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

Even If Pandemic Models Were Right, Were Covid Lockdowns Wrong?

1889 has been quite critical of pandemic modeling that government officials have relied on for their Covid-19 response. We have also criticized shutdown orders in light of flaws in the models. But let’s assume for a moment that the worst predictions really would have come true if nothing was done. Even in those worst case scenarios, it’s fair to ask if our governments did the right thing. Were involuntary shutdowns justified, or would people have found a way to both limit the contagion and maintain some level of productivity? Was putting healthy citizens under house arrest acceptable even if they were willing to risk infection?   While large groups of people are often compared to herd animals, we are not sheep. We don’t behave like animals. We can, have, and will step up when our communities are in danger. When government and journalists give incomplete or false information, people will act irrationally. Depending on the situation, some will blindly follow the first aut...
Read more

About Those Roads in Texas

A s Sooner fans head south for the OU-Texas game next week, they will encounter a phenomenon most of us are familiar with: as you cruise across the Red River suddenly the road gets noticeably smoother. The painted lane stripes get a little brighter and the roadside “Welcome to Texas” visitors’ center gleams in the sunlight, a modern and well-maintained reminder of how much more money the Lonestar State spends on public infrastructure than little old Oklahoma. Or does it? Why are the roads so much, well… better in Texas? Turns out, it isn’t the amount of money spent, at least not when compared to the overall size of the state’s economy and personal income of its inhabitants. Research conducted by 1889 Institute’s Byron Schlomach reveals that Oklahoma actually spends significantly more on roads than Texas as a percentage of both state GDP and personal income . And that was data from 2016, before Oklahoma’s tax and spending increases of recent years. The gap is likely gr...
Read more

Played for Chumps: The Waste and the Trap that Is MAPS 4

If you own a business and an employee constantly shows incompetence, are you likely to give that incompetent a raise, or promote him to a management position? Obviously, there’s no way. Yet, this is what Oklahoma City’s residents are being asked to do, by passing a 1-cent sales tax for a fourth round of Metropolitan Area Projects (MAPS). These are projects that have a history of being seen, but not really making much of a positive difference in most Oklahoma City residents’ lives. Oklahoma City’s voters should politely decline the “opportunity.” Oklahoma City’s government often demonstrates incompetence in providing basic city services. Take traffic management, for example. There was a period of time when my own commute on Northwest Expressway was interrupted repeatedly – three times in one week at one point – by malfunctioning traffic lights. The flashing lights turned a controlled intersection into a 4-way stop and traffic on the Expressway backed up for almost a mile, unexpecte...
Read more

George Floyd versus Union Cops: Is that the Real Story?

No one with a brain can look at the video of the Minneapolis cops putting their weight on George Floyd’s entire body, including a knee to his neck, and see his resulting death as anything but murder. The first autopsy cited pre-existing health conditions as a contributing factor in Floyd’s death. The second autopsy found Floyd’s death to be murder due to his carotid artery being crushed, cutting off blood flow to his brain. The official coroner seems to have come around to the murder conclusion, but regardless, those cops killed a man for passing a counterfeit 20-dollar bill; and because he’s dead, we can’t even find out if Floyd knowingly did so. Were the cops indifferent to Floyd’s pain because of racism? I don’t know, and no one else does, either. The cop with his knee on Floyd’s neck is obviously responsible for Floyd’s death. The other cops, who did nothing to alleviate Floyd’s suffering when he complained that he couldn’t breathe, are at least culpable in the murder. Three of the...
Read more