ALANA Candidates - Alabama Association of Nurse Anesthetists
advancing quality anesthesia care, serving our members, promoting the nurse anesthesia profession
I am pleased to announce that the ALANA membership approved the slate of candidates for the upcoming election at the
annual Spring Meeting in Sandestin.
As the Nominating Committee Chair, I would like to thank the members of the Nominating Committee and all of the
Board members for their help in assembling the ballot. I would also like to express my appreciation to the candidates who
have offered their time and experience to serve on the ALANA Board and work on behalf of the members and our great
profession. This year’s ballot consists of the following positions: President Elect, Vice President/Secretary, three Board of
Directors positions and a Nominating Committee Chair.
Look for more information on the slate of candidates in the next ALANA NewsBulletin. Also, please keep in mind that we
will be utilizing online voting for the upcoming election. Information regarding instructions for accessing the electronic
ballot will be delivered via email. Please be sure you have a valid email address on file with the AANA and ALANA.
Again, I am very pleased to offer this year’s slate of candidates. I encourage each and every member to take the time to
research and get to know the nominees and VOTE!
Nominating Committee Chair
Central Robin Holt
Nominating Committee Chair
Krista Pettus Niedermeier
As I cleaned out the family car this weekend
and removed bits and pieces of sand, sunscreen,
marine life, and sand castle tools, and I could
not help but reflect on the time that I recently
spent in Sandestin at the 2015 ALANA Spring
meeting. The Program Committee, Group
Management Services, and the ALANA Board
once again put together another very successful spring conference.
We had fantastic attendance, accomplished speakers, distinguished guests,
and the never disappointing world class facilities of the Hilton Sandestin
Golf and Beach Resort. The ultrasound-guided regional anesthesia workshop taught by Patrick Moss, CRNA, MS, APN was very successful and
anesthetists were able to further their knowledge of regional anesthesia
while incorporating the technology of ultrasound guidance. Friday morning began with Suzanne Wright, PhD, CRNA discussing doctoral education
and the afternoon concluded with attendees enjoying a beautiful sunset and
drinks on the deck. Saturday morning came refreshingly early with some
runners enjoying a brisk downpour during the 2nd Annual DesFlo Run and
then we kicked off the ALANA Business Meeting with a breakfast buffet to
feed those weary, damp runners. During our business meeting, we presented our new slate of ALANA candidates. Salima Mulji and the Nominating
Committee did a great job soliciting talented candidates for our
upcoming ballot. These individuals should be commended for their
willingness to lead and serve our profession.
I had the pleasure of recognizing our Federal Political Director, Amy Pfeil
Neimkin, DNP, MBA, CRNA for recently receiving the prestigious 2015
Daniel D. Vigness Federal Political Director Award at the AANA Mid-Year
Assembly in Washington . It is presented annually to an individual who has
made a significant contribution to the advancement of the national healthcare agenda of Certified Registered Nurse Anesthetists by coordinating
grassroots CRNA involvement at the state level or through special
contributions to the federal political process. Dr. Neimkin has been an
important and invaluable member of our state association for years and has
invested much of her time and treasure over the years advocating for our
The afternoon concluded with the famous ALANA beach party. The weather was a bit blustery and cloudy; nevertheless; the rain held off and the
show went on. The food was served, the drinks were cold, and the sand was
like sugar. Our little tikes were able to dig and scavenge for prize laden “sea
turtle” eggs, and the sandcastle competition between the UAB and Samford
anesthesia programs did not disappoint. The ALA-CRNA PAC held a very
successful event and raised thousands of dollars auctioning priceless items.
