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News BulletinA Publication of the Alabama Association of Nurse AnesthetistsALANA

Volume 27, Number 1, 2010 Jim Henderson, Editor

In This Issue

President’s Address Michael Fiedler, CRNA 2

Haiti in a Hurryby Nina McLain, CRNA, Ph.D.

On January 12, 2010, an earthquake that measured greater than 7.0 on the Richter Scale struck Haiti. Over 52 aftershocks, most of which measured greater than 4.5, contin-

ued to rattle the damaged country during the next couple of days. The media responded rapidly, as did the international community and the United States military. I remember seeing footage on TV and the computer of the devastation in the city of Port au-Prince, unfathomable carnage, and a death toll rising at an imaginable rate. My only comparison for an earthquake of that magnitude was the San Francisco earthquake in 1989, and the death toll was nowhere near as astounding. Like most everyone, I had great sympathy for those affected and donated money to an organization to help the citizens. The earthquake and its consequences were certainly discussed over the next couple of weeks at work and as time passed, the conversations became less intense and less frequent. Lakeland Anesthesia in Jackson, Mississippi is my employer and our CRNAs cover both Women’s Hospital and Runnels Plastic Surgery Center. I have the luxury and enjoyment of providing anesthesia at both places and work for a great group of MDAs. January 28th, 2010 I had worked at the Runnels Center and Dr. Scott Runnels (plastic surgeon and owner) mentioned he would like to get a team up to go to Haiti for reconstructive surgery, that he would need an anesthesia provider. I told him that sounded “cool” and I wouldn’t mind going. I had one of those talks with myself then with God. I decided if God worked it out for him to be able to go, that I would go and not worry about it. The rest of the night I went about my business as usual.

By noon the next day, I’d forgotten about the trip because I had not heard back from him and I was deep into other projects. At 1:45 pm my phone rang and Dr. Runnels said, “Do you think you can go to Haiti?” I said, “Sure, when?” He paused, then said, “At 8:30 in the morning.” Evidently, a team scheduled to go relieve the original group had backed out and they were in a bind. They had contacted Dr. Runnels to see if he could pinch hit. Instant-ly, my promise to God came back through my mind, what else could I say except “….okay.” We checked to be sure I could get off work emergently and my group made it happen. Everyone pitched in to cover my schedule for the week, so I packed.

In less than 14 hours, Dr. Runnels had pro-cured a Lear jet, obtained supplies, gotten

Dr. Runnels

ALANA Legislative Day 12AANA Region 7 Update

Bruce Weiner, CRNA, MS 5

Anesthesia Abstracts 1416Calendar of Events

Roth IRA ConversionsAndy Easterling 19

202010 Outstanding Clinical Preceptor Awards

21He Who Laughs, LastsJennifer Overton, CRNA

advancing quality anesthesia care, serving our members, promoting the nurse anesthesia profession

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2 ALANA NewsBulletin

ALANA NewsBulletin Copyright 2009 • Alabama Association of Nurse Anesthetists, Inc. • All Rights Reserved.

The ALANA NewsBulletin (USPS 019-869) is published quarterly by the Alabama Association of Nurse Anesthetists, Inc, Post Office Box 240757, Montgomery, Alabama. POSTMASTER: Send address changes to ALANA NewsBulletin, Post Office Box 240757, Montgomery, AL 36124.

Volume 27 Number 1 March 2010

PresidentMichael A. Fiedler8221 Wynwood DriveHelena, AL 35080205.533.1302 (phone)[email protected]

President-ElectHeather Rankin2515 Oak Leaf CircleBessemer, AL 35022205.249.0650 (cell)[email protected] Vice-President/SecretaryCliff Chandler1313 Park Brook CircleBirmingham, AL 35215205.835.9103 (cell)[email protected]

TreasurerFrank Saliba8370 Timber Creek DrivePike Road, AL 36064334.294.0767 (cell)[email protected]

Senior DirectorDavid Fort1417 Timber Ridge CircleHoover, AL 35244205.936.2352 (cell)[email protected]

Senior DirectorDavid Hambright 5630 New Harvest DriveMontgomery, AL 36116334.819.0499 (cell)[email protected]

Senior DirectorJennifer Overton 4545 Crown Point LaneMt. Olive, AL 35117205.531.4469 (cell)[email protected]

Senior DirectorJoe WatkinsPO Box 416Winfield, AL 35594205.246.1130 (cell)[email protected]

DirectorHeather Fields2330 Ridge RoadOpelika, AL 36804334.728.3030 (cell)[email protected]

DirectorAlbert Herrington3012 Barcody Road SEHuntsville, AL 35802256.651.8893 (cell)[email protected]

DirectorAndrew Morris6216 Kestral View RoadTrussville, AL 35173205.602.0198 (cell)[email protected]

Nominating Committee ChairCyndi Bass118 Ashford CircleBirmingham, AL 35242205.381.0668 (cell)[email protected]

UAB Student RepresentativeLeAnn Winburn533 N. John StreetNew Brockton, AL 36351334.447.3995 (cell)[email protected]

Samford Student RepresentativePennie Nichols2737 Crowne Ridge DriveBirmingham, AL [email protected]

Publisher

Alabama Association of Nurse AnesthetistsPost Office Box 240757 • Montgomery, Alabama 36124 334.260.7970

Executive DirectorLarry A. Vinson Group Management Services, LLC Post Office Box 240757 Montgomery, AL 36124 334.260.7970 (office) [email protected]

General CounselT. Joe Knight Kress Building, Suite 500 301 19th Street N Birmingham, AL 35203 205.531.5157 (cell) [email protected]

Government Relations SpecialistSusan Hansen Franklin Resources Group 4120 Wall Street Montgomery, AL 36106 334.244.2187 (office) 334.320.7539 (cell) [email protected]

Federal Political DirectorAmy Neimkin368 Woodward CourtBirmingham, AL 35242205.243.8382 (cell)[email protected]

EditorJim Henderson106 Ember WayLaGrange, GA 30240706.882.5658 (evenings) [email protected]

State Peer Assistance AdvisorJohn Morris186 Ricky LanePell City, AL 35128205.527.3556 (cell) [email protected]

AANA Foundation AdvocateKyle Vanderford293 High Ridge DrivePelham, AL 35124205.266.8912 (cell)[email protected]

From the Office of the ALANA President

Special Services

Executive Staff

Board of Directors

I may be biased, but in my opinion the current batch of ALANA committee chairs and com-mittee members are working harder than any before them. No disrespect intended to previous

committees, I am just thoroughly pleased with the great ALANA leadership team we have this year. That said, here is a quick look into some of what they are accomplishing for you, the mem-bers of the ALANA.

• The Bylaws committee is reviewing every aspect of our current bylaws with an eye toward making our association more productive and involving all ALANA members more fully. • The Finance committee is writing guidelines for overseeing our financial activities and budgeting process. • The Government Relations committee has produced a brochure showing where and how CRNAs serve the state of Alabama; and where we are the only anesthesia providers who serve. • The Nominating committee has written a guide to the nominations process which will allow future Nominating committee chairs to get off to a faster start, whether or not they have any previous service with the ALANA. • The Political Action Committee has truly been in action, gearing up for upcoming elections by producing a brochure of their own, modernizing the system for processing credit card payments to the PAC, and encouraging ALANA members to contribute to the PAC - no matter how small the contribution. Remember, if everyone will give a little the PAC can accomplish a lot. • The Program Committee has, somehow, continued to make our spring meeting better and better each year. I hope to see a lot of you at the Spring Meeting. The faculty is outstanding and the venue is beautiful. Please mark your calendars for April 30 through May 2.

Now that I’ve bragged on our outstanding committees, I need to take a minute to fill you in on an unusual turn of events. As it turns out, you will be seeing my name on the AANA ballot for region 7 Director this year. It is quite unusual for a serving state president to become a candidate for another office and you are entitled to know how that happened.

Each year, the AANA nominations committee solicits nominations for each position on the national ballot. This year they had a vacancy at the Region 7 position (which includes Alabama) after the deadline for nominations passed. At that point, the national nominating committee began seeking candidates on their own. I was contacted. My first response was that I was already serving as state president and the newly elected region 7 director would take office before my term ended. My duty was to complete my term as ALANA president. I was contacted again. They still had only one candidate for region 7. I consulted first with the officers of the ALANA (pres-ident-elect, vice president, & treasurer). President-elect Heather Rankin was willing to assume the duties of president two months early if needed. The officers agreed that it would be good for Alabama to have one of our members as region 7 director and approved of my candidacy. Next, I consulted with the entire ALANA board of directors during an online board meeting. The board had some appropriate, probing questions, which I answered. Perhaps the most important question was, “would I be able to campaign for region 7 director and still perform my duties as ALANA president?” My answer was that as long as I was president, my duty to the ALANA would come first - whatever campaigning I could do would be a subordinate priority. With their questions answered the full board also agreed that I should run for AANA region 7 director. The next day I completed the paperwork.

So, that is the short version. If you want a longer one please feel free to contact me. In the mean time, if you’d like to see an Alabama CRNA as the next region 7 director I could really use your help. I believe I can serve region 7 well next year as director on the AANA board. But right now, I’m serving Alabama CRNAs as ALANA president.

