a task force from each group to study areas of common ground but that elimination of physician supervision and adding TEE credentialing would not be part of that process. After the meeting several board members approached Dr. Reeves and thanked him for the written letters and calls from ASE and ACC members, and for the Medical University of South Carolina’s united support and the documentation provided. These materials made the ultimate board decision easier. We have never been more proud to call ourselves Fellows of ASE than we were on February 6 ^th .

Since the SCBME vote, these issues have become the common discussion topic at many hospitals’ operating rooms and cardiology practices across South Carolina and the nation. We have no doubts that this process will continue. Being an election year, there will be a push to legislate what has not been accomplished through education. We want to thank the ASE leadership and all our members their recent and future support. Moving forward, we await the ASE guideline on the practice of TEE that includes training and supervision guidelines aimed at ensuring optimal patient care and safety.

The ASE is truly a society that understands the value of advocacy!