2 ALANA NewsBulletin •
Volume 33, Number 2
Alabama Association of Nurse Anesthetists
Post Office Box 240757 • Montgomery, Alabama 36124
Board of Directors
David Gay, CRNA, MSN, MNA
6615 Lubarrett Way
Mobile, AL 36695
Michael W. Humber, CRNA, DNP,
1816 Hardwood View Drive
Birmingham, AL. 35242
Heather Fields, CRNA, MBA, MSN
2330 Ridge Road
Opelika, Alabama 36804
Matt Hemrick, CRNA, MSN
709 Braddock Ave
Birmingham, AL 35213
Todd Hicks, CRNA, MNA
8600 Lenox Way
Montgomery, AL 36116
Jay Kendrick, CRNA, MSN
2529 Simpson Point Road
Grant, AL 35747
Lisa Vallely, CRNA, MSNA
4314 Boulder Lake Circle
Vestavia Hills, AL 35242
Trey S. Burg, CRNA, MNA
202 Pebble Creek Ln
Enterprise, Al. 36330
Lisa M. McKinley CRNA, MS
9900 Turtle Creek Lane South
Mobile, AL 36695
David Sloan, CRNA, MSN
125 Easy Street
Anniston, AL 36207
Bryan A. Wilbanks, CRNA, DNP
105 Shady Spring Drive
Harvest, AL 35749
Salima P. Mulji, CRNA, MNA
Nominating Committee Chair
1503 Scout Ridge Dr,
Birmingham, AL 35244
Christina Smyth, SRNA
UAB Student Representative
633 12th Street NW
Alabaster, AL 35007)
Aaron Smith, SRNA
Samford Student Representative
480 Walker Way
Pelham, AL 35124
Brad A. Hooks, CRNA, MSNA
Montgomery, AL 36117
Amy P. Neimkin, CRNA, DNP, MBA
Federal Political Director
368 Woodward Ct.
Birmingham, AL 35242
Government Relations Specialist
4120 Wall Street
Montgomery, AL 36106
Joe Knight, CRNA, JD
ALANA General Counsel
Kress Building, Suite 500
301 19th Street North
Birmingham, Alabama 35203
Larry Vinson, CAE, MPA
ALANA Executive Director
Post Office Box 240757
Montgomery, AL 36124
ALANA NewsBulletin Copyright 2015 • 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,
President’s Letter Continued
If you missed the beach party, make plans to attend next year. If you missed the PAC event, you can still make a difference
by enrolling in the ALA-CRNA PAC program.
Juan Quintana, CRNA, DNP, AANA President-Elect spoke Sunday morning and delivered the AANA update and gave
attendees an insightful, educational lesson on the cost effectiveness of anesthesia providers. If you missed the 2015
ALANA Spring meeting, make plans to attend next year. The destination meeting in Sandestin will be held April 22-24,
2016. It’s always a great time to get together with friends, co-workers, old classmates and peers from other states.
The weekend prior to the ALANA Spring meeting, a delegation of 10 CRNAs and 4 SRNAs attended the AANA Midyear
Assembly in Washington. Our team advocated for your profession with our Federally elected officials addressing issues
of importance on a national level. One of the main areas of focus this year was advocating for the authorization of all
advanced practice registered nurses in the Veterans Health Administration, including CRNAs, to practice as full-practice
providers. Your state association and profession were well represented and respectfully received in DC.
The ALANA held its annual CRNA Legislative Day in Montgomery on April the 8th. The Government Relations Committee, Susan Hansen, and Larry Vinson did a fantastic job of putting together a day that allowed our SRNAs to learn
about Civics 101 and the political process. State Representatives April Weaver and Elaine Beech addressed our group
and spoke about the importance of the political process and your professional career. Students were able to sit in on a
House Health Committee meeting and a Senate Health Committee meeting while in Montgomery. Peggy Benson, the
new Executive Officer for the Alabama Board of Nursing, spoke to the students while they enjoyed lunch in the Archives
building across from the State Capitol building. The ALANA Board of Directors and the Government Relations Committee continually engage our state officials on issues of importance to our profession and practice in the state. We continue
to grow and nurture relationships with our state’s elected officials. We have strong relationships with many influential
members in the Alabama Legislature, and we will continue to promote our long-standing profession with these important
members. If you or a family member have a connection to one of these very important elected individuals, please do your
part, and communicate this to your ALANA leadership. Your participation in promoting our profession with state political
leaders is vitally important.