And, as always, “CRNAs, the ALANA has your back.”

Michael Fiedler, PhD, CRNA

www.ala-crna.org 3

vaccinations and medications, clearance for medical relief entrance, and we were on our way. The group we were affiliating with (Life Enhancement Association for People, LEAP) made arrangements for transportation of supplies and ourselves to the Com-munity Hospital in Port-au-Prince.

Being an open minded Air Force Brat and having lived in Okinawa in the late 1960’s and early 1970’s, I wasn’t fearful of what I’d see culturally, but was a tad anxious about the growing reports of unrest and riots in the city. I reminded myself that God worked it out for me to go so I’d be fine. Once we landed, I saw many of the good ‘ole 82nd Airborne from the USA about and they even helped us unload our very heavy supplies. I’ve never worn camouflage but I must say the Army was a comforting sight to be-hold.

Dr. Craig Hobar, the founder of LEAP, met us at the airport with transportation and we began our ride to the community hospital. We sat rather speechless as we passed piles and piles of crumbled buildings, section after section of make-shift tent cities. The resiliency of the people had begun to poke through the rubble as they made efforts to return to some semblance of normalcy by setting up their wares in front of ramshackle buildings. Schools have not started back so children were everywhere. People bathed on the side of streets in public fountains.

The international community efforts were well represented as we saw trucks from the United Nations, the World Food Programme, CARE, and the Red Cross, just to name a few. Many countries besides the US were represented militarily and medically, the United Kingdom, France, Germany, the United Arab Emirates, Dubai, Taiwan, among others. The US had a many teams from different states. We realized that the world can pull together when the chips are down. Amazingly, Cuba allowed flights bound for Haitian relief to fly over its airspace. We were but ants in this maze of international and cultural melding.

The once modern community hospital had fallen victim to poor funding and lack of upkeep. Prior to the earthquake it provided primarily clinic type services. Now six operating rooms had been set up, only three had anesthesia machines, and the hospital had been sectioned off into zones for triage, preoperative and postoperative areas, patient wards, pediatrics, and obstetrical. Understand this is all very “loosely” structured. For example, the obstetrical zone consisted of some makeshift curtains on string that did not completely surround the bed where the patient would deliver. We passed these areas as we were led to our operating suite. We were fortunate enough to have the initial LEAP team was still working when we arrived so we could have a few minutes of “inservice” and ori-entation before working, we were there to relieve them so they could return to the States for a week. Twenty minutes later, we were running an operating room.

Two physician anesthesiologists from Dallas were with the original LEAP team and were wonderful to buff me up on my spinal techniques (it had been a few years) and give me a superb in-service on the army portable anesthesia machine I’d never seen. I’ve never been in a mobile army surgical hospital (MASH) setting, but I think that this was about as close as I can come without enlisting.

Because of the urgency for care and the disastrous circumstances that the hospital was oper-ating under, disorganization was rampant on most levels. People were just trying their best

and making it work where they could. Dr. Runnels saw the need for some structure and communication between the orthopedic teams, plastic team, and nurses, and pulled together a wound care team and program to facilitate dressing changes and evaluation of patient healing for wound closure and grafting purposes. Very quickly, we saw cleaner wounds coming to the operating room and were able to begin grafting and performing flaps on many more patients, which allowed them to avoid amputations. Our days were long, typically 12-15 hours of operating, a quick meal ready to eat (MRE) or peanut butter crackers, and pass out onto the cot. We did have a shower, cold, but a shower none the less.

A couple of special patients stuck with all of us. Michaella was a young lady in her late 20’s who came back a couple of times debridements. She ended up in ICU after her first trip to us due to sepsis and severe dehydration. A skin temperature of 105 degrees, heart rate of 150, and BP of 88/50, was beginning to become normal to me. After much fluid, multiple antibiot-ics, and some super debridement, she came to us for closure and grafting. Her left arm had been pinned in wreckage and her left hip had constant pressure on it for three days. Her fam-

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ily was able to hand her water and food, but it was scarce. She had to have an arm amputation to be freed from the concrete pinning her. Her hip had a massive wound to the bone from the pressure of lying still for three days. As I was getting ready to put her to sleep, she pointed to her hip and asked in broken English, “Anesthesia?” I answered “Oui, anesthesia, nuit, nuit” and demonstrated her sleeping and snoring. She smiled a smile that would light the world, then pointed to her stump on her left arm and said “no anesthesia” and made a sad face. That was the closest I had come in what was a nightmare of horror stories to losing my ability to function. I just hugged her and gave her Versed. No ketamine, no morphine, no block, no alcohol even, just amputated in the field to free her. Yet, her personality was absolutely glowing. She always smiled at us and called us by name whether were doing dressing changes for her or on the patient in the next cot. We’d taken her Ensure and Pop Tarts every day since patient food was scarce and we needed her to heal to close her wound. Before we left, I gave her my pink snuggie. We were able to close and graft her and she will keep her leg. But, as much as people may think we helped her, she touched us even more greatly.

One other patient comes to mind for me because she did not like me much at all. She was 2 ½ and her name was Decembre. She had a right arm wound open to the humerus and it likely would have been amputated were it not for Dr. Runnels and the ability to perform plastic surgery. She knew when she saw me coming it meant either, a shot of Ketamine on the floor for a dressing change, or I was taking her to surgery to make her breathe that nasty, smelly stuff. Her mother was killed in the earthquake, her dad is still missing. Her only living relative was the 19 year old boy taking care of her, and that he did. He brushed her hair, her teeth, kept her clean and dressed, entertained her, and held her while I put her to sleep. He had the luxury of understanding what we were doing was to help Decembre, she did not. Our circulator/recovery room nurse, Krista, gave Decembre Pop Tarts and such when she would take her back to her room. After one trip she reached up and patted Krista’s face and said “Mon Amie, Krista”. Krista cried. Decembre just glared at me. I smiled anyway. After her graft and last dress-ing change, I took her a pack of Pop Tarts. She glowered at me for a minute, then hesitantly took them from me. She looked at me a tad suspiciously and muttered….”Amie.” I smiled and left wishing I’d had a child’s pink snuggie to give her.

After 8 days of sheer exhaustion, we decided to quit a bit early and take a two hour ride around ground zero. We had the big cases done and out of the way, Dr. Runnels had coordinated with orthopedics to follow our patients that needed it, the wound care team was in place and doing a great job, and the new team was on the way down. We’d just wound up for the afternoon and were waiting on our driver when Dr. Runnels got the call that our flight was delayed and we would not get home until Monday night. He had postponed many cases to be gone a week, many of whom were breast cancer reconstruction cases. He got on the phone and with the help of American Express, got us a flight out of Santo Domingo for early the next morning. The only problem then was, the border between Haiti and Santo Domingo closed at 5:30 and it was 3:45pm. We had 15 minutes to pack and get on the road to the border. We crossed at 5:28pm, the gates closing behind us. Then we had a four hour drive to Santo Domingo with many checkpoints along the way. We made it, needless to say.

I’m grateful for many things on the trip: Pop Tarts, MREs, power bars, bottled water, snuggies, the iPhone map and multiple other applications, American Express, Starbucks instant Café Via, all the people who sent medical supplies, the translators, our driver, our safety, all the medical personnel there working for the Haitian people, my anesthesia group for allowing me to go, the LEAP Mississippi team (Scott Runnels, Jenny Mullen, Krista Swan) who supported me and propped me up over and over, our patients who gave to us as much as we gave to them, and God for leading me there and back. Without the amazing efforts of Dr. Runnels, the trip would have never been pos-sible. His personal sacrifice on so many levels, allowed multiple people to keep from having extremities amputated and allowed his “team” to participate in something so much bigger than themselves. I personally thank him for the invitation and the opportunity to serve some-one else in a way I could have never imagined. Should you ever find yourself in the position to do something similar, do it. You’ll never be the same. I’m not.


