Skip to main content

Perfusionist (What’s That?) Licensing: Making Heart Surgery More Dangerous


Do you know what a perfusionist is? I didn’t, either, but it’s one of the many occupations that are licensed in the State of Oklahoma. However, we at the 1889 Institute are gradually looking into each licensed occupation to learn if there is justification for forcing people to ask the government’s permission to earn money doing it. So, we got curious about these perfusionists, about which we knew nothing, and why they are licensed (our report).

It came as no surprise that perfusionists use their skills in medicine. Nearly every occupation involved in medicine, other than custodians, especially in Oklahoma, is licensed. Yet, the majority of states do not license perfusionists. Perfusionists do perform an important service. They monitor and operate the machines that regulate blood and air flow of patients having heart surgery.

And perfusionists have accidentally killed people, sometimes due to something as simple as failing to notice a kinked hose.

We have previously reviewed 11 other occupations licensed in Oklahoma, asking two simple questions. First, is it likely people will be significantly harmed if the occupation is not practiced properly? Second, is there some reason markets and civil law fail to protect people? We have answered “No” to both of these questions 11 times. And, only if the answer to both questions is “Yes” would we determine that licensing is justified.

But this time, the answer to the first question is clearly “Yes.” Patients lying on an operating room table, under anesthesia, with a heart stopped and undergoing dissection, are clearly vulnerable if the person charged with keeping the blood flowing and oxygenated neglects that important work.

Nevertheless, the answer to the second question is clearly “No.” If there were some kind of inherent market and/or legal failure, surely all fifty states, rather than a minority, would require individuals to ask permission to be a perfusionist through licensing. Why isn’t this the case?

The answer is that people are already essentially asking permission to act as perfusionists. Surgeons select the perfusionists with whom they work, and surgeons are the ultimate authorities facing potential liability should something go wrong in the operating room. That liability is a much stronger motive for selecting skilled, attentive perfusionists than any motive a licensing board will ever have, since the board faces no consequences at all.

Two facts expose the lie that licensing perfusionists in Oklahoma was ever about public safety. First, the licensing law included a grandfather provision, which made it easy for any bad actor already working as a perfusionist at the time to continue doing so. Second, there are so few perfusionists in Oklahoma and nationwide that they are often in the operating room exhausted and lacking sleep after attending too many surgeries. At least one expert believes the vast majority of perfusionist errors are due to fatigue and stress.

Licensing only makes perfusionists scarcer, especially since the nearest training program to Oklahoma is in Houston, Texas. That artificially limited supply helps to explain why perfusionists, who average more than $120k per year, are worth the money they earn. That scarcity, partly caused by licensing, also explains why patients are at risk from groggy, over-worked perfusionists.

Byron Schlomach is Director of the 1889 Institute and can be reached at bschlomach@1889institute.org.


Popular posts from this blog

When It Comes to the Cox Center, “What if I Get to Meet a Movie Star?” Isn’t Good Enough

In a recent   post , 1889 Institute expounded on the fiduciary duty of elected officials “to act in the best interest of the people of the state as a whole,” a “high duty, executed as a public trust … wherein one puts the people’s interest above one’s own.” This fiduciary duty must not stop with elected officials. Once an elected body or an elected official – the legislature, a city council, the governor, or a mayor – has taken final action, the faithful implementation of each enacted law, policy, or program falls to an army of bureaucrats. Thus, a fiduciary duty to execute laws and policies with diligence and integrity, tantamount to that of elected officials, must extend to government employees. Recently, I had a few moments to sit down and watch a show with my children. Unsurprisingly, my son picked a series entitled “The Stinky and Dirty Show.” I was naturally skeptical that the show would yield any real value. However, as I watched, I found myself pleasantly surprised. Each ep...
Read more

Be Careful What You Wish For

The state of Oklahoma has California in its sight s . People and businesses seeking greater opportunity are fleeing California, and justifiably so. The most humane thing for Oklahoma to do is open our borders and offer economic asylum to the oppressed refugees of the People’s Republic of California. However, I urge caution. In an age dominated by masked faces and super-sensitivity to the spread of viral conditions, I suggest the California Condition (condition) should be met with great trepidation.   What is the condition? It is the virulent spread of tyranny and oppression. Common symptoms include limited freedom and mobility accompanied by exorbitant costs of living, energy, doing business, and pretty much everything else. Those suffering under the condition often experience a diminished capacity for reason. Uncommon symptoms may include fever and fits of rage. The condition is progressive. It tends to worsen as reason diminishes and illogic consumes the mind. Many that experienc...
Read more

OG&E and the Corporation Commission Aren’t Doing Their Jobs

At the time of this writing, it’s been a full week since there was power at my home. I live within OG&E’s electrical grid, so when it comes to being without power this past week, I’m nothing special. Many of OG&E’s customers had no power for days, and some will have no power for well over a week. By the time power is restored to everyone in their service area, OG&E’s own estimate is that it will have taken ten full days to repair all the damage from Oklahoma’s latest ice storm. Ice storms are bears, no doubt about it. They are very hard on trees, and if the roads ice over, they are very hard on cars. But roads, for the most part, were not an issue during Oklahoma’s “Icemageddon” of 2020. The problem was the extra weight of the ice on trees, wires and poles. And what we discovered was that Oklahoma’s electric power grid, once again, was not up to the challenge. Fact is, Oklahoma’s power grid isn’t up to much of Oklahoma’s weather. Every time the electricity goes out, which ...
Read more

The Legislators in Black Robes Strike Again

Once again, the Oklahoma Supreme Court has usurped the Legislature’s constitutional authority. This time, it has legislated new election rules, behind closed doors, on a compressed timetable, and without public input. All with an election looming in which the new rules will apply. On Monday, the Court eliminated the requirement that citizens voting by absentee ballot have their identity verified by a notary. If left unaddressed by the Legislature, absentee voters will be permitted to vote with little more than a pinky-swear promise that they are who they say they are, while in-person voters will still be required to show ID at the polling place. The Court’s decision not only harms the integrity of our election process, but was arrived at through a highly unusual process. The legal challenge to the notarization requirement was launched by a coalition of progressive organizations calling themselves “Let the People Vote.” Their stated reasoning for allowing unverified voting is...
Read more