As we head into the sun filled days of summer, the oppressive heat of July and August, the busy season of vacations and
summer break, please reflect on your career, your profession, and your future. I challenge each of you that read this to
look for tangible ways to give something back to your profession.
I’ve said it before and I’ll say it again. Be proud of your profession. Promote your profession. Protect your profession.
David Gay, MSN, MNA, CRNA
• Summer 2015
ALANA NewsBulletin 3
Postoperative opioid-induced respiratory depression
Anesthesiology 2015;122: 659–665
Lee LL, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB
The purpose of this study was to identify clinically relevant aspects of respiratory depression recorded in malpractice
insurance claims. The data source was the ASA closed claims project database.
Previous studies have identified a wide range for the incidence of respiratory depression during the first 24 hours
postoperatively, 0.1% to 37%, depending in part upon the definition of “respiratory depression.” When respiratory
depression was defined as the administration of naloxone, the incidence was low. When respiratory depression was
defined in terms of respiratory rate or oxygen saturation, the incidence was much higher.
A JCAHO review spanning eight years of data associated “wrong dose”medication errors with half the cases of respiratory
depression. The JCAHO subsequently recommended five steps to reduce the risk of postoperative respiratory depression
in patients receiving opioids, largely based upon expert opinion:
identify patients at high risk for opioid-induced respiratory depression
use non-opioid analgesics
emphasize assessment of patient sedation, ventilation, & oxygenation
educate healthcare providers who monitor for respiratory depression
institute a quality improvement process for respiratory depression incidents
Investigators evaluated 9,799 records from the ASA closed malpractice claims database. Claims involving acute pain
management and respiratory depression occurring between 1990 and 2009 were collected, 138 in all. The certainty that
respiratory depression was present was defined using the following criteria:
Definite respiratory depression:
patient received naloxone and respirations improved
Probable respiratory depression:
respiratory rate < 8/min
oxygen saturation <90% (unless abnormal baseline)
high opioid dose in patient not previously taking opioids
snoring, airway obstruction, cyanosis
Possible respiratory depression:
cardiac arrest not due to another cause and
risk factors for respiratory depression
4 ALANA NewsBulletin •
(continued on next page)
Abstract, continued from previous page
Patients who experienced respiratory depression received opioids via a spinal or epidural, IVPCA, or IM/IV bolus. Each
case was examined for factors that may have contributed to respiratory depression, such as:
Obstructive Sleep Apnea (diagnosed or high risk)
opioids given by multiple routes
multiple opioid prescribers simultaneously
history of chronic opioid use
time between last patient check and discovery of respiratory depression
Result Inclusion criteria were met by 92 records. Respiratory depression was classified as “definite” or“probable” in 73%
of patients. In general, patients with respiratory depression had a mean age of 50 years old and were obese; fully two-thirds
had a BMI ≥30 kg/m2. Obstructive Sleep Apnea was either diagnosed or a high risk in a quarter of the patients. About half
of patients received opioids by more than one route of administration, and about half were receiving a continuous infusion
of opioids. The vast majority of events involving respiratory depression occurred within the first 24 hours post-op.
Prior to a respiratory depression event, nursing assessments noted somnolence in 62% of patients and heavy snoring in
15% of patients. The time between the last nursing check and discovery of a respiratory depression event was not known
for all patients. When it was known, the time between the last nursing check and discovery of a respiratory depression
event was as brief as 15 minutes. It was 60 minutes or less in over half of patients. In the remainder of patients it was
between 1 hour and 5 hours (with one exception in which the patient was discovered in respiratory depression 8 hours after
the last nursing check). Nursing checks were judged by the panel of investigators as “inadequate” in about one-third of
patients based upon missing the importance of clinical signs (e.g. oxygen desaturation) or length of time between
nursing checks. In one case a patient was discovered obtunded and with an SpO2 of 49%. The only action taken was to
When respiratory depression occurred the severity of injury was high, death in 55% of patients and permanent brain
damage in 22%. Only 23% of patients recovered with temporary effects. The anesthesia care provided was classified as
“less than appropriate” by the investigators in 40% of patients. Almost all were likely preventable with improved care.
