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Introduction to Nurse Anesthesia
Putting the pieces together-
Units 7 & 8- History
Lynn L. Lebeck, CRNA, PhD
A Brief Look at Nurse Anesthesia
History-Time Line
• 1861-1865
Catherine S. Lawrence and other nurses provided
anesthesia for surgeons operating on the wounded during
the Civil War
• 1877
Sister Mary Bernard, a Catholic nursing sister at St.
Vincent's Hospital in Erie, Pennsylvania, was the first nurse
known to have specialized in anesthesia
• 1893
Alice Magaw begins as nurse anesthetist for Dr. Mayo, who
would later bestow upon Magaw the title "Mother of
Anesthesia" for her mastery of open drop ether
A Brief Look at Nurse Anesthesia
History -Time Line
• 1899
Magaw published the first paper by a nurse anesthetist in
the Northwestern Lancet
• 1914-1917
Agatha Hodgins and many other nurse anesthetists in
volunteer American medical units provided anesthesia for
casualties during World War I
• 1917
In Frank v South, the Kentucky Court of Appeals ruled that
nurse anesthetist Margaret Hatfield was not engaged in the
practice of medicine when she administered anesthesia for
surgeon Louis Frank’s cases
A Brief Look at Nurse Anesthesia
History -Time Line
• 1931
Agatha Hodgins, together with 47 nurse anesthetists,
founded the National Association for Nurse Anesthetists
(NANA)
• 1934
In Chalmers-Francis v Nelson, the California Supreme Court
affirmed the Superior Court finding for nurse anesthetists
Dagmar Nelson in a ruling that confirmed the legality of
nurse anesthesia practice
• 1939
NANA became the American Association of Nurse
Anesthetists (AANA)
A Brief Look at Nurse
Anesthesia History –
Time Line
• 1941-1945
Second Lieutenant Mildred Clark, who would later become
the first nurse anesthetist to serve as Chief of the Army
Nurse Corps, and many other nurse anesthetists provide
anesthesia for the wounded in World War II
• 1945
AANA administered its first qualifying (certification)
examination
• 1952
AANA implemented its program for accrediting nurse
anesthesia schools
A Brief Look at Nurse Anesthesia
History -Time Line
• 1956
AANA members adopt the credential Certified Registered
Nurse Anesthetist (CRNA)
• 1969
AANA members approved a voluntary continuing education
for CRNAs
• 1974
Board of Directors adopts Standards for Nurse Anesthesia
Practice
• 1975
The Council of Certification of Nurse Anesthetists (CCNA),
the Council on Accreditation of Nurse Anesthesia
Educational Programs, and the Council for Public Interest
in Anesthesia were formed
A Brief Look at Nurse Anesthesia
History -Time Line
• 1977
AANA members approved mandatory continuing education
for CRNAs
• 1978
The Council on Recertification of Nurse Anesthetists was
established
• 1986
-- Congress passed legislation providing CRNAs direct
reimbursement under Medicare Part B
-- Board of Directors endorsed Harvard Patient Monitoring
Standards
A Brief Look at Nurse Anesthesia
History -Time Line
• 1989
-- Direct reimbursement for CRNAs under Medicare Part B
was implemented
-- Guidelines for Obstetrical Epidural Anesthesia Services
were implemented
• 1996
CCNA administered the certification examination for the
first time using computerized adaptive testing
• 1997
Guidelines for Office-Based Anesthesia for CRNAs were
implemented.
A Brief Look at Nurse Anesthesia
History -Time Line
• 1998
The U.S. Department of Health & Human Services' Health
Care Financing Administration (HCFA) published a
proposed rule to defer to the states on physician
supervision of CRNAs for Medicare cases
• 1999
AANA’s Standards for Office Based Practice for CRNAs
were adopted
• 2000
HCFA announced it would finalize the rule to defer to the
states on physician supervision of CRNAs for Medicare
cases
A Brief Look at Nurse Anesthesia
History -Time Line
• 2001
Bush administration first suspends and then
implements rule that does not defer to the
states on CRNA supervision but allows “opt
out” option by individual states
• 2002
As of November, 2002 six states have “opted
out” of the Bush supervision rules. Those
states are Iowa, Idaho, Minnesota, New
Hampshire, Nebraska, and New Mexico
A Brief Look at Nurse Anesthesia
History -Time Line
• 2004
Total of 12 states have “opted out” of Bush
supervision rules
• 2005
14 states have “opted out” of the Bush
supervision rules.
