RMV->) Re: "Can Surgery Centers Profit From Anesthesia?" (April, page 64). This article is counterproductive at best and unseemly at worst. When in the same issue others are describing the scrutiny that physician-owned surgical facilities are increasingly fending off, it would seem that physician-owners would be looking to consolidate their friends rather than make new enemies. Why would any good, smooth-running surgical center want to shave profits from another provider when it's obvious that this will cause resentment and lead to negativity?

Donald Claeys, MD
Anesthesiologist
Emerald Valley Anesthesia Service
Eugene, Ore.
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In our physician-owned ASC, the anesthesiologists were restricted to less than 6 percent of all shares, with the majority reserved for the surgeons. Yet we're accountable for running the operating suites in a smooth, efficient and effective manner. We're required to wait for surgeons who double-book cases at the nearby hospital or sit around during downtime. We're often scrutinized when our pain procedure counts take a dip in the monthly totals. Mr. Manigan doesn't entirely represent the whole picture in his article.

Marc T. Reichel, MD
Anesthesiologist
Beaufort, S.C.
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Mr. Manigan replies: I think the writers are interpreting the attitude of ASC-owners who seek to profit from anesthesia as my own. The value of a cohesive, efficient and experienced anesthesia team is hard to understate.

Nurses Performing Endoscopy
Re: "Nurses Doing Flexible Sigmoidoscopy and Colonoscopy" (May, page 28). As an advanced practice nurse practitioner specializing in internal medicine, I found it interesting that the nurses who oppose nurses' performing endoscopy aren't the nurses with advanced degrees. I wonder what the opposition was to nurse-performed flex sig when the idea was first conceived? I also found it unbelievable that the article suggested that nurse practitioners can't perform colonoscopy because they lack sufficient training, but yet gastroenterology nurses can become trained to administer sedation in lieu of an anesthesiologist or CRNA to increase productivity and volumes while holding costs down. How can this increase productivity when the problem we're having is a limited number of qualified practitioners to perform colonoscopies, not with the practitioners available to administer anesthesia for these cases?

Patricia Atherton, CRNP
Albuquerque, N.M.
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RNs and Propofol Don't Mix Well
Re: "Gastro Docs, Nurses Support Nurse-Administered Propofol Sedation" (April, page 12). I've spent most of the 23 years I've been an RN in the OR, the last 10 in an outpatient surgical facility. I find it difficult to believe that any RN would put herself in the dangerous position of administering IV sedation/propofol drip sedation. We're not trained anesthesiologists. Why should we take on that responsibility? We certainly wouldn't receive the compensation that an anesthesiologist would expect, nor should we. The only answer that I can come up with is that physicians are trying to save money be using RNs to provide care that is clearly out of their scope of practice. As a profession, we need to be very clear on what our role is in patient care. Providing a safe surgical environment is the operating room nurse's most significant role. Cost-containment is another role, but it can never, ever conflict with patient safety.

Susan Anello, RN, BSN, CPSN, CNOR
The Advanced Plastic Surgery Center
Yonkers, N.Y.
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Thanks for Donated Surgical Supplies
Re: "Peace on Earth, One Dog at a Time" (December 2003, page 88). Since this story appeared in Outpatient Surgery, surgery centers across the United States have shipped their surplus, unneeded or outdated surgical supplies to help the Homeless Animals Relief Project provide free spay/neuter surgery, free vaccinations and free medical care to less fortunate dogs and cats in north Mississippi.

We've received major donations of suture, surgical instruments, bandages, casting materials and other medical supplies. It's been a bountiful harvest that has us shaking our heads in wonder at the kindness of strangers. These are people who've never met the hungry mama dog living under an elderly lady's dilapidated trailer. Or the terrified, term pregnant cat that's just been tossed in a ditch. Or the bloodied, injured feline trembling on the centerline of the highway. And yet, to help these unseen animals, they're boxing up and shipping supplies that might otherwise have gone in the trash. When they help the animals, they help our whole community, as sterile and vaccinated animals are essential to human health and welfare.

In an era when daily news and current events are often both disturbing and frightening, it lifts our hearts and spirits to see how strangers will reach out to help the helpless. From our all-volunteer team of veterinarians, nurses and techs, but most of all from the animals you've helped, I send heartfelt thanks to Outpatient Surgery Magazine and its readers.

Linda Chitwood, CRNA, MS
Director
Homeless Animals Relief Project, Inc.
Brentwood, Tenn.
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