AANA UpdateBruce Weiner, CRNA, MSAANA Region 7 Director

Profession is derived from the Latin ”to swear (an oath).” Professionals exercise autonomy in the

workplace, and are expected to utilize their indepen-dent judgment and professional ethics in carrying out their responsibilities. A professional provides a service (in exchange for payment or salary), in accordance with established protocols for licensing, ethics, procedures, standards of service and training/certification. A pro-fessional maintains a high standard of ethics and work behavior. The American Association of Nurse Anesthetists is our professional organization. As a member-driven organi-zation, policymakers recognize the AANA as a highly influential professional organization. The commitment of our members, through annual dues and advocacy, en-sures our continued strength as an organization. Of the $645 dollars that members pay, $232.50 goes directly to the state association and $62.50 goes to the State Or-ganizational Development Committee (SODC). The SODC assists with funding the small states in an effort to build and strengthen their infrastructure. The SODC also provides financial assistance to states dealing with legislative and regulatory issues that may adversely af-fect CRNA practices. The remaining $350 is used to fund AANA activities and initiatives. These initiatives include state and federal advocacy including protection of CRNA reimbursement and practice rights, provider wellness, public relations, credentialing, and establish-ing evidence based practice standards and guidelines. As Region 7 Director I have had the direct advan-tage of witnessing the commitment and dedication of the AANA Board of Directors and staff in ensuring that we continue to be recognized leaders in anesthesia care. With each challenge that we may face comes an op-portunity for all of us to participate, affect change and achieve extraordinary results. Change however, is often thwarted by opposition. As the AANA and state associ-ations attempt to build nurse anesthesia practice based on inquiry and evidence, our physician colleagues skew the facts in an attempt to deny our patients the right

to CRNA services. Restrictions on interventional pain management and the licensure of anesthesiologist as-sistants continue to be the primary focus of physician groups who argue patient safety and access without evi-dence to back up their claims. With a change in make-up of the U.S. Senate, health care reform appears to be in limbo while Congress de-velops a bipartisan bill. In the interim, we continue to work with members of Congress and our coalition partners advocating for provider nondiscrimination language, removal of the sustained growth rate (SGR) cuts to Medicare due to take effect March 1, 2010, and improvements to nurse and CRNA workforce develop-ment programs. AANA has also made it clear to Con-gress that it is important for payment reforms and rates for new, affordable health coverage plans to be suffi-cient to ensure sustainable, high-quality healthcare de-livery. The Mid-year Assembly, occurring in late April, provides the perfect opportunity to let our voices be heard. If ever there was a time to affect change, the time is now. I encourage you to participate and look forward to seeing you in Washington, DC. Please join me in congratulating Region 7’s own Juan Quintana, CRNA, DNP, from Texas in being the first CRNA to be named to the Medicare Evidence Develop-ment and Coverage Advisory Committee (MEDCAC). Dr. Quintana will use his expertise in cost effective analysis, reimbursement and the economics of provid-ing healthcare services to evaluate medical literature, review technology assessments and examine data on the effectiveness and appropriateness of medical items and services that are covered or eligible for coverage under Medicare. On a final note, it has been a great honor to serve as Region 7 Director these past two years. While many decisions have been difficult, the choices made by your Board in representing the 40,000 members of our asso-ciation have continued us on a pathway of change that will benefit our practice, our patients and our profes-sion.


Heather Fields, ALANA Director, was recently invited to par-ticipate in a panel of Advance Practice Nurses for the Senior

nursing students at Auburn University. The panel contained a Clini-cal Nurse Specialist, a Nurse Midwife, a Nurse Practitioner, and Heather, a CRNA. The panel talked about how to lead a practice and what it takes to become a member of the respective professions. They answered questions from the Senior class about what experi-ence to get, how to handle the interviews, scholarships, demand for CRNAs and job requirements. ALANA is eager to partcipate in such panel discussions and welcomes invitations to spread the word about the benefits and rewards of being a CRNA.

Heather Fields (Center) visits with senior nursing students at Auburn.

The ALANA has retained the services of the law firm of Johnston Barton Proctor and Rose LLP to work on Prac-tice and Reimbursement issues for Alabama CRNAs. The firm is well known in the healthcare arena. You can visit their web site at www.johnstonbarton.com. Look for fur-ther details on their work on behalf of ALANA in the near future.

Student Report

Nursing School Visit

Special Notice

It is with our deepest sympathy to report the death of

Rebecca B. LeinfelderBirmingham, Alabama

important updates

Dear fellow SRNAs, On January 27, I had the privi-lege of attending legislative day at our state’s capitol. I was fortunate to be able to meet and interact with many of our state’s representatives and senators. In doing this I came to the realization that few totally understand what our profession entails. Now I understand why it is so important for our association to have a Political Action Committee who works diligently to help promote our association to these legislators. As students we all have taken the first step toward the commitment of professional growth by becoming associate members of the AANA and ALANA. However, our com-mitment must not end with only membership. It is vital for students to become active members of our association. This can be accomplished by attending state and national meetings, contributing to the PAC fund, and explaining our profession to every patient we encounter. This year’s theme for National Nurse Anesthetists Week was “We never miss a beat”. As students, we must internal-ize this theme not only in operating room but in our in-volvement with our profession’s association as well. I look forward to seeing everyone at the spring meeting in Destin. I also want to compliment the board of directors on the fantastic job they did in Montgomery.

See ya'll soon!

LeAnn WinburnUAB Student Representative

In Memorium

www.ala-crna.org 7

CE Documentation for Alabama RN and CRNA License RenewalSeptember 1, 2010 is the opening day for renewal of your Alabama Board of Nursing RN license and CRNA approval. Your approval to practice as a CRNA will expire on December 31, 2010, if you do not renew your RN and CRNA prior to midnight (31Dec2010 at 2400 hr).

For RN license renewal, 24 CE credits must be earned during the current 24-month RN license period, January 1, 2009 to December 31, 2010. In order to renew your CRNA status, six (6) of the 24 credits must be pharmacology topics. The Alabama Board of Nursing “recognizes” (accepts) AANA Continuing Education credits and other national nursing organizations for RN. However, “recognized” providers do not submit your CE credit transcript to the Board of Nursing. You may add CE credits to your Alabama Board of Nursing Individual CE Record at any time. Follow these steps to add course credits to your record. • On the ABN website, go to your Individual CE page www.abn.alabama.gov | Continuing Education | Access Individual CE Record or https://www.alabamainteractive.org/cgi-bin/abn/online_services/ infochange/abnchangeinfo.cgi • Key in your RN license number and PIN number (last 4 digits of your SSN) and click on Continue • Confirm your address and contact information, and Continue • Select Individual CE Record. • Scroll down to review the courses already listed on your CE record, if any. • Courses reported by ABN Provider are listed with the provider’s ABNP number. Contact the provider if a course is not correct. Only the provider can edit these courses. • To add CE CREDIT to your list: Click on the large blue letters, Add Course”. • Fill in the provider name and course information including Pharmacology Hours. Skip the box labeled Alabama Provider Number. • “Save This” entry. Add as many course credits as you wish. • You may edit the course information that you have entered on your list. You cannot edit course records that were electronically submitted to ABN by the ABNP Provider. ABN Administrative Code, Continuing Education 610-X-10-.01 Definitions: 2) Board Recognized Continuing Education Provider: A national or regional agency, journal, Alabama regula-tory agency or board, or another Board of Nursing recognized by the Alabama Board of Nursing as providing or approving continuing education in accordance with criteria that are substantially the same as those required of Alabama Board of Nursing approved providers of continuing education.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Charlene B. Cotton, MSN, RN, Nurse Consultant for Advanced Practice [email protected] • [334] 242-4787, [334] 242-4060, FAX [334] 242-4360 • www.abn.alabama.govAlabama Board of Nursing • P. O. BOX 303900 • Montgomery, Al 36130-0900

Medicare Corrects Some Teaching Rules Advisory Documents Before New Rules Take Effect Jan. 1, 2010; AANA Posts New FAQ Document

At the request of the AANA, the Medicare agency corrected and posted its advisory guidance documents on the implementa-tion of the new Medicare anesthesia payment teaching rules, so that for services effective Jan. 1, 2010, a teaching CRNA may bill 100 percent of a fee for each of two Medicare anesthesia services involving student nurse anesthetists. Previous agency guidance posted in a “Medlearn Matters” article indicated teaching CRNAs would be reimbursed less in such instances, incon-sistent with the statute and the final rule enabling the new teaching rules. To help AANA members, such as nurse anesthesia program directors and clinical nurse anesthesia faculty, understand the new teaching rules, the AANA has posted and updated a new “Frequently Asked Questions” (FAQ) document describing the issues, and providing links to source materials from the Medicare agency, and providing email links to report to the AANA any impacts that the new teaching rules might have on CRNA educational programs. The new FAQ page is available at www.aana.com/teachingrules.aspx (requires AANA member login and password).


We make a living by what we get, we make a life by what we give. Sir Winston ChurchillBritish politician (1874 - 1965)

The spirit of giving was profoundly demonstrated recently by a Samford faculty member and student. After hearing that a Haiti-bound surgical relief group was planning to abort their trip because the anesthetist was suddenly unable to travel,

Dr. Nina McLain roared into action. With barely one day’s notice, Nina rushed to obtain all the requisite vaccines and permits, and within 24 hours was on her way to this ravaged area. Nina reported that it was “a life altering, heart-wrenching and heart-warming experience” and that she did what God wanted her to do. Leah Deanhardt, SRNA, class of 2010 also responded to the need for ICU nurses in Haiti, and again with minimal notice, arranged her vacation schedule to provide service to these people in need. Leah and Nina clearly demonstrate that one person can make a difference.

We welcomed 22 students into the class of 2012 in January. This outstanding group of students is distinguished by their smarts, experience, and enthusiastic spirit. They come from all areas of the country including Florida, Mississippi, Georgia, Washington, Texas, Virginia, and Tennessee. Class of 2012, welcome to Birmingham, to Samford, and to our great profession.

In an effort to improve our simulation instruction, the program invited John O’Donnell, CRNA, PhD from the University of Pitts-burgh for an on-site consultation. Dr. O’Donnell is helping us maximize the use of this valuable tool. Hopefully, our simulation efforts will continue to allow our students to practice and perfect clinical skills in a controlled, but realistic non-patient environ-ment.

We can never say it enough . . . our program appreciates the dedication of our clinical sites and our CRNA preceptors.