• 2007
Major General Gale Pollock, CRNA appointed
Interim Surgeon General of the Army
A Brief Look at Nurse Anesthesia
History -Time Line
• 2009
– California opts out- court challenges
upheld the op out
• 2010
– Colorado opts out- 16 states have opted
out of the supervision requirements
A Brief Look at Nurse Anesthesia
History- People
• Alice Magaw 1860-1928
– Early published nurse anesthetist
– Administered anesthesia for the Mayo brothers
– Observations in Anesthesia-a report on over 3000
anesthetics published in the Northwestern Lancet in 1899
– Updated this report several times
– A Review of Over Fourteen Thousand Surgical Anesthesias
published in 1906
– Known as the “Mother of Anesthesia”
A Brief Look at Nurse Anesthesia
History- People
• Agatha Hodgins 1877-1945
– Early nurse anesthetist
– Co founded the Lakeside School of Anesthesia
– Organized the NANA (later know as the AANA)
– First President of NANA
– Award for Outstanding Accomplishment
A Brief Look at Nurse Anesthesia
History - People
• Helen Lamb 1900-1979
– Chairman of the Education Committee 1931-1939
– Curriculum standards and Certification Exam
– Cofounder and director of the Barnes Hospital School of
Anesthesia 1929-1951
– Two terms as President of the AANA 1940-42
– Award for Outstanding Educator
A Brief Look at Nurse Anesthesia
History - People
• Gertrude Fife
– First Secretary of NANA
– Coordinated the first annual meeting 1933
– Second President of the AANA
– First Editor of the AANA Bulletin 1933-1945
– Treasurer of the AANA 1935-1950
A Brief Look at Nurse Anesthesia
History- People
• Florence McQuillen
– Mayo Clinic 1927
– First Executive Director of the AANA 1948-1970
– Known as a very direct person
– Gained recognition for the AANA from the AHA and the US
Dept of Health, Education and Welfare for functions of
accreditation and certification
AANA Headquarters
& Executive Directors
• 1931-1937- University Hospitals of
Cleveland
AANA Headquarters
& Executive Directors
• 1937- 1951 American Hospital
Association Building, Chicago, Illinois
– 1939- 1 desk- Anna Willenborg, CRNA
volunteer at first then full-time salaried
– 1946- had grown to a small suite, with an
Executive officer and Executive Secretary
AANA Headquarters
& Executive Directors
• 1951-1957 116 South Michigan Ave
Chicago, Illinois
– Very small but all that could be afforded at
a fashionable address
AANA Headquarters
& Executive Directors
• 1957-1971 Prudential Building
– Bernice Baum-Executive Director 1970-
1976
– Oversaw the formation of three councils
– Rebuffed challenges
to accreditation of
anesthesia programs
AANA Headquarters
& Executive Directors
• 1971-1978- Illinois Center 111 East
Wacker Dr
• 1977-78 J. Martin Stone, MHA
– Only non-CRNA to hold the position
– First male Executive Director
– Council on Recertification formed
AANA Headquarters
& Executive Directors
• 1978-1992 216 Higgins Rd, Park
Ridge, Illinois- first building
purchased by AANA
AANA Headquarters
& Executive Directors
• 1976-77 Acting & 1979-1983
• Nancy Fevold, CRNA- Executive
Director
• AANA Education and Research
Foundation formed
• 1st independent
AANA annual meeting
1976
AANA Headquarters
& Executive Directors
• 1983-2001 John F. Garde, CRNA, MS,
FAAN
– AANA subsidiaries
– Publication of Watchful
Care
– Opening of the
Washington DC office
AANA Headquarters
& Executive Directors
• 1992-present 222 South Prospect Dr,
Park Ridge, Illinois
– Members contributed $500,000 through
a fundraising drive chaired by Ruth M.
