Something in the bottled water? Another prominent Hollywood plastic surgeon tells major media that nurse anesthetists are unsafe
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July 13, 2004 -- Hot on the heels of the June Vogue's quotation of a Santa Monica plastic surgeon as saying that the use of nurse anesthetists is unsafe, Dr. Robert Kotler of Beverly Hills bluntly stated on the July 13 "Deborah Norville Tonight" show (MSNBC) that plastic surgery consumers should not use nurse anesthetists. In fact, research has shown that care of nurse anesthetists is at least as good as that of anesthesiologists. MSNBC's broadcast of Dr. Kotler's scientifically unfounded assertions without any response from a nurse anesthetist is irresponsible.
The hour long "Deborah Norville" segment focused on what Norville described as the United States' "obsession with plastic surgery," and it included discussions with patients, media figures, a psychologist, and Dr. Kotler. In response to a question from Norville, Dr. Kotler indicated that the real risk in plastic surgery isn't so much the surgery itself as it is the anesthesia. He stated plainly that anesthesia "should be given by a physician anesthesiologist. Unfortunately--not a nurse anesthetist." Dr. Kotler then implied that the fact that a nurse anesthetist (as opposed to an anesthesiologist) was involved in the recent Goldsmith case was a factor in the patient's death: "The state of New York was critical of the hospital because the nurse anesthetist was apparently unsupervised, as they described it. So I believe--and frankly, for myself and my family, I want a doctor anesthesiologist." A few moments later, discussing the importance of adequate facilities, Dr. Kotler asserted that "a doctor anesthesiologist will not work in a facility that's not up to snuff," clearly implying that a nurse anesthetist would. The piece offered no statistical or anecdotal support for Dr. Kotler's statements, nor did a nurse anesthetist appear to respond. Dr. Kotler's plastic surgery business is heavily promoted in the mass media, as it was being promoted on this MSNBC piece. Another recent example is Dr. Kotler's April 2004 appearance on the web site of the Los Angeles ABC affiliate, KABC-TV, where he once again is cited as believing that plastic surgery patients should use anesthesiologists, not nurse anesthetists.
Contrary to Dr. Kotler's public statements, many published studies have shown that the care of nurse anesthetists is at least as good as that of anesthesiologists. Many such studies are collected in the American Association of Nurse Anesthetists' research database. Nurse anesthetists are skilled professionals with at least master's degrees who provide vital anesthesia services to thousands of surgical patients daily, especially in more remote areas with insufficient business potential to attract anesthesiologists. It is not clear what would qualify any plastic surgeon to dismiss an entire category of anesthesia professionals who save lives in varied health care settings. MSNBC should have consulted a nurse anesthetist or the AANA for the facts.
In general, though the media sometimes publishes statements questioning the quality of care provided by advanced practice nurses (APRNs) such as nurse anesthetists, numerous studies have found that APRNs provide care equal to or better than that of physicians. The FAQ section of the Center's web site contains a growing list of studies comparing the quality of care delivered by these two types of health care professionals.
Dr. Kotler and MSNBC owe nurse-anesthetists, who number 30,000 in the United States alone, an apology. The Center urges all supporters to seek one, and to speak out about the critical role nurse anesthetists play in modern health care.
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