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

Oklahoma Mayors Acted Unlawfully With COVID-19 Orders

In response to COVID-19, the mayors of Oklahoma’s three largest cities subjected their citizens to draconian shelter in place orders, restricting their freedom, damaging them financially, and undermining their constitutional rights. The mayoral decrees were more restrictive than those of the Governor, and in significant ways contradicted his policy. To this day, city-mandated social distancing rules remain in place in Oklahoma City, Tulsa, and Norman that are not required by the state’s reopening plan. The mayors claim that where their rules are more restrictive than the state’s, the city rules apply. Was any of this unilateral mayoral activity legally valid? For the reasons examined in my paper published today, An Argument Oklahoma’s Mayors Acted Unlawfully During COVID-19 , the short answer is no. (A summary of the paper can be found here .) A close examination of relevant city ordinances and state laws governing the mayors’ COVID-19 decrees forces the conclusion tha...
Read more

One More Suburban Draw: A Black Lives Matter Chapter in Every Oklahoma City School

“You don’t want to live in the Oklahoma City school district.” That was the universal advice I got from everyone I talked to in Oklahoma when I moved from Phoenix with my wife and son, who had a couple of years of high school left to complete. The clear and simple message was that Oklahoma City district schools were pitiful and should be avoided at all costs. You’d think that with a reputation like this, the last thing on the mind of the superintendent of Oklahoma City district schools would be to make sure every school has a Black Lives Matter chapter, but you’d be wrong. I happened to see a recent meeting of the Oklahoma City school board, and that is exactly what the superintendent, Sean McDaniel, said, that he wanted to make sure every campus had a BLM chapter. You’d think that OKC district leaders would be concerned about academics, student motivation, and how to hold both students and educators more accountable for attaining what most people think schools are for – decent educat...
Read more

Lack of Action from Oklahoma’s Occupational Licensing Advisory Commission

Apparently, if you’re a legislator in Oklahoma and want to look like you’re doing something about an issue while not actually doing anything at all, you pass a bill to create a commission to study the issue. At least, that’s how the Oklahoma Occupational Licensing Advisory Commission (LAC) has operated so far. According to a study I did while at the Goldwater Institute, Oklahoma ranked as the 24 th most-licensed state. A study by the Institute for Justice ranked Oklahoma 35 th in how broadly and onerous its licensing laws are. But these, and similar studies, are really just counts of how many occupations states license, so they leave out a lot of nuance. The Institute for Justice’s report does add some nuance, reporting that by its standard of measure, Oklahoma ranks 18 th in how burdensome are its licensing laws. That is an important piece of information. On the one hand, according to the Institute for Justice, Oklahoma’s licensing laws cover fewer occupations than in ma...
Read more

OKC Public Schools Elevating a Privileged Elite over Oklahoma Taxpayers

The hypocrisy of the Soviet Union’s pretense of egalitarianism was well known enough to be the subject of mockery and parody. Ronald Reagan never tired of the jokes . Soviet communism espoused equality, but the reality is that party apparatchiks and government officials enjoyed special perks that no one else had access to. This special class wasn’t officially paid much more than the average skilled worker, but enjoyed privileges like dachas on the coast or countryside, special stores with imported goods and without the endless lines that were commonplace everywhere else, and more advanced medical treatment. For all their talk about eliminating class distinctions, the Soviet nomenklatura —those “doing the people’s work”—could feather their nest with the best of ‘em. Apparently, a similar attitude reigns in our government schools. Our friends at OCPA report that Oklahoma City Public Schools (OKCPS) will not offer in-person instruction to students for the first nine weeks of school this ...
Read more