The vast majority of respiratory depression events in this study resulted in death/brain damage, occurred within 24 hours
post-op, and were preventable. Somnolence was usually observed prior to the respiratory depression event.
Respiratory depression that puts the patient at risk is difficult to study. This closed insurance claims study was a
reasonable effort, but it is important to point out that it does not tell us how often respiratory depression occurs or in how
many patients. It is only able to identify commonalities amongst patients who experienced a problem sufficient to result
in a malpractice insurance claim. Most of us probably believe that respiratory depression that results in significant risk to
patients is relatively rare; whether or not that is true is unknown. I do think we could demonstrate that respiratory
depression resulting in the deadly outcomes reported in this study is fairly rare. In anesthesia we have thankfully reached a
time when most of our quality improvement effort is directed at making uncommon complications even more uncommon.
We have an opportunity to do that when we consider respiratory depression. Why should we apply our efforts to make
respiratory depression even less common? Most cases of respiratory depression included in this study were preventable
using well-known principles. Is it even an anesthesia problem? The anesthesiologists who conducted this study judged
inappropriate anesthesia care to be a factor in 40% of the respiratory depression, so, yes, it is an anesthesia problem.
The authors did a good job of identifying procedures that can reduce the risk of respiratory depression, such as
identifying at-risk patients, using multimodal analgesia, improving patient assessment (monitoring by a person rather than
(continued on next page)
• Summer 2015
ALANA NewsBulletin 5
Anesthesia Abstract, continued
just a machine), and avoiding the administration of opioids by multiple routes simultaneously. I want to add one more
factor. I think in addition to assessing the patient we need to assess the abilities of those who care for our patients in the
PACU, the ICU, and on the ward. When I say “assess the abilities,” I’m not saying assess their intelligence, rather their
knowledge and how much time they have to apply that knowledge to the patient. Here is a story to illustrate my point,
the story that taught me this lesson.
I once did a long case that I knew would require high levels of analgesia for postoperative pain. To provide that analgesia
I used a sufentanil infusion as the basis of the anesthetic with enough inhalation agent to ensure amnesia and a muscle
relaxant. I had done many cases that way at a previous institution and had the timing down so patients would wake up
and breathe but have no pain. But this was the first time I’d done one in the OR I worked in at the time. The patient had
received enough sufentanil that I knew it wasn’t going to wear off for 2 - 3 hours. I took the patient to the PACU well
oxygenated and breathing deeply. In report, I told the PACU nurses about the technique I’d used and warned them that
if they gave any opioids in the PACU the patient would stop breathing. Everything was fine. I left and started my next
case. The PACU nurses gave the patient IV morphine. He had a respiratory arrest and was reintubated and placed on a
ventilator without harm. These PACU nurses were not dumb. They had simply not seen a case done as I had done that one.
They were unfamiliar with the pharmacokinetics of a sufentanil infusion. They knew all the patients who had that surgery
needed morphine in the PACU. I had failed to assess their knowledge, and I had not taken their experience and the PACU
culture into consideration. Fortunately, the patient suffered no harm.
Postoperative respiratory depression can be all but eliminated if we will be careful to consistently apply what we know
about preventing it. That includes taking time to educate the nursing staff and restraining ourselves from using techniques
that depend upon the nursing staff having knowledge and procedures they’ve not yet gained.
Michael A. Fiedler, PhD, CRNA
National Nosocomial Infection Surveillance System – is an ongoing collaborative surveillance system sponsored
by the Centers For Disease Control (CDC) to obtain national information specific to nosocomial infections. For
further information on the surveillance system see: Am J Infect Control. 1991;19:19-35 - National nosocomial
infections surveillance system (NNIS): description of surveillance methods
ANESTHESIA ABSTRACTS IS A PUBLICATION OF LIFELONG LEARNING, LLC © COPYRIGHT 2014
ISSN Number: 1938-7172
Provided as a service to the ALANA by Anesthesia Abstracts (www.AnesthesiaAbstracts.com)
Michael A. Fiedler, PhD, CRNA, Editor
6 ALANA NewsBulletin •
CRNAs on the Hill
Ray Dunn, Heather Rankin, Brittney Kilgore and Jay Kendrick
pose with Congressman Robert Aderholt (Center).
