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

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

Here’s a Way to Shore Up State Employee Pensions: Sell Unneeded State Assets

The State of Oklahoma owns a lot of property. This includes land and buildings, but it also includes valuable assets like the state-owned electric power company, the Grand River Dam Authority (GRDA). GRDA reports nearly $1.8 billion in assets on its most recent balance sheet , with a “net position” of more than $622 million. Or the Tobacco Settlement Endowment Trust (TSET), which sits on a $1.2 billion endowment that does nothing but sit and produce investment income to fund the yearly operations of TSET. To the tune of roughly $50 million per year . We would all most likely be better off if some (probably most) of these assets were sold or leased to private entities where they could (1) be put to more economically productive use, (2) be put on the tax rolls (they are not taxed now), and (3) relieve the state from the burden of maintenance and operations expenses. What’s more, such an asset sale/lease (a “monetization”) would generate a large financial windfall for the stat...
Read more

COVID-19 Proves Our Schools Are Social Service Centers First, Education Institutions Second

There is no way the 180-day (or 1,080 hours) school year can be completed by the end of previously established school calendars for this year given the fact that spring break has now already been effectively extended an additional two weeks. One option would have been to extend the school year into the summer. Given the level of family togetherness being experienced now, and the fact that incomes are being lost and many would be interested in making up the losses, it’s not unreasonable to expect vacation plans to be radically remade or canceled anyway. Instead, Oklahoma’s State Board of Education precipitously closed the schools and did not call for an extension of end-of-school dates. Thus, the summer option has been foreclosed. The State Board is within its rights. Oklahoma statutes (70 O.S. § 1-109 E) state, “A school district may maintain school for less than a full school year only when conditions beyond the control of school authorities make the maintenance of the term imp...
Read more

Follow the Science: Eliminate Social Distancing and Focus Resources to Protect the Vulnerable

As the country entered into an election year, COVID-19 reared its head and became an unusual campaign issue. Exposed to extreme politization, facts were buried in an abundance of misinformation perpetuated by the invocation of “science.” With the overly polarized rhetoric of stump speeches mercifully behind us, it is time to return to the rigor and integrity in research that public policy deserves. Now that the polls have closed, let’s move on, dig into the facts, and, indeed, follow the science.   Upon the outbreak of the novel coronavirus, SARS-CoV-2 and the COVID-19 illness, little was known about it. Symptomatically, it was even difficult to tell whether or not one had the disease given that the list of symptoms seemed to expand continually. Despite what little information existed, there was no lack of self-proclaimed experts claiming the knowledge necessary to contain the disease. With the state's presumptive authority and dubious expertise, numerous state and local governmen...
Read more