Samford students are indebted to all of our clinical preceptors. This year, six exceptional CRNAs were voted as Outstanding Preceptors in the Samford program: Denise Drace, UAB-West, Kayla Dodd, Riverview, Ralph Pugh, Baptist South Montgomery, Keith Brown, UAB-West, Mark Schmitz, Tanner, and Rick Warren, Gadsden Regional. Congratulations and thank you, from the bottom of our hearts! You are truly making a difference in someone’s life!

Please mark your calendars! Samford will be hosting a Clinical Coordinator’s workshop on March 25, 2010Leigh Ann Goodwin, SRNA, class of 2011 was selected as one of twenty students from across the country to participate at the Assembly of School Faculty meeting in San Antonio. Leigh Ann was able to attend lectures and meetings and was informed on the issues, challenges, and advances in nurse anesthesia education today. Leigh Ann, thanks for getting involved and representing our program so well!

Samford students benefitted tremendously from the ALANA-sponsored Legislative Day in Montgomery, January 27, 2010, and observed first-hand the value of a strong and committed CRNA professional organization. Thank you David Hambright, Michael Fiedler, Joe Knight, Susan Hansen, Heather Rankin, and all the others who helped make this event a success on many fronts.

Nurse Anesthesia Program NewsMary C. Karlet, PhD, CRNA, Chair, Department of Nurse Anesthesia

www.ala-crna.org 9

On their very last day of school, graduates of the Class of 2009 attended a graduation ceremony at the Green and Gold Room at Bartow Arena. Friday, November 20, 2009 signified the end of a long and challenging trail for these students. Those re-

ceiving awards included Mary Ann Dean, Leslie King Denton, Mary Alice Vitale, Christopher L. Walsh, Danielle Ann Slaten and Kevin M. Lott. We certainly wish all of the graduates long and prosperous careers in nurse anesthesia.

Candidate interviews for the class of 2012 were recently concluded. Using the new behavioral interview technique at all inter-view sites, a very diverse group of students were selected. This chosen group will begin their anesthesia education in earnest this coming August.

The Junior Class celebrated National Nurse Anesthesia Week with a breakfast and treats provided by Mrs. Laura Wright. The students also attended Legislative Day in Montgomery on Wednesday, January 27th. Breakfast was provided for Samford and UAB students by ALANA. The students gained useful and insightful information by listening to prepared statements from ALANA President Dr. Michael Fiedler, Senator Means from Atalla, ALANA lobbyist Susan Hansen, and ALANA legal counsel Joe Knight.

Two well known alumni from the UAB Nurse Anesthesia program were recently honored as part of the forty year anniversary celebration of the School of Health Professions at UAB. Our very own Larry Hornsby and Ronnie Whorton were selected as members of the “Fab 40”. The Fab 40 consists of the most successful and influential graduates of the School of Health Profes-sions over the past 40 years.

The first graduate assistant position within the program was filled by senior student Mindy Nix. Mindy will be assisting Dr. Chad Epps in providing a meaningful educational simulation experience for our students. The school now has 2 simulation sites with the addition of a simulated OR at the UAB Center for Patient Safety and Advanced Medical Simulation. This is a shared site with the UAB Department of Anesthesiology and features METI HPS (top-of-the-line high fidelity human patient simulator specifi-cally designed for training in anesthesia) and an advanced audiovisual solution from B-Line Medical for recording, debriefing, and assessment of simulation sessions.

Dr. Luc Frenette, Professor of Anesthesiology, UAB, recently accepted the position of Medical Director for the Nurse Anesthesia Program. Dr. Frenette completed his anesthesiology residency at the University of Montreal in 1988. He then completed a Fel-lowship in Liver Transplantation at the University of Pittsburgh. Dr. Frenette has spent the last nineteen years at UAB where he serves as the Director of Liver Transplanta-tion. As Medical Director, some of Dr. Frenette’s duties will include a combination of teaching, curriculum design, participation in program committees, and assisting with the development of support within the University of Alabama at Birmingham and the sur-rounding medical communities.

The Program recently received a visit from Dr. Betty Horton. If that name rings a bell, it should. Dr. Horton served the AANA as Director of Education for six years and also served as the Director of Accreditation, Council on Accreditation of Nurse Anesthesia Educational Programs for twelve years. She is assisting our program as an accreditation consultant as we prepare for the re-accreditation process that will conclude this April.

The UAB Nurse Anesthesia Alumni Association will hold its first event ever for mem-bers at the Ross Bridge Renaissance Hotel beginning March 26, 2010. Planned events include ACLS training Friday night along with a reception that night. Four free continu-ing educational units will be available Saturday morning as dynamic speakers present anesthesia related topics. A golf tournament is planned for Saturday afternoon. Please contact Michael Humber at [email protected] for more information.

Dr. Luc Frenette

Nurse Anesthesia Program News

Phillip Kendrick, PhD, CRNA, Assistant Professor, Director of UAB Nurse Anesthesia Program


AANA Hard at Work for YOU in DCif you are not at the table, you might be on the menu!Amy Neimkin, DNP(c), MBA, CRNA

“Information is the currency of democracy.” Thomas Jefferson

Over the coming weeks and months, I will be sending out many communications by email, Facebook and Twitter about the 2010 Congressional elections. I will endeavor to relay to you who the candidates are and where they stand on key

CRNA issues to afford you the information you need to vote wisely in the primaries and in November. After April 1st, we will personally be calling CRNAs in each district to ask you to help the candidate that the AANA has identified as friendly to CRNAs by placing signs in your yards or answering phones in campaign headquarters. We are looking for Key Contacts who will be the primary local contact between the AANA and Congress, linking the AANA Federal Government Affairs office with legislators that serve your district. The ultimate goal of the Key Contact is to develop and foster a personal as well as profes-sional relationship with the Representatives and Senators and their district staff. If anyone is interested in becoming a Key Contact and getting involved, please e-mail me at [email protected]. We would LOVE to have your help!

The 2010 United States midterm elections will be held on Tuesday, November 2, 2010. All 435 seats in the United States House of Representatives and 36 of the 100 seats in the United States Senate will be contested in this election along with 38 state and territorial governorships, many state legislatures, four territorial legislatures and numerous state and local races. In Alabama, four of the seven districts promise interesting races, but a key race that everyone is already watching and that could not only affect residents in North Alabama, but politics nationwide, is the race in the 5th Congressional District. This race be-came interesting when U.S. Rep. Parker Griffith switched parties just before Christmas less than a year after taking office as a Democrat. The 5th is one of the few districts in the South that has not elected a Republican since Reconstruction. Democrats still hold most local offices as well as most state legislative seats in the area, but the district's residents have been increasingly willing to support Republicans at the national and state level.

The Honorable Parker Griffith, M.D. to Speak about health care reform at Spring Meeting Congressman Griffith represents the 5th District of Alabama and is a retired physician and small business owner. He de-veloped several local businesses and has been active in charitable and community activities for more than thirty years. He was elected to the Alabama Senate in 2006 and has worked to improve our healthcare system, lower taxes and expand early childhood education programs. As a physician, Griffith was the first radiation oncologist in North Alabama and a pioneer in the early diagnosis and treatment of cancer. He established the first Comprehensive Cancer Center in North Alabama to treat all types of cancer. As a doctor, he provided free and discounted care to patients without insurance. This experience will continue to aid him in addressing and fighting for the healthcare needs of our community.

Before his election to the United States Congress, Griffith was a member of the Alabama Senate, representing the 7th District from 2006 to 2008. The district includes parts of Madison County and Huntsville. During his term, he sponsored bills to pro-mote investment in alternative fuels, cut taxes and establish a Statewide Trauma Care System to speed critical medical care.Griffith has stated that he leans conservative on a variety of issues. He states that he is a fiscal conservative who has called repeatedly for reducing the national debt. He is a strong supporter of NASA and America’s dominance in space. Griffith also states that he favors increased defense spending, supports gun rights, a balanced budget, secure borders, investment in nuclear power and offshore drilling and is pro-life. Griffith voted against the Affordable Health Care for America Act, cap-and-trade legislation and the 2009 economic stimulus act.

On December 22, 2009, Griffith announced he would become a Republican citing the health care bill as a major reason for his switch. As a result of the change in party affiliation, Griffith has been stripped of all of his committee assignments. Parker and his wife, Virginia, have five children and ten grandchildren and have been vital members in the Huntsville community for over thirty years.

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Congressman Griffith will speak about the current state of healthcare reform at the ALANA Annual Spring Meeting on Saturday, May 1 at 9:15 am at the Sandestin Hilton. To register for the meeting please visit the ALANA website at www.ala-crna.org or call (334) 260-7970. As a physi-cian, Griffith understands and supports the issues that are of vital importance to CRNAs during this ongoing process of healthcare reform. If you live in the 5th District and would like to support Congressman Griffith by volunteer-ing for his campaign or becoming a Key Contact for the District, please e-mail me at [email protected].

“That government is the strongest of which every man feels himself a part.”

Thomas Jefferson

2010 Mid-Year AssemblyMembers of the ALANA will be in Washington, DC for the 2010 Mid-Year Assembly federal advocacy confer-ence and will be visiting their members of the House and Senate. In addition to educating legislators about the role and value of CRNAs in ensuring patient access to high-quality and cost-effective healthcare in the commu-nity, CRNAs and student nurse anesthetists who attend the conference will be discussing the following issues: provider nondiscrimination, nurse and CRNA workforce development, rural anesthesia access, payment sufficient to support access to care, and promoting the development of the anesthesia professional workforce by ensuring the Medicare anesthesia payment teaching rules are imple-mented fairly and effectively.