Emily Yeap, Salima Mulji, Congressman Gary Palmer, Brittany
Jones, Michael Humber and Amy Neimkin
Christina Smyth and Brittney Kilgore taking the CRNA
message to the Hill.
ALANA General Counsel Joe Knight addresses the
students on CRNA Day
Senate Majority Leader Greg Reed speaks to the SRNAs before
the Senate Health Committee meeting.
Terri Cahoon and Salima Mulji visit with Senator Jabo
Waggoner after the Committee meeting.
• Summer 2015
ALANA NewsBulletin 7
PEGGY SELLERS BENSON APPOINTED
The Alabama Board of Nursing has appointed Peggy Sellers Benson, RN, MSHA, MSN,
NE-BC, to the position of Executive Officer. A native of Dora, Mrs. Benson holds Bachelor of
Science degrees from the University of Alabama–Birmingham and Jacksonville State University (JSU) and Master of Science degrees from Kennedy Western University and JSU. She has
enjoyed a long and distinguished career in health administration and professional nursing in the state of Alabama.Mrs.
Benson served as a member of the Board of Nursing from 2001 to 2004, occupying the position of Board President in
2004. She has been employed with the Board since 2012, serving as the agency’s Deputy Director from May 2013 to the
present. She assumed the duties of Interim Executive Officer in December 2014.
Board President Francine Parker, EdD, MSN, RN, said, “I am very pleased with the Board’s decision to appoint Mrs.
Benson Executive Officer. Peggy is a consummate professional and is recognized throughout Alabama and the United
States as a leader in our profession. We were very fortunate to have the ideal candidate already on staff at the Board.”
Mrs. Benson lives in Clanton. She and her husband, Harold, have four children and two grandchildren.
Further information on nursing practice and education in Alabama may be found at www.abn.alabama.gov.
Medical Business Management
“CRNA Billing Specialist”
Contact: Joe Gribbin
1025 Montgomery Highway, Suite 100
Birmingham, AL 35216
8 ALANA NewsBulletin •
By Lisa McKinley CRNA, MS
This year’s legislative session is underway and bustling
with activity. Thank you to many of my colleagues, for
your time, efforts, and donations to the PAC in 2014. Your
contributions were essential in supporting the 2014 candidates.
email and/or mail. The old system
ceased to exist as of May 16th,
2015. Again, please bear with us
as we navigate through this
Your ALA-CRNA PAC supports political candidates and
the political process which in turn promotes the Alabama
Nurse Anesthesia Profession, Practice and Education. The
PAC is non-partisan and strategically donates to campaigns
of candidates who have proven to be friendly to the issues
and concerns of Alabama Nurse Anesthetists. Your contributions continue to allow us a
voice within our state’s legislative
process. And it is a powerful voice.
To hear one of our legislators say,
“what do the nurse anesthetists say
about this?” proves that we are sitting at the decision table. There is
a saying in politics, “if you’re not
sitting at the table, you may be the
meal on the table.”
In the near future, on the updated
ALANA web site, you will be able to directly make a PAC
contribution. Soon, the ALA-CRNA PAC will recognize
both CRNAs and SRNAs for annual donation levels as
*Platinum: CRNA donation of
$300 or more
*Gold: CRNA donation of
*Silver: CRNA donation of
*Bronze Plus: SRNA donation of
$60 or more
*Bronze: SRNA donation of
Your ALA-CRNA PAC has undergone some major changes
this year. We have updated our logo (see above), updated
our credit card processing system, and are in the process of
revamping our annual donation levels.
