His message was that the use of political-action-committee money swayed the decision by the legislature on that issue. Implicit is that the legislature prevented reform that would have benefited patients, although Mr. Baer candidly admitted he didn't "know enough about medicine to know what's right here." In fact, he is wrong on all counts.

House Bill 1256 would expand the ability of CRNAs to provide anesthesia care independently. It is true that the bill has not moved through the House Professional Licensure Committee and that the Pennsylvania Society of Anesthesiologists opposed it. But the reason it hasn't moved is not because of political money but because it is bad medicine.

Patients have a right to have a physician responsible for their anesthesia care during one of the most crucial and life-threatening times of their lives. Evidence presented to the committee showed that the proposed change would be bad for patients. Furthermore, it will not improve access or decrease health-care costs.

Other House bills dealing with the scope of practice of certified registered nurse practitioners, nurse midwives, dental hygienists and physician assistants were passed and signed into law after extensive negotiations with the Pennsylvania Medical Society to ensure they benefited care. But House Bill 1256 cannot be altered and still keep physicians in charge of the anesthesia care of Pennsylvania citizens.

You don't fix a possible health care shortage by promoting nurses to doctors. Nurses provide a great service to the patient, as do doctors. But their roles are not interchangeable. What we need in this state is a way to keep physicians here and bring new ones in. That is the only way to solve a shortage of physicians.

Joseph F. Answine, M.D., President

Pa. Society of Anesthesiologists