Wright, CRNA
AANA Headquarters
& Executive Directors
• 2001-2009
– Jeff Beutler, CRNA, MS
• Education
– BSN- Ferris State
– BS Anesthesia
– MS Anesthesia
• Wayne State
• Practiced in Grand Rapids-10 years
AANA Headquarters
& Executive Directors
• 2009 to present
– Wanda O. Wilson,
CRNA, PhD
– Past director of
University of Cincinnati
– Past President of AANA
A Brief Look at Nurse Anesthesia
History-Firsts
• First Annual Meeting-1933
• First Educational Standards- 1933
• First Certification Examination-1945
• First Males allowed to join-1947
• First Accreditation of Schools-1952
• First use of “CRNA” credential-1957
• First all-male class at Walter Reed-1961
A Brief Look at Nurse Anesthesia
History-Michigan
• Michigan Association of Nurse Anesthetists (MANA)
founded
– November 11, 1937
– 28 members of NANA met at the Stadler Hotel in Detroit
– Gertrude Fife, past NANA president present
– Ester Meil, CRNA first MANA president
– Affiliated with NANA December 29, 1937
– First State Mtg June, 1938 at Hotel Northland in
Marquette
Past Presidents of the AANA
from Michigan
– Helen Vos 1965-66
• Director of Hurley Program
– John F. Garde 1972-73
• Director of Wayne State Program
– Christine S. Zambricki 1995-96
• Director of Mercy Graduate Program
• Founding Director of Oakland University-
Beaumont Graduate Program of Nurse
Anesthesia
Agatha Hodgins Award
• For Outstanding
Accomplishment
– Established in 1975 to
recognize individuals
whose dedication to
excellence has furthered
the art and science of
nurse anesthesia
Agatha Hodgins Award Winners
with Michigan Connections
• 1979- Helen Vos
• 1994- Jeff Beutler
• 2000- John Garde
• 2001- Christine Zambricki
• 2004- Ruth Wright
Helen Lamb Award
• Outstanding Educator Award
– Established in 1980 and presented to a
CRNA who has made a significant
contribution to the education of nurse
anesthetists
Helen Lamb Award Winners with
Michigan connections
• 1981-John Garde
• 1985- Celestine Harrigan
• 1996- Helen Vos
• 2000- Agnes Hagan
• 2002- Karen Zaglanicnzy
History of Nurse Anesthesia
Education
• Initial
– On the Job Training
– Salesmen
– Hospital training courses
• Early Program- pre WWI
– 3 months long
• Early Standards- 1930s
– Length- 6 months required, 12 preferred
– Cases- 250
• Specific requirements
– Granted certificates
Nurse Anesthesia Education
• 1950s
– Certificate programs
– 12 months
– Accreditation process in place
• 1960s
– 18 months
• 1970s-1980s
– 24 months
– Moved into academic settings
• Bachelors degrees
Nurse Anesthesia Education
• 1990s-
– 24 months and longer
– 64% were at the Master level by 1990
– Mandate to all be graduate level by 1998
• 2000s-
– Clinical Doctorate program first
accredited in 2007/08
History of Practice Battles
• Historical Invisibility
– Physician Anesthesiologists refused to
recognized contributions of nurse
anesthetists
• A question of money
– Nurse anesthetists were taking money
out of the MDs pocket
History of Practice Battles
• Public relations campaigns
– Scare tactics directed at the public
– How to guides for getting rid of nurse
anesthetists
– Look magazine
• American College of Surgeons defended NAs
• Legal challenges
– Frank vs. South
– Dagmar Nelson
History of Practice Battles
• Control of Accreditation
– Lakeside School of Nursing- 1916
• Control of Education
– 1912- AAA resolution “no member shall
instruct an undergraduate nurse or orderly in
the art of anesthesia”
– 1947- ASA Bylaws- “Unethical”
History of Practice Battles
• Control of Accreditation
– Lakeside School of Nursing- 1916
• Control of Education
– 1912- AAA resolution “no member shall
instruct an undergraduate nurse or orderly in
the art of anesthesia”
– 1947- ASA Bylaws- “Unethical”
– 1975- Hearings before the US Office of
Education
History of Practice Battles
• Control of Certification
• Insurance issues
• Introduction of AAs
• Addition of “educational” membership
class within ASA
– CRNA must be “sponsored by 2 ASA
members” and subscribe to the ACT statement
History of Practice Battles- People
• Dr. Francis McMechan
– Background in newspapers, theater
– Crippled by arthritis in 1911
– Life-long crusade
• Organizing MDs
• Legal Challenges
• Legislative bills
• Publishing
• Speeches
History of Practice Battles- People
• Dr. Ralph Waters- Father of
Academic Anesthesia
– Economics of anesthesia
– Every physician should have a hobby-
anesthesia
– Tried to shame the Mayo Clinic for
having nurses give anesthesia and
claiming that a nurse makes a better
anesthetist than the average doctor.

