The Israel Anesthesiology Society has written a furious letter to Health Minister Ya'acov Ben-Yizri and Finance Minister Ronnie Bar-On saying its members "will not participate in training nurses to give anesthesia or authorize their activities in operating rooms under our authority." The letter, released on Sunday, followed the signing of an agreement on August 6 between the two ministers to allow nurses to administer anesthesiology under some conditions. The agreement was kept from the public and its existence was denied by Health Ministry spokeswoman Einav Shimron-Greenbaum on Thursday. Under the agreement, it was decided to "expand the authority of nurses to allow them to give anesthesia in medical procedures after they pass professional training and meet professional conditions that will be defined. The health minister will anchor the change as secondary legislation, and everything needed to establish this in primary legislation will be carried out by October 30, 2008." The Israel Anesthesiology Society's letter of protest was signed by 28 directors of hospital anesthesiology departments. "The field of anesthesiology is very complex, and any error can cause serious harm to health and even death. Any compromise on the quality of professional training of those who work in anesthesiology will endanger patientsâ€š lives," they wrote. The signatories wrote that they would refuse to cooperate in the training of nurses to give anesthesia and not allow them to participate in procedures in their departments. They demanded that the ministers consider proposals submitted by the society to increase the number of physicians who specialize in anesthesiology. A few months ago, Health Ministry director-general Prof. Avi Yisraeli issued a circular expanding the authority of nurses in certain fields, such as counselling diabetics, and a press release to that effect was released by the office of the previous ministry spokeswoman. Not long ago, Yisraeli stated categorically to a Knesset committee that he opposed the expansion of nurses' authority to include anesthesiology. The director-general declined Sunday to comment on his minister's new initiative or whether he was consulted on it. Asked why her office had denied Thursday that the ministry had decided to expand the responsibility of nursing to anesthesiological procedures, Shimron-Greenbaum said she had not been told of the agreement. She said anything to do with Ben-Yizri must be referred to his personal spokesman, Tal Harel. Harel did not deny that his minister had signed the agreement with Bar-On, but added that "nothing will be done without consultation with the anesthesiologists and the nurses. Yet there is an urgent need to find a solution to the serious shortage of anesthesiologists." Asked why he had not informed the press and the public of the Ben-Yizri/Bar-On agreement, Harel said: "I, the minister's personal spokesman, decide on whether and when to issue press releases regarding the minister. The ministry's spokeswoman does not know and is not informed about every action taken by the minister. We saw no reason to inform the public about this matter." The shortage of anesthesiologists has been known for several years. The number of medical graduates who decide to go into the specialty and spend years studying the subject has sharply declined because there is little opportunity to earn extra money in private practice, the irregular work hours and the potential for lawsuits. As a result, elective surgery is sometimes postponed due to the lack of an anesthesiologist, and in the future, some tests and other procedures that require one may have to be performed without anesthesia. In the US, a similar shortage has led to nurses being trained as nurse-anesthetists to perform the more simple procedures, but many physician-anesthesiologists there have strongly opposed the expansion of the nurses' responsibilities. Israeli anesthesiologists have urged financial and other incentives to encourage more doctors to go into the field, but the Treasury preferred to give nurses the right to do some of their work because they are cheaper than physicians. The fact that the ministry's director-general opposes the move, while Ben-Yizri acceded to the Treasury's demands, is seen by many as evidence of an increasing tendency by Ben-Yizri to reach decisions under pressure from the Treasury, without consulting ministry professionals or while acting against their advice. Shoshana Riba, the ministry's chief of nursing, is abroad and could not be reached for comment.