If you plan to attend Mid-Year Assembly, please let me know so you can be included – it is almost time to make the appointments!!!

2010 Beat the Clock CampaignCRNA-PAC’s Beat the Clock campaign is a collective effort of states and regions to do their part toward help-ing CRNA-PAC raise $1.75 million by December 31, 2010, strengthening CRNA’s voices in Washington. The CRNA-PAC is the only federal PAC allocating dollars to federal candidates on behalf of the AANA. State PACs cannot give funds to federal candidates! In November 2010, Americans will vote once again for Congress. Between now and then, legislators and candidates will be acting, voting, and speaking out on healthcare reform. We CRNAs will need to make ourselves heard now! In light of this important election year, I would like to encourage you to donate to CRNA-PAC today by going to CRNA-PAC in the member’s section of www.aana.com.

Place Joe Knight PDF

“I hope you will join my effort to bring new common sense leadership to the Jefferson County Commission. The years ahead will require tight control over finances and a new style of management. I will make sure your tax dollars serve you.”

www.VoteJoeKnight.com


Calendar of EventsMarch 27-28, 2010 Upper and Lower Extremity Block AANA Foundation Learning Workshop Center, Park Ridge, IL

April 25 - 28, 2010 AANA Mid-Year Assembly Renaissance Washington DC Washington, D.C.

April 30 - May 2, 2010 ALANA Spring Meeting Sandestin Beach Hilton • Destin, FL June 1, 2010 Primary Election

August 7-11, 2010 77th Annual AANA Meeting Washington State Convention & Trade Center, Seattle, WA

October 29-31, 2010 ALANA Fall Meeting Wynfrey Hotel • Birmingham, AL

November 2, 2010 General Election

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David Hambright, CRNAour member in the spotlight

What is the most rewarding aspect of your career as a CRNA? I cannot imagine any greater reward as a professional than to have someone actually trust you with their very life or the life of their spouse, parents, or children. I never take for granted the great privilege of this trust and find it extremely rewarding to know I have honored that trust with my very best effort.

Biggest surprise when you started working as a CRNA? I continue to marvel at the courage and faith of the patients and families that I encounter. I am always amazed and inspired when those that I care for face life threatening illness with such dignity and courage.

How did you get interested in a career as a nurse anesthetist? As an undergraduate at UAB, I started working in the operating room of a local hospital to gain experience for an anticipated medical career. I had the good fortune to come across this group of folks called Nurse Anesthetists. The knowledge and expertise these professionals displayed motivated me to begin the process of pursuing Nurse Anesthesia as a career.

Do you recommend this career to others? Without question. Nurse Anesthesia is founded on the substantial principles that have made nursing one of the most honorable and caring professions in our nation. The opportunity to obtain advanced practice expertise in anesthesia offers nurses unique opportunities to build on that nursing foundation and challenge themselves as nursing profes-sionals. While working in a cold, sterile operating room in the middle of the night is not very glamorous, you will end each day knowing that the effort invested in each case truly made a difference.

What is the most frustrating aspect of your career as a nurse anesthetist? A wise professor shared with my anesthesia class early in my education that I should never confuse providing ex-cellent care with being God. I am most frustrated when I know that I have done everything possible to care for my patients, but despite this the patient's prognosis is poor. Accepting that ultimately life and death are not factors I can completely control is a challenge.

What do you hope to accomplish that you have not yet accomplished? I hope to begin working on my DNP in the near future. As a relatively new faculty member at Samford University, I hope to devote more of my professional energy in the future to the educational preparation of future anesthetists.

Most Memorable CRNA moment? Recently, I was asked to provide anesthesia to one of my peer's children. I was reminded that no matter what our station in life, when the stretcher rolls through the surgery doors with our loved one, we are all reduced to waiting, anxious family wanting our loved ones cared for in a respectful and quality manner. Having the trust of co-workers with their family is special

Why are you active in ALANA?One of the major factors motivating my ALANA service is the recognition that the quality of Nurse Anesthesia in

continued on page 14


introduce yourselfThe goal of every public relations campaign is to inform the public about who we are, what we do, and why they

should care. We could spend thousands of dollars each year on print ads, billboards, TV spots, and radio ads to promote our profession ~ yet none of these could be near as effective as simply telling each patient that we are nurse anesthetists. Just think ~ we have more than 1000 members who each administer about 600 anesthetics per year. In just one year's time, we can get our message out to more than 600,000 patients. It has been said that Certified Regis-tered Nurse Anesthetists are the best kept secret in all of healthcare. Well, it is time to let the cat out of the bag! It is time to get the word out. When our patients know who actually administers their anesthetic, when our legislators know who actually adminis-ters anesthesia, when the general public recognizes us for the outstanding job we do every day with every anesthetic ~ then our public relations goal is met!Take pride in advancing your profession ~ introduce yourself as a nurse anesthetist.

Alabama did not happen by accident. There are countless individuals who have sacrificed is so many ways to provide this opportunity for me. I hope that those that follow behind me are more able to practice to the fullest extent of their education and licensure and reimbursed accordingly because of my efforts.

What advice would you give those contemplating a career as a CRNA?Preparation for a career in anesthesia must begin early with a focus on excelling in classes. Like all worthwhile goals, there are no shortcuts. There is always a tendency to focus on the positive aspects of a career, and there are many in nurse anesthesia, but the path is difficult and requires much hard work. If you are willing to work very hard, you will be rewarded with one of the greatest jobs available.

continued from page 13

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ALANA Brings Great Crowd

Nurses Day on the Hill was another grand success this year, with over 1,500 people participating. ALANA had a great turnout, and our members were proud to play an important role in getting our message out to the Legis-

lature. We have featured a number of photos of ALANA members at Nurses Day. Thank you for taking time out of your schedules to stand up for ALANA.

Over 1,500 nurses, students and instructors rally on the steps of the State House Office Build-ing while the Legislature meets.

A picture is worth a thousand words.

ALANA leaders met with Governor Bob Riley and Representative Randy Woods (R) of Anniston.

UAB’s Laura Wright heads for the Hill with students in tow.

CRNA posters were everywhere to see.

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for Nurses Day on the Hill

ALANA lobbyist Johnny Crawford enjoys visit with Senator Means (D) of Atalla at ALANA Student Breakfast.

ALANA President Michael Fiedler welcomes students to the breakfast and stresses the importance of speaking out on behalf of the profession.

ALANA President Elect Heather Rankin ral-lies the crowd.

Rep. Howard Sanderford (R) of Huntsville visits with Dr. Fiedler, Andy Morris and Pennie Nichols.

ALANA crowd poses for group photo on the steps of the RSA Plaza. ALANA President Fiedler, Andy Morris, Rep. Cam Ward (R) of Alabaster, Sen. Hank Erwin (R) of Montevallo, ALANA General Counsel Joe Knight, Heather Fields and Pennie Nichols visit before ALANA-sponsored luncheon.


Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65,712 procedures with positive pressure ventilationAnaesthesia 2009;64:1289-1294Bernardini A, Natalini G

Abstract

Purpose The purpose of this study was to test the hypothesis that pulmonary aspiration of gastric contents was more likely when the airway was managed with an LMA than an endotracheal tube when patients were mechani- cally ventilated.

Background The Laryngeal Mask Airway (LMA) has a number of advantages over an endotracheal tube and it can be useful in the management of a difficult airway when ventilation through a facemask is difficult. Neverthless, the LMA does not seal the trachea against entry of gastric contents as well as an endotracheal tube (ETT). Positive pressure ventilation may result in gastric inflation and increase the risk of regurgitation and aspiration during LMA use. There is, however, little evidence about the actual risk of pulmonary aspiration with an LMA vs. an ETT during mechanical ventilation. Criteria considered to contraindicate the use of an LMA are based primarily on opinion and not on evidence.

The overall incidence of pulmonary aspiration (all types of airway management) has been reported to be between 1 in 3,216 and 1 in 14,139 general anesthetics.

Methodology This retrospective study examined data in a preexisting quality improvement database. Data had been collected over a 10+ year period. Records were included in the analysis if either an LMA or ETT was used during a general anesthetic with mechanical ventilation. The selection of an LMA for airway management was driven by locally accepted contraindications to LMA use including: patients who were not NPO, intesti- nal obstruction, pregnancy, procedures involving the airway, and prone position. An LMA was occasionally used when one or more of these contraindications were present in a difficult airway situation.

Default volume controlled ventilator settings were tidal volume 8 – 10 mL / kg with respiratory rate adjusted according to the end tidal CO2. Surgical procedures included major abdominal, urologic, gynecologic, retro- peritoneal, and laparoscopic surgery. Pulmonary aspiration of gastric contents was defined as the presence of gastric contents or bilious fluid in tracheal aspirate; bilious fluid on the LMA or in the oropharynx; or postoperative dyspnea, hypoxia, or “auscultatory abnormalities.” When a case of aspiration was identified in the quality improvement database the original chart was reviewed to verify the data.