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Intro to na unit 7 & 8 2012 narrated compressed

  • 1. Introduction to Nurse Anesthesia Putting the pieces together- Units 7 & 8- History Lynn L. Lebeck, CRNA, PhD
  • 2. A Brief Look at Nurse Anesthesia History-Time Line • 1861-1865 Catherine S. Lawrence and other nurses provided anesthesia for surgeons operating on the wounded during the Civil War • 1877 Sister Mary Bernard, a Catholic nursing sister at St. Vincent's Hospital in Erie, Pennsylvania, was the first nurse known to have specialized in anesthesia • 1893 Alice Magaw begins as nurse anesthetist for Dr. Mayo, who would later bestow upon Magaw the title "Mother of Anesthesia" for her mastery of open drop ether
  • 3. A Brief Look at Nurse Anesthesia History -Time Line • 1899 Magaw published the first paper by a nurse anesthetist in the Northwestern Lancet • 1914-1917 Agatha Hodgins and many other nurse anesthetists in volunteer American medical units provided anesthesia for casualties during World War I • 1917 In Frank v South, the Kentucky Court of Appeals ruled that nurse anesthetist Margaret Hatfield was not engaged in the practice of medicine when she administered anesthesia for surgeon Louis Frank’s cases
  • 4. A Brief Look at Nurse Anesthesia History -Time Line • 1931 Agatha Hodgins, together with 47 nurse anesthetists, founded the National Association for Nurse Anesthetists (NANA) • 1934 In Chalmers-Francis v Nelson, the California Supreme Court affirmed the Superior Court finding for nurse anesthetists Dagmar Nelson in a ruling that confirmed the legality of nurse anesthesia practice • 1939 NANA became the American Association of Nurse Anesthetists (AANA)
  • 5. A Brief Look at Nurse Anesthesia History – Time Line • 1941-1945 Second Lieutenant Mildred Clark, who would later become the first nurse anesthetist to serve as Chief of the Army Nurse Corps, and many other nurse anesthetists provide anesthesia for the wounded in World War II • 1945 AANA administered its first qualifying (certification) examination • 1952 AANA implemented its program for accrediting nurse anesthesia schools
  • 6. A Brief Look at Nurse Anesthesia History -Time Line • 1956 AANA members adopt the credential Certified Registered Nurse Anesthetist (CRNA) • 1969 AANA members approved a voluntary continuing education for CRNAs • 1974 Board of Directors adopts Standards for Nurse Anesthesia Practice • 1975 The Council of Certification of Nurse Anesthetists (CCNA), the Council on Accreditation of Nurse Anesthesia Educational Programs, and the Council for Public Interest in Anesthesia were formed
  • 7. A Brief Look at Nurse Anesthesia History -Time Line • 1977 AANA members approved mandatory continuing education for CRNAs • 1978 The Council on Recertification of Nurse Anesthetists was established • 1986 -- Congress passed legislation providing CRNAs direct reimbursement under Medicare Part B -- Board of Directors endorsed Harvard Patient Monitoring Standards
  • 8. A Brief Look at Nurse Anesthesia History -Time Line • 1989 -- Direct reimbursement for CRNAs under Medicare Part B was implemented -- Guidelines for Obstetrical Epidural Anesthesia Services were implemented • 1996 CCNA administered the certification examination for the first time using computerized adaptive testing • 1997 Guidelines for Office-Based Anesthesia for CRNAs were implemented.