We are now using Moneris as our credit card processing
system. We have received improved fees and better service. In the past we have not had a system in place to contact donors of expired credit cards. With Moneris, an email
will be generated to inform the merchant of an upcoming
expiration date. Currently, with the older system there were
several expired credit cards. Those with expired cards were
unaware that they were no longer contributing. A letter has
been generated and sent to those individuals. Please bear
with us as we navigate through the transition process. We
are also attempting to transition our current $1/more a day
recurrent donors from the old system to the new system.
This includes 45 individuals and represents a significant
portion of the PAC funds. If the transition proves to be successful the date the funds are pulled will continue to be the
10th of the month. You will see the payment change from
MES*ALA-CRNA PAC to ALA-CRNA PAC. If the transition is unsuccessful we will address those individuals via
Our spring meeting in Destin tends to be the largest
generator of PAC funds. This year we had 8 CRNAs sign
up for $1 or more a day recurring donations and 7 SRNAs
sign up for our dime-a-day program. In addition, our raffle
and auction brought in $6,160. We are off to a great start!
However, your ALA-CRNA PAC still needs you! Please
contact Susan Hansen to make your PAC contribution:
Susan Hansen, Franklin Resources Group
4120 Wall Street, Montgomery, AL 36106
334-244-2187 - Office - Email - [email protected]
As ALANA President David Gay says, “it’s a great time to
be a CRNA.” Please help promote and protect this great
profession. It is an honor to serve the ALANA membership.
Please contact me with any questions.
Lisa McKinley CRNA, MS
ALANA Board of Directors
Chair - Political Action Committee
• Summer 2015
ALANA NewsBulletin 9
Spring Meeting 2015
The Regional UltraSound Class was a sell-out!
We had 26 exhibitors this year showcasing lots of products
and services for CRNAs.
Drinks on the Deck is a great way to end the day, or start the
Team UAB won the Sandcastle Contest. That evens the score
at one to one.
10 ALANA NewsBulletin •
Okay, okay, okay – they weren’t digging for real sea turtle eggs,
Larry Hornsby wins the YETI Package as Farlie Templeton
emcees the auction.
Spring Meeting 2015
ALANA Programs Co-Chair Bryan Wilbanks addresses
Donna Dryden and David Gay visit between sessions.
ALANA Governmental Affairs Representative Susan Hansen
and emcee Farlie Templeton pulling Raffle winners.
ALANA Program Co-Chair Todd Hicks and UAB Student Rep
Christina Smyth pose with Speaker Dr. Scott Augustine.
Amy Neimkin, Heather Rankin and Kerry Gossett visit with
Juan Quintana, AANA President-Elect.
The Beach Party is always a hit.
• Summer 2015
ALANA NewsBulletin 11
Neimkin Wins AANA Award
Please take a moment to congratulate Amy Pfeil Neimkin, DNP, MBA, CRNA
on receiving the prestigious 2015 Daniel D. Vigness Federal Political Director
Award. The Federal Political Director of the Year Award, established in 2001,
was renamed the Daniel D. Vigness Federal Political Director Award in 2013 in
tribute and memory of its first winner, Dan Vigness. Dan was an active
member of the South Dakota Association of Nurse Anesthetists (SDANA) and
in his memory, SDANA is funding the crystal award for ten years.
It is presented annually to an individual who has made a significant
contribution to the advancement of the national healthcare agenda of
Certified Registered Nurse Anesthetists (CRNAs) by coordinating grassroots
CRNA involvement at the state level or through special contributions to the
federal political process.
Amy has been an important and invaluable member of our state association
for years and has invested much of her time and treasure over the years
advocating for our great profession.
She received the award at the Mid Year Assembly in Washington, D.C. in April.
Congratulations Amy! We are so proud of you.
August 29-September 1, 2015 Nurse Anesthesia Annual Congress
(Formerly AANA Annual Meeting)
Salt Lake City, Utah
October 16 - 18, 2015
ALANA Fall Meeting
Ross Bridge Resort
April 22-24, 2016
ALANA Spring Meeting