Result Slightly over 1,000,000 cases were contained in the database. Of those, 65,712 met the criteria for inclusion; general anesthesia and mechanical ventilation with either an LMA or ETT. Of those, 2,517 were major abdominal surgery or laparoscopy performed with an LMA. The airway was managed with an LMA in 1.7% of cases in which a contraindication to LMA use was present.

Aspiration occurred in 10 cases. Of these, 4 occurred during an elective procedure; 2 with an LMA and 2 with an ETT. The other 6 occurred during a non-elective procedure; 1 with an LMA. Only 2 of these patients were admitted to intensive care due to aspiration related problems; 1 of the ICU admissions was an LMA

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patient and 1 was an ETT patient. The occurrence of pulmonary aspiration in patients whose airway was managed with an LMA and mechanical ventilation was no different than those whose airway was managed with an ETT (odds ratio 95% confidence interval 0.09-1.4; P=0.141). The power of the study (the probability of rejecting the hypothesis when it is false) was calculated after the fact to be 0.69.

The primary factor associated with pulmonary aspiration was emergency surgery, not the airway management device. The overall incidence of aspiration was 1 in 6,571 anesthetics.

Conclusion The incidence of pulmonary aspiration was no greater when an LMA was used than when an ETT was used during general anesthesia with mechanical ventilation. Institutional contraindications to LMA use may have influenced the results.

Comment The focus of this study was the risk of aspiration when mechanical ventilation was used with an LMA. Accepted contraindications to LMA use were observed. The study was not about the risk of using an LMA for any and every case. It was about the added risk (if there is any) of using mechanical ventilation with an LMA. I’m glad to see this question addressed. Many of my colleagues are hesitant to use a ventilator with an LMA, yet manually bagging with an LMA is fine. Both are positive pressure ventilation. If our concern is insufflating the stomach with air it can happen with either method of ventilation. In my view, it is all about technique. I sometimes use mechanical ventilation with an LMA but I don’t use the ventilator the same way I’d use it with an ETT. I take care, for example, to keep peak pressures below 20 cm H2O. This study indicated that there may not be any increased risk of aspiration when mechanical ventilation is used with an LMA (see limitations in the following paragraphs). While I’m not ready to use an LMA as widely as this group apparently did, I do believe that with proper technique mechanical ventilation can safely be used with an LMA.

While the study is retrospective, it is unlikely it could have been conducted any other way, and, as such, it is probably nearly the best we are going to get. As retrospective studies go, this was a good one. Most retrospective studies are not based upon a detailed quality improvement database. The authors also took the wise step of reviewing the charts of all patients identified by the QI database as having experienced pulmonary aspiration. And, it has the advantage of including a large number of patients, especially important for a relatively low frequency event such as aspiration. Still, few aspirations were detected and there may have been a true difference in the aspiration rate that was undetectable as a result. Based upon the detailed statistical tests they reported and, in my judgment, one error in analysis, I believe there is a reasonable chance that the actual incidence of pulmonary aspiration may have been greater with the LMA than with an ETT (see note following).

The investigators rightly point out that the QI database may not have detected all cases of aspiration because complications were reported to the database by the anesthesiologist caring for the patient. Self reporting tends to underestimate the incidence of a complication because the clinician unconsciously gives themself the benefit of the doubt and because reporting can get put off until later and forgotten.

While it has a couple limitations, this study is important and enlightening because it is generally well done and encompasses a very large group of patients. The institution where this study was conducted does a great service by taking the time and effort to maintain a detailed quality improvement (QI) database for over a decade. Without it, this study would not have been possible.

Michael Fiedler, PhD, CRNA

NOTE: The upper boundary of the adjusted odds ratio 95% CI of the risk of aspiration with an LMA was 5.62 times greater than an ETT. A one sided test was used to calculate the power of the study.

© Copyright 2009 Anesthesia Abstracts · Volume 3 Number 12, December 31, 2009


ALA-CRNA PACthe voice of the nurse anesthesia profession in alabama

ALANA Honors Senator Larry Means with the 2010 Legislative Healthcare Leadership Awardby Susan Hansen, ALANA Government Relations Specialist

Larry Means was born and raised in Attalla, Alabama. He graduated from Etowah High School in 1965, and is a 1970 graduate of Jacksonville State University, earning a B.S. Degree in Business Administration. Senator Means worked as a supervisor for Republic Steel and Gulf States

Steel from 1970-1994. He worked as a Sales Manager for McCartney Construction Company from 1994 until he retired in 2007.

Senator Means’ political career began in 1976 when he was elected to serve on the Attalla City Council. He was re-elected in 1984, and served until 1988 as Mayor Pro-Tem. He was elected Mayor in 1992 and re-elected in 1996 for a second term. While serving as Mayor, he was elected chairman of the Etowah Metropolitan Planning Organization, and served in that capacity until he was elected to the Alabama Senate in 2002. He is currently serving his third term as Senator of District 10, and is active on the following Committees: Chairman – Industrial Development & Recruitment, Vice Chair – Agriculture, Conservation & Forestry Vice Chair – Energy & Natural Resources Vice Chair – Health Member – Business & Labor, Commerce, Transportation & Utilities, Confirmations, Finance & Taxation - Education Governmental Affairs, Joint Transportation Committee, Joint Oversight Committee on Rehabilitation Services, Joint Oversight Committee on License Plates, Energy Council, Alabama Building Commission, Alabama Toll Road, Bridge and Tunnel Authority. Municipal Government Legislative Committee Senator Means is totally dedicated to his family. He has been married for more than 41 years to Karen Gidley Means. They have two children: Brent (wife, Jenny) and Tanya MacMillan (husband, Michael). Senator Means will tell you the best part of having children is grandchildren. He has two grandsons, Seth MacMillan and Ellis Means; and two granddaughters, Romy Evelyn Means and Lauren Katherine MacMillan. He has been a life-long member of the First Baptist Church of Attalla.

When ask about his hobbies, the number one answer was his grandchildren. He also enjoys hunting, fishing and golf when he has time. Being a senator is quote “a part-time job” but for Senator Means it is a full-time situation.

Larry and his wife Karen try to visit family and friends whenever possible, especially those in nursing homes and shut-ins. “These are important folks in your life, we don’t need to forget them,” Senator Means said.

Senator Means shared a personal note about CRNAs. Not too long ago he had a medical procedure done. The CRNA came in and visited with him. They introduced themselves, asked if he had questions, assured him they would be with him through the procedure and made him feel much more comfortable about the whole thing. His favorite saying now is “I understand the putting you to sleep part, but I like the waking me up part best.”

The bottom line is that Senator Means is a friend to CRNAs. He has always been quick to help us and has been open to our concerns. ALANA is always encour-aging CRNAs to get involved in the political process. This is an excellent opportunity for the CRNAs in the Atalla and Gadsden areas to do just - get involved and volunteer with the Senator Means campaign. It’s fun, educational, exciting and rewarding. If you are inter-ested, you can contact Senator Means in Montgomery at 334.242.7800 or reach his campaign at Friends of Senator Larry Means – P.O. 786, Attalla, AL 35954.

Congratulations Senator Larry Means and thank you for your service to the people of Alabama.

UAB Student Rep LeAnn Winburn, ALANA President Michael Fiedler and Samford Student Rep Pennie Nichols pose with Senator Larry Means (D) of Atalla, winner of the 2010 Healthcare Award.

www.ala-crna.org 21

There is so much publicity about Roth IRA conversions that I wanted to take some time to explain how it works.

In 2009, an individual could convert their IRAs or 401(k) accounts to a Roth IRA, but were subject to income limitations. In other words, if their modified adjusted gross income is $100,000 or less, and were single or married filing jointly, they could convert to a Roth IRA account. If their modified adjusted gross income exceeded $100,000, or they were married filing separately, they could not convert to a Roth IRA. The taxpayer had to pay income tax on the taxable portion in the year of the conversion.

In 2006, President Bush signed the Tax Increase Prevention and Reconciliation Act that repeals the $100,000 modified adjusted gross income limit on conversions for all taxpayers, including individuals married filing separately, allowing taxpayers the op-portunity to convert their accounts in 2010. Also, the Act allows the taxpayer to report half of the conversion in 2011 and the remaining half in 2012. This allows the taxpayer to pay income tax on the taxable portion of the conversion over two years, rather than paying all the income tax in the year of conversion.

Before 2008, you could not roll funds from an eligible employer plan directly to a Roth IRA unless the rollover came directly from a Roth 401(k) or a Roth 403(b) account. Now you have the opportunity to simply roll over both Roth and non-Roth dollars directly from an eligible employer plan. But remember that the non-Roth portion is subject to income tax when rolling over to a Roth IRA account.

There could be a taxing problem for a person that has an IRA account that contains both after-tax dollars and pre-tax dollars. This is due to the IRS rule that states that you cannot convert just the after-tax dollars to a Roth IRA and avoid paying income tax on the conversion. Instead, the amount you convert is deemed to consist of a pro-rata por-tion of the taxable and nontaxable dollars in the IRA. You cannot escape this rule by using separate IRAs. The IRS makes you aggregate all of your traditional IRAs (including SEPs and SIMPLEs) when calculating the taxes due on the conversion.