  • 9. A Brief Look at Nurse Anesthesia History -Time Line • 1998 The U.S. Department of Health & Human Services' Health Care Financing Administration (HCFA) published a proposed rule to defer to the states on physician supervision of CRNAs for Medicare cases • 1999 AANA’s Standards for Office Based Practice for CRNAs were adopted • 2000 HCFA announced it would finalize the rule to defer to the states on physician supervision of CRNAs for Medicare cases
  • 10. A Brief Look at Nurse Anesthesia History -Time Line • 2001 Bush administration first suspends and then implements rule that does not defer to the states on CRNA supervision but allows “opt out” option by individual states • 2002 As of November, 2002 six states have “opted out” of the Bush supervision rules. Those states are Iowa, Idaho, Minnesota, New Hampshire, Nebraska, and New Mexico
  • 11. A Brief Look at Nurse Anesthesia History -Time Line • 2004 Total of 12 states have “opted out” of Bush supervision rules • 2005 14 states have “opted out” of the Bush supervision rules. • 2007 Major General Gale Pollock, CRNA appointed Interim Surgeon General of the Army
  • 12. A Brief Look at Nurse Anesthesia History -Time Line • 2009 – California opts out- court challenges upheld the op out • 2010 – Colorado opts out- 16 states have opted out of the supervision requirements
  • 13. A Brief Look at Nurse Anesthesia History- People • Alice Magaw 1860-1928 – Early published nurse anesthetist – Administered anesthesia for the Mayo brothers – Observations in Anesthesia-a report on over 3000 anesthetics published in the Northwestern Lancet in 1899 – Updated this report several times – A Review of Over Fourteen Thousand Surgical Anesthesias published in 1906 – Known as the “Mother of Anesthesia”
  • 14. A Brief Look at Nurse Anesthesia History- People • Agatha Hodgins 1877-1945 – Early nurse anesthetist – Co founded the Lakeside School of Anesthesia – Organized the NANA (later know as the AANA) – First President of NANA – Award for Outstanding Accomplishment
  • 15. A Brief Look at Nurse Anesthesia History - People • Helen Lamb 1900-1979 – Chairman of the Education Committee 1931-1939 – Curriculum standards and Certification Exam – Cofounder and director of the Barnes Hospital School of Anesthesia 1929-1951 – Two terms as President of the AANA 1940-42 – Award for Outstanding Educator
  • 16. A Brief Look at Nurse Anesthesia History - People • Gertrude Fife – First Secretary of NANA – Coordinated the first annual meeting 1933 – Second President of the AANA – First Editor of the AANA Bulletin 1933-1945 – Treasurer of the AANA 1935-1950
  • 17. A Brief Look at Nurse Anesthesia History- People • Florence McQuillen – Mayo Clinic 1927 – First Executive Director of the AANA 1948-1970 – Known as a very direct person – Gained recognition for the AANA from the AHA and the US Dept of Health, Education and Welfare for functions of accreditation and certification
  • 18. AANA Headquarters & Executive Directors • 1931-1937- University Hospitals of Cleveland
  • 19. AANA Headquarters & Executive Directors • 1937- 1951 American Hospital Association Building, Chicago, Illinois – 1939- 1 desk- Anna Willenborg, CRNA volunteer at first then full-time salaried – 1946- had grown to a small suite, with an Executive officer and Executive Secretary
  • 20. AANA Headquarters & Executive Directors • 1951-1957 116 South Michigan Ave Chicago, Illinois – Very small but all that could be afforded at a fashionable address
  • 21. AANA Headquarters & Executive Directors • 1957-1971 Prudential Building – Bernice Baum-Executive Director 1970- 1976 – Oversaw the formation of three councils – Rebuffed challenges to accreditation of anesthesia programs
  • 22. AANA Headquarters & Executive Directors • 1971-1978- Illinois Center 111 East Wacker Dr • 1977-78 J. Martin Stone, MHA – Only non-CRNA to hold the position – First male Executive Director – Council on Recertification formed
  • 23. AANA Headquarters & Executive Directors • 1978-1992 216 Higgins Rd, Park Ridge, Illinois- first building purchased by AANA
  • 24. AANA Headquarters & Executive Directors • 1976-77 Acting & 1979-1983 • Nancy Fevold, CRNA- Executive Director • AANA Education and Research Foundation formed • 1st independent AANA annual meeting 1976
  • 25. AANA Headquarters & Executive Directors • 1983-2001 John F. Garde, CRNA, MS, FAAN – AANA subsidiaries – Publication of Watchful Care – Opening of the Washington DC office
  • 26. AANA Headquarters & Executive Directors • 1992-present 222 South Prospect Dr, Park Ridge, Illinois – Members contributed $500,000 through a fundraising drive chaired by Ruth M. Wright, CRNA
