Thank you for bringing the office based anesthesia regulations proposed rule change to my attention. The Virginia Board of Medicine will consider this rule change during the July 14-16, 2005 meeting. The background of this issue is the following: 1. The Final regulations of the Board of Medicine on office-based anesthesia were adopted February 6, 2002. These rules stated that deep sedation, general anesthesia and major conductive blocks shall be only administered by an anesthesiologist or by a crna. 2. In October the Virginia Society of Physical Medicine and Rehabilitation (VSPMR) pointed out that physician specialists such as neurosurgeons, orthopedic surgeons and interventional physiatrists perform major conductive blocks. 3. In discussions with the administrative staff of the Board I suggested that in an effort to create a safe environment for patients receiving office-based anesthesia we overlooked the important work physiatrists perform on a daily basis. I recommended that the regulations be amended to allow physicians with appropriate training can perform major conductive blocks performed for diagnostic or therapeutic purposes. 4. Unfortunately, the currently proposed language included crnas in the ability to perform diagnostic and therapeutic major conductive nerve blocks. This may have been an oversight given the ability of crnas to perform major conductive block for surgery. Clearly giving crnas the ability to perform diagnostic and therapeutic procedures would cross the line into the practice of medicine and open the possibility of freestanding crna-run pain clinic. Patrick W. Clougherty, M.D., Chairman Department of Anesthesiology Inova Fairfax Hospital (703) 776-3138 (703) 776-2623 ----------------------------------------