Due to complexity of the factors to consider such as age, years to retirement, tax rate, etc, you should consider con-sulting with a financial and/or tax professional before pro-ceeding with a Roth IRA conversion in 2010.

Andy Easterling, CPA/PFS, CFP®Certified Financial Planner™

Grandview Financial Group, LLCTwo Perimeter Park South, Suite 310EBirmingham, AL 35243(205)262-1120 Office(205)262-1118 Faxandy@grandviewfinancialgroup.comwww.grandviewfinancialgroup.com

Securities and Investment Advisory Services offered through Multi-Financial Securities Corporation, member FINRA/SIPC. Grandview Financial Group, LLC is independent of Multi-Finan-cial Securities Corporation.

Roth IRA Conversions Andy Easterling, CPA/PFS, CFP, Grandview Financial Group, LLC

Securities and investment advisory services are offered through Multi-Financial Securities Corporation, member FINRA/SIPC

GrandView Financial Group, LLC is not affiliated with Multi-Financial Securities Corp.

GrandView Financial Group, LLC is a full-service financial service firm that specializes in assisting individuals, families and businesses in estate and legacy planning and helping them pursue their financial goals.

Rebuilding confidence in your finances ~

with a personalized approach to your financial planning goals.

ANDY EASTERLING, CPA/PFS, CFP® CERTIFIED FINANCIAL PLANNER™ Two Perimeter Park South, Suite 310-EBirmingham, AL 35243Phone: 205.262.1120 Cell: [email protected]


2010 Outstanding Clinical Preceptor Awards

For the past six years, the highlight of the ALANA observance of National Nurse Anesthesia Week has been the announcement of the Outstanding Clinical Preceptor Awards. These awards were developed to recognize those individuals

who consistently provide nurse anesthesia students with excellent clinical experiences and create an environment that is conducive to learning the science and art that is nurse anesthesia.

Based upon recommendations from students and faculty, each nurse anesthesia program can name up to five individual recipients. The recipients are awarded a Certificate of Appreciation and given a $100 tuition grant to attend an ALANA Educational Meeting. Recipients are honored at the Business Meeting of the ALANA Annual Spring Meeting in San Destin, to be held April 30 - May 2, 2010.

ALANA is pleased to announce this year’s Outstanding Clinical Preceptor recipients:

Melissa Beard, Baptist Medical Center, Princeton

Keith Brown, UAB West, Birmingham

Brandon Daughtry, Huntsville Hospital Women's & Children's

Kayla Dodd, Riverview, Gadsden

Claude Johns, Jackson Hospital, Montgomery

Bill Oakes, Southeast Alabama Medical Center

Ralph Pugh, Baptist South, Montgomery

Seth Richardson, UAB

Mark Schmitz, Tanner Medical Center, Carrollton, Georgia

Rick Warren, Gadsden Regional Medical Center, Gadsden

ALANA salutes these fine professionals for their work and service to the nurse anesthesia profession.

Kayla Dodd, Riverview, Gadsden

Senior Charee Hibbs and Keith Brown, UAB West

Senior Charee Hibbs and Denise Drake, UAB West

Senior Lyndsey Patrick and Ralph Pugh, Baptist South,

Montgomery

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He Who Laughs, Lastsby Jennifer Overton, CRNA

It’s contagious and also the best medicine. Some may do this ‘til it hurts. Some do it ‘til they cry. It is known to cause

facial and abdominal pain and shortness of breath. If you expe-rience a bout of it, you may be rolling in the floor, begging for mercy before it’s over. Over the years, it seems as though we have likened laughter to a disease with such descriptors, when in fact, this could not be further from the truth. Perhaps it is the combination of high levels of stress and sometimes odd hours or perhaps it’s just because of the ran-domness of constant day to day human interaction, but from my experience, CRNAs tend to be a group who really enjoy and appreciate a good laugh. You may be interested to know that while you are telling a joke or relating a funny story to your peers, you may actually be promoting their health and wellness and your own. The anatomy involved with laughter and humor perception is still largely unknown. After exhaus-tive research into the neu-roanatomy of this activity, I have found that it is ex-tremely complicated. There are actually several differ-ent types of laughter, how-ever, laughter as we think of it- laughing about stories with friends and co-workers is thought to be initiated by cessation of cortical frontal inhibitory tracts. Basically, you have to let your guard down to be able to laugh. Many structures of the brain are involved including the basal ganglia, hypothalamus, periaqueductal gray (PAG), and both motor and premotor cortices. The PAG is thought to actually send the initial signal to laugh. (6) An interesting side note with regards to the neuroanatomy of a laugh: nitrous oxide (AKA “laughing gas”), an NMDA recep-tor antagonist, most likely works by affecting neurons in this same pathway in the premotor and motor cortices. (6) Laughing influences our bodies in many different ways and has interesting effects when it comes to stress. The study of the body’s physiological immune response to all kinds of psychological stressors falls under an entire field called psy-choneuroimmunology. Research in psychoneuroimmunology has repeatedly documented that high levels of stress can cause many damaging changes in both psychological and physiolog-ical processes secondary to the influences of catecholamines and several other substances released into the body. (2) Where psychoneuroimmunology and gelatology (the study of laugh-

ter) meet, we begin to learn some surprising facts about the hu-man body. According to some studies, laughter may cause a modification of some of these stress chemicals, specifically, neuroendocrine hormones involved in the stress response. One author found that participants in an experimental group who viewed a humorous movie for one hour had decreased levels of cortisol, dopac (do-pamine metabolite), and epinephrine- all hormones associated with stress. (4) Upon further investigation, this same author studied 16 healthy, fasting males who were not taking any supplements or medications and had not exercised in at least 3 days. Blood was drawn prior to watching their favorite funny movie, 4 times during, and 3 times after watching in the experimental group, while the control group read magazines in a waiting room and

had blood drawn at these same intervals. The author found that just the expecta-tion of laughter increased baseline endorphin levels by 28 percent and human growth hormone levels by 87 percent. (4) Laughter may also play an important role in longevity as it has posi-tive effects on the immune system. In a study of 52 healthy men, again view-ing a humorous movie, the authors discovered an in-

crease in a multitude of neuroimmune components. Specifically of note, there was an increase in activity of natural killer cells, activated and helper T cells, leukocytes and lymphocytes with some effects lasting up to 90 minutes after the movie. There was also an increase in the activity of immunoglobulins IgA, IgG, and IgM which lasted 12 hours after the experience. (3) Since low immune function is associated with a diminished resistance to disease, perhaps the saying “He who laughs last, laughs best” is not so far from the truth. So, you made a New Year’s resolution to lose weight and already fell off the wagon. Don’t worry, laughter will help you burn those extra calories. In examining the health benefits of laughter, one study found that laughter increases baseline energy expenditure by 10-20%, so 10-15 min of laughter per day could burn an extra 10-40 kcal. (5) Although this may not convince you to trade your workout routine for a funny movie, it may be important to note that in today’s society where obesity is becom-

“To laugh often and much; to win the respect

of intelligent people and the affection of

children...to leave the world a better place...

to know even one life has breathed easier

because you have lived. This is to

have succeeded.” — Ralph Waldo Emerson

Continued on page 26


WelcomeMark your calendars and complete the registration form for the Annual Spring Meeting of the ALANA to be held in beauti-ful Destin, Florida at the Hilton Sandestin Beach Golf Resort and Spa, April 30-May 2, 2010. We are hoping that the at-tendance for this popular meeting will increase again this year. We think the contined growth in participation at this meeting is due in large part to the outstanding faculty the ALANA Pro-gram Committee has assembled to present the state-of-the-art in anesthesia continuing education? Or, is it the fabulous ac-commodations and resort amenities offered at the Hilton Sand-estin? Or, is it the time of year, held at a time when we all need a spring break? Whatever the reason, find out for yourself why the Annual Spring Meeting of the ALANA is consistently rated as one of the top ten anesthesia meetings in the country!

FacultyThe ALANA Program Committee has really outdone them-selves this year in compiling one of the strongest, most im-pressive faculties ever presented. We have a United States Congressman, President of the AANA and a host of distin-guished speakers and presenters providing the absolute best in nurse anesthesia continuing eduation. Faculty include Con-gressman Parker Griffith M.D., representing Alabama's Fifth Congressional District, James R. Walker, AANA President, Baylor College of Medicine and the Ben Taub General Hos-pital in Pearland, Texas, Julie Lowery, Chair of the AANA Resolutions Committee, University of North Carolina Hos-pital, Bruce Weiner, AANA Region Seven Director; Michael Rieker, NBCRNA Representative, Wake Forest University Baptist Medica Center, Winston Salem, North Carolina, Dr. Mary Karlet and David Fort from Samford University and Dr. Michael Fiedler, ALANA President. This outstanding faculty has been carefully selected to offer you the very best in nurse anesthesia continuing education.

Special FeaturesYour registration fees include a CD containing the speaker's presentations, lots of your favorite foods and beverages and the ever-popular CRNA Beach Party.

Beach PartySaturday, May 1, 3:30PM

Relax at the beach and enjoy seafood treats with a cold bever-age. Network with your friends, classmates, speakers, exhibi-tors and board members at this fun-filled event.