  • 27. AANA Headquarters & Executive Directors • 2001-2009 – Jeff Beutler, CRNA, MS • Education – BSN- Ferris State – BS Anesthesia – MS Anesthesia • Wayne State • Practiced in Grand Rapids-10 years
  • 28. AANA Headquarters & Executive Directors • 2009 to present – Wanda O. Wilson, CRNA, PhD – Past director of University of Cincinnati – Past President of AANA
  • 29. A Brief Look at Nurse Anesthesia History-Firsts • First Annual Meeting-1933 • First Educational Standards- 1933 • First Certification Examination-1945 • First Males allowed to join-1947 • First Accreditation of Schools-1952 • First use of “CRNA” credential-1957 • First all-male class at Walter Reed-1961
  • 30. A Brief Look at Nurse Anesthesia History-Michigan • Michigan Association of Nurse Anesthetists (MANA) founded – November 11, 1937 – 28 members of NANA met at the Stadler Hotel in Detroit – Gertrude Fife, past NANA president present – Ester Meil, CRNA first MANA president – Affiliated with NANA December 29, 1937 – First State Mtg June, 1938 at Hotel Northland in Marquette
  • 31. Past Presidents of the AANA from Michigan – Helen Vos 1965-66 • Director of Hurley Program – John F. Garde 1972-73 • Director of Wayne State Program – Christine S. Zambricki 1995-96 • Director of Mercy Graduate Program • Founding Director of Oakland University- Beaumont Graduate Program of Nurse Anesthesia
  • 32. Agatha Hodgins Award • For Outstanding Accomplishment – Established in 1975 to recognize individuals whose dedication to excellence has furthered the art and science of nurse anesthesia
  • 33. Agatha Hodgins Award Winners with Michigan Connections • 1979- Helen Vos • 1994- Jeff Beutler • 2000- John Garde • 2001- Christine Zambricki • 2004- Ruth Wright
  • 34. Helen Lamb Award • Outstanding Educator Award – Established in 1980 and presented to a CRNA who has made a significant contribution to the education of nurse anesthetists
  • 35. Helen Lamb Award Winners with Michigan connections • 1981-John Garde • 1985- Celestine Harrigan • 1996- Helen Vos • 2000- Agnes Hagan • 2002- Karen Zaglanicnzy
  • 36. History of Nurse Anesthesia Education • Initial – On the Job Training – Salesmen – Hospital training courses • Early Program- pre WWI – 3 months long • Early Standards- 1930s – Length- 6 months required, 12 preferred – Cases- 250 • Specific requirements – Granted certificates
  • 37. Nurse Anesthesia Education • 1950s – Certificate programs – 12 months – Accreditation process in place • 1960s – 18 months • 1970s-1980s – 24 months – Moved into academic settings • Bachelors degrees
  • 38. Nurse Anesthesia Education • 1990s- – 24 months and longer – 64% were at the Master level by 1990 – Mandate to all be graduate level by 1998 • 2000s- – Clinical Doctorate program first accredited in 2007/08
  • 39. History of Practice Battles • Historical Invisibility – Physician Anesthesiologists refused to recognized contributions of nurse anesthetists • A question of money – Nurse anesthetists were taking money out of the MDs pocket
  • 40. History of Practice Battles • Public relations campaigns – Scare tactics directed at the public – How to guides for getting rid of nurse anesthetists – Look magazine • American College of Surgeons defended NAs • Legal challenges – Frank vs. South – Dagmar Nelson
  • 41. History of Practice Battles • Control of Accreditation – Lakeside School of Nursing- 1916 • Control of Education – 1912- AAA resolution “no member shall instruct an undergraduate nurse or orderly in the art of anesthesia” – 1947- ASA Bylaws- “Unethical”
  • 42. History of Practice Battles • Control of Accreditation – Lakeside School of Nursing- 1916 • Control of Education – 1912- AAA resolution “no member shall instruct an undergraduate nurse or orderly in the art of anesthesia” – 1947- ASA Bylaws- “Unethical” – 1975- Hearings before the US Office of Education
  • 43. History of Practice Battles • Control of Certification • Insurance issues • Introduction of AAs • Addition of “educational” membership class within ASA – CRNA must be “sponsored by 2 ASA members” and subscribe to the ACT statement
  • 44. History of Practice Battles- People • Dr. Francis McMechan – Background in newspapers, theater – Crippled by arthritis in 1911 – Life-long crusade • Organizing MDs • Legal Challenges • Legislative bills • Publishing • Speeches
  • 45. History of Practice Battles- People • Dr. Ralph Waters- Father of Academic Anesthesia – Economics of anesthesia – Every physician should have a hobby- anesthesia – Tried to shame the Mayo Clinic for having nurses give anesthesia and claiming that a nurse makes a better anesthetist than the average doctor.