A legislative committee has failed to settle a turf battle between doctors and nurses over treatment for chronic pain. At issue is the Board of Medicine’s decision to prohibit nurse anesthetists  from using an x-ray machine to monitor pain relief injections near the spine. Critics say it hurts rural hospitals, which find it difficult to keep anesthesiologists on staff.

Ginny Wangerin is the President of the Iowa Nurses Association, which opposes the restriction. “We believe that these rules will only serve to decrease access and to increase cost by limiting reasonable services that are provided by proven practitioners who have practiced safely for decades,” she says. But Dr. Patrick Allair, an anesthesiologist from Ames, says the restriction is long overdue.

“There is sort of a Wild West mentality that occurs in some locations — not widespread — where patients are not receiving a thorough evaluation of their problem prior to being referred to a ‘pain clinic,’” Allair says. Physicians like Allair argue injecting pain relief near the spine is a complicated procedure that requires a higher level of education and training.

Mark Bowden, executive director of the Board of Medicine, says their objective is to set standards before injuries occur. “You don’t put up the stop signs after the crash,” he says. “You put of stops signs to avoid crashes.” The Iowa Hospital Association argues the policy is unwarranted and will reduce treatment options in rural Iowa. Senator Tom Courtney, a Democrat from Burlington, agrees.

“It just seems to me that if someone were getting hurt, we’d have real complaints from real people,” Courtney says. There’ll be a court battle on this issue. The Legislature’s Administrative Rules Review Committee voted five-to-four to object to the Board of Medicine’s policy, but needed six votes to have that objection recognized by the court. The Iowa Medical Society and Iowa Society of Anesthesiologists recently filed lawsuits to block nurses from using x-ray equipment during pain injections.