What Happened To
US Navy Medicine?
From Craig Michael Uhl, MD, CPA <>

Dear Jeff,
A letter of mine was read on your show several weeks ago regarding the Anthrax vaccination. I have since read a news item that should shock any active duty and dependent military member in the US Navy that is not a VIP or dignitary. Here it is.
Why should are active duty personnel get sub-standard care? Why should VIP s get better treatment? Who made this decision? I was a former active duty Navy Physician who resigned because I saw this unethical and immoral policy implemented on a daily basis. In fact, I resigned my commission three months ago and have yet to hear a response.
This story exemplifies the state of Navy Medicine in ways I could never articulate. This story is appalling and it should to any active duty man or woman. I hope you have the honor, courage and commitment to pursue this with all its implications regarding the state of Navy Medicine.
Craig Michael Uhl, MD, CPA, P.O. Box 3961 Monarch Beach, CA 92629
Navy Fires Doctor
By Jeff Nesmith COX NEWS SERVICE 11-18-99
WASHINGTON--The chief anesthesiologist at the National Naval Medical Center was relieved of his command last week for refusing to place specially trained nurses in charge of administering anesthesia to some patients.
The hospital's policy of administering sleep-inducing drugs only under the supervision of an anesthesiologist will remain in effect for VIP patients, staff members were told. Members of Congress and other high-ranking government officials, including the president, receive medical care at the Bethesda, Md., hospital.
However, other active duty personnel, retirees and their dependents will receive the drugs from nurse-anesthetists without the supervision of physicians specializing in anesthesiology.
Physicians and other professional staff members at the hospital were told Nov. 11 that Dr. Alvin Manalaysay, a Navy captain, was being relieved of his command.
Officials of the American Society of Anesthesiologists said the staff was told the action was because Manalaysay refused to carry out an order that he institute the change.
The new policy will apply only to treatment of healthy or mildly ill patients, physicians were told at a staff meeting.
Dr. Manalaysay declined comment late Wednesday, saying that questions about his being relieved of his command must be addressed to the hospital's public affairs office.
The hospital did not respond to questions about the policy change Wednesday. A spokesman said that the hospital commander, Rear Adm. Bonnie Potter, was in a meeting and was not available to answer questions.
Dr. John Beauregard, a civilian anesthesiologist in Washington who left the Navy two years ago, said he was told by hospital staff members that Potter was specifically asked at a staff meeting what the policy would be when dignitaries are treated. She replied that their care would continue to be supervised by an anesthesiologist, he said.
"I was told by current active-duty anesthesiologists that that's what the policy will be for high government officials, high-ranking officers and physicians who are treated at Bethesda," Beauregard said. He said he left the Navy two years ago without accepting promotion to commander, partly out of frustration at being constantly pressured to expand the role of nurse-anesthetists. He was chief cardiac anesthesiologist at Bethesda when he left the Navy and remains in close contact with his former colleagues there, he said.
"This means that Bethesda has a lower standard of care than any other hospital in the Washington area," Beauregard said. "It's unethical and immoral."
"They have decided they can't justify spending the money on anesthesiologists just to avoid a few complications."
One of the findings of a 1997 Dayton Daily News investigation of problems in military hospitals was that in some cases, nurses and physician's assistants provide medical care that Defense Department regulations require a doctor to perform.
Among these were the administration of anesthesia by unsupervised nurse-anesthetists and even student nurses.
In denouncing the Bethesda change as "something that could not legally happen in 49 of the 50 states," Dr. Ronald Mackenzie, president of the American Society of Anesthesiologists, warned that problems involving the use of anesthesia can happen to healthy patients "right out of the blue." But Jan Stewart, president of the American Association of Nurse-Anesthetists, said members of her profession "are highly qualified and educated people" who have been delivering anesthesia on battlefields for decades without a doctor's supervision.
Certified registered nurse-anesthetists (CRNAs) handle all phases of administration of anesthesia in 75 percent of the cases in rural civilian hospitals in America, she said.
"CRNAs plan what kind of anesthesia to deliver, administer the drug, maintain the patient during surgery and oversee the recovery," said Stewart, a Chicago nurse-anesthetist.
She added that CRNAs administered anesthesia on battlefields in Korea, Vietnam, the Persian Gulf war and in Bosnia, "and there's no demonstrable difference in outcome between their care and that of anesthesiologists." Mackenzie said the change "means that the finest young men and women in the United States, the ones who are serving their country in the Navy, are going to receive substandard care."
"We did a careful survey of state laws governing medical and nursing practice, and in only one state, New Hampshire, would this be legal," said Mackenzie, an anesthesiologist at the Mayo Clinic in Rochester, Minn. He added that "there is no scientific data that this (change) is safe." Bethesda, across the street from the campus of National Institutes of Health, has been called the "crown jewel" of Navy medicine.


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