The Hilton Sandestin Beach Golf Resort & SpaThis is Northwest Florida’s premier luxury Gulf-front hotel. Located along Florida’s Emerald Coast, the Hilton Sandestin is situated on a 2,400-acre playground overlooking the most beautiful beaches in the world. The hotel boasts a heated in-door pool, two outdoor pools, two whirlpools, private beach, a full-service spa, salon and fitness center, and the finest din-ing options, from elegant to casual. Resort amenities include fourteen tennis courts, four championship golf courses, and a full-service marina and bicycle rental. Children’s recreational programs and beach equipment rentals are also available.

Accommodations 1-800-367-1271Reservations should be made directly with the Hilton Sandestin by using Group Code ANS to assure you get the discounted group rate. Check in time is 4PM and checkout is 11AM. Deadline for receiving rooms at this special pricing is March 30, 2010. Reserve your room early as the hotel always sells out!

On-line RegistrationIf paying by credit card, you can register on-line on the ALANA web site at www.ala-crna.org. Credit card transactions are managed through the PayPal Merchant Account. This is truly a quick, hassel-free way to make sure you are included for the 2010 ALANA Spring Meeting.

An ALANA Meeting of DistinctionThe ALANA Program Committee and Program Directors know what it takes to provide you, our members and guests with the very best in nurse anesthesia continuing education. It is the attention to details that separates us from other provid-ers. We are not satisfied with just holding your meeting at a world-class resort and assembling the best faculty possible. We offer table seating, presentations on CDs, breakfast buffet, continuous coffee and drinks, delicious luncheon buffet, and exhibit hall ~ all just just steps from your deluxe guest suite.

Why do we go to so much trouble? Because this is YOUR meeting and you deserve it. At ALANA we recognize and ap-preciate that each of you advance the profession every day at work. This is our opportunity to show our appreciation!

21 Continuing Education UnitsThis educational program has been approved by the American Association of Nurse Anesthetists for 21 CEUs. The program includes 4.5 hours of designated pharmacology content.

ALANA Annual Spring MeetingInformation & Registration

www.ala-crna.org 25

RegistrationSelect the educational sessions you would like to attend. The “Full Meeting” registration fee includes admission to all educational sessions, including all three of the Wellness Electives. The “Daily Registration Fees” allow participants to attend one or more days and do NOT include the fee for the Wellness Electives. If daily registrants are interested in attending the Wellness Electives, please select the sessions desired and include the fee in your total.

The Wellness ElectivesThe Wellness Electives will feature a DVD Series and group discussion. The series will be divided into three - 1 hour sessions including 45 minutes of video with 15 minute allowed for discussion and questions. The full meeting registration fee includes admission to the 3 Wellness Electives. Daily registration fees do not include the Wellness Electives and require an additional $25 fee for each elective.

Sponsor-A-Student ProgramThis year the ALANA is offering each of you an opportunity to show your support for the future of our profession by sponsoring a student to attend the Spring Meeting. The ALANA does not charge a fee for attendance by students, so all of your contributions will be combined to offer additional hotel rooms for the students to share. A ribbon will be added to your nametag designating you as a Sponsor-A-Student Donor and a Group Photo will be taken for publication in the ALANA NewsBulletin. Wear it proudly!

Send completed registration form and payment to:

ALANAPost Office Box 240757Montgomery, AL 36124

For those with special needs or questions about the meeting, call Bruce Von Hagel at 205-902-9600 or send e-mail to [email protected]

Refund policy: Refunds on tuition will be honored upon receipt of a written request prior to April 20, 2010, subject to a $50.00 cancellation fee.

Name:Address:City/State/Zip:Employer:E-mail address:Cell phone: AANA Number:

AANA Member Registration FeesR CEs Before April 20 After April 20

Full Meeting 21 $400 $450daily fees

Friday 7 $175 $225Saturday 6 $150 $200Sunday 5 $125 $175Wellness I 1 $25 $25Wellness II 1 $25 $25Wellness III 1 $25 $25

Total CE & Fee

AANA Non-Member Registration FeesR CEs Before April 20 After April 20

Full Meeting 21 $500 $550daily fees

Friday 7 $225 $275Saturday 6 $200 $250Sunday 5 $175 $225Wellness I 1 $25 $25Wellness II 1 $25 $25Wellness III 1 $25 $25

Total CE & Fee

Total Registration Fee (from above) $Sponsor-a-student $ALA-CRNA PAC Contribution $Total Fees $

Method of PaymentCheck EnclosedCredit Card (AMEX, MC or Visa):Card Number:Expiration: Billing Zip Code:Name on card:


Continued from page 21

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Experienced. Visionary. Proven Leadership.

Committed to infrastructural

stability and financial health through

diligence and fiscal conservatism.

6$0+1(71%-1$8(9:/)8(;<Education: BSN-University of Delaware MS-Medical College of Virginia

Employment: Clinician and Educator, Moffitt Cancer Center

[email protected]

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• AANA Region 7 Director 2008-2010• CRNA-PAC Committee 2008-2010• Chair, Government Relations Committee 2007-2008• Government Relations Committee 2003-2008• Nominating Committee 2004-2005 • Occupational Safety and Health Committee 2002-2003 • Adhoc Committee on Communications and Technology

2000-2001• Adhoc Annual Meeting Committee 1998-1999• Member of AANA since 1985

• President 2001-2002 • President-Elect 2007-2008, 2000-2001• Board of Directors 1995-1998, 2004-2007• Federal Political Director• Chair, Government Relations Committee• Website Committee Chair• Chair, FANA PAC• Finance Committee• Florida Nurses Association ARNP Task Force

Passion, Integrity and a Vision for the Future

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ing increasingly prevalent, every calorie counts. Perhaps this article has convinced you of the true health benefits of laughing and you are trying to imagine ways to incorporate more laughter into your day. Here are a few ideas. 1. Don’t take yourself too seriously. Remember, back to the beginning of this article. In the neuroanatomy of a laugh, the first step in initiating a good laugh involves letting your guard down. 2. Apparently, we all need to be watching funny movies. Almost every study that I found involved an experimental group watching a funny movie. Great things happened. 3. Do all things that will prime your body for laughter and improve your mood- get enough rest and sleep. Be well. References1. http://www.the-aps.org/press/journal/08/14.htm 2. Bennett, MP & Lengacher, CA. Humor and laughter may influence health I: his-tory and background. Evidence-based Complementary and Alternative Medicine. 2006 3(1):61-633. Berk L, Felten D, Tan S, Bittman, Westengard J, Modulation of neuroimmuneparameters during the eustress of humor-associated mirthfullaughter. Altern Ther Health Med 2001;7:62–72, 74–6.4. Berk L, Tan S, Fry W, Napier B, Lee J, Hubbard R, et al, Neuroendocrineand stress hormone changes during mirthful laughter. Am J Med Sci1989;298:391–6.5. Buchowski MS, Majchrzak KM, Chen Ky, Byrne DW, Bachorowski JA. (2007) Energy expenditure of genuine laughter. International Journal of Obesity 31 (1):131-7.6. Wild, B. Rodden, FA., Grodd, W., Ruch, W. (2003). Neural correlates of laugh-ter and humour. Brain. (126) 2121-2138.

MBM M o ntg o M e ry B u s i n e s sM a n a g e M e nt

MBM

www.ala-crna.org 27

In September, the ALANA retained Larry A. Vinson, MPA, CAE as the new Executive Director of the ALANA. Additionally, Larry's company, Group Management Services

was retained for association management services. Larry is the President of Group Man-agement Services, a professional association management company. GMS is a niche com-pany, serving trade and professional associations offering a complete suite of services and products for today’s association. GMS provides the administrative personnel, office space, computer hardware, software and business services to give ALANA the necessary support services required to meet their ever-growing obligations, responsibilities and needs to both members and the public.

Vinson earned a Masters of Public Administration from Auburn University at Montgomery in 1983. He received his Bachelor of Science degree from Auburn University in 1979, and earned the prestigious Certified Association Executive designation from the American Society of Association Executives in 1989.

Vinson has been involved in the association industry since 1979, serving as the chief lobbyist for the Alabama Asso-ciation of Realtors from 1980 – 1985, and the Alabama Hospital Association from 1985-1986. In 1986, he was named as President of the Southern Community Bankers before forming his management company in 1994.

Group Management Services currently employs four association management professions. Vinson is joined by his wife Karen, a graduate of Auburn University, Wendy Perry, a graduate of Jacksonville State University with a gradu-ate degree from Auburn University and Karissa Juday, a graduate of Auburn University of Montgomery.

Group Management Services provides office space, office equipment, mailing address, telephone service, daily ad-ministration of the office, point of contact for correspondence with the membership. The GMS team will maintain the membership database, administer Executive Committee and Board meetings, produce and conduct registration for the Annual Meetings, produce the newsletter, work with the webmaster to maintain the web site and keep ALANA’s books.

ALANA Hires Executive Director

Larry Vinson, CAE

Karen Vinson Wendy Perry Karissa Juday

Alabama Association of Nurse Anesthetists, Inc.Post Office Box 240757Montgomery, Alabama 36124

Prsrt. Std.U.S. Postage

PAIDPermit #275

Montgomery, AL

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