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Posted - August 25, 2010

Outcome of the Fiberoptic Endoscopic Evaluation of Swallowing Issue

Dear SHAV Board, SHAV PAC, SHAV Members and all of our esteemed FEES trained colleagues in the Commonwealth of Virginia:

On May 3, 2010, The Virginia Board of Audiology and Speech-Language Pathology (BASLP) received a joint position letter from Daniel W. Karakla, M.D., President of The Virginia Academy of Otolaryngology-Head and Neck Surgery representing members of the Virginia Society of Otolaryngology (VSO).  The letter stated “there was a question regarding whether functional endoscopic evaluation of swallowing (FEES) can be performed by speech-language pathologists independent of otolaryngologists-head and neck surgeons.” Therefore, the position of the VSO was “that patient safety and care will be compromised if speech-language pathologists perform FEES without otolaryngologist-head and neck surgeons’ supervision.”

The BASLP contacted ASHA to gather information on SLPs’ Scope of Practice for FEES and incidence rates for poor outcomes. On June 3, 2010, the BASLP met to discuss the issue during a regularly scheduled quarterly meeting. The meetings are posted on their web-site for public comment. There was a motion by the BASLP that “SLPs cannot perform FEES unless properly trained and in the presence of a physician.” This policy was posted on the BASLP website as Guidance Document 30-7.

This issue came to my attention on June 23rd when Janice Brannon, ASHA Director of State Special Initiatives called me. She informed me that ASHA was notified by concerned SLPs at Mary Washington Hospital of this policy statement. I began networking, emailing, and calling Janice Brannon, David Bailey (SHAV’s Lobbyist) our SHAV Board, SHAV PAC and interested SLPs from around the Commonwealth who perform FEES.

On July 14th, David Bailey had a meeting with Elaine Yeatts, Senior Policy Analyst and Leslie Knachel, Executive Director of BASLP to discuss our concerns with Guidance Document 30-7. He requested a public hearing. Ms. Knachel arranged a special hearing with the BASLP for public comment. Thank you David Bailey! SHAV and SLPs performing FEES owe you a debt of gratitude.

Via emails, two teleconferences and weeks of preparation and organization, we gathered many concerned SLPs who perform FEES. ASHA’s Janet Deppe wrote two letters of concern and support. I wrote two letters from SHAV and spoke with Leslie Knachel, Executive Director for the BASLP. Many of the SLP’s who could not attend the meeting wrote letters of concern and support to the BASLP including some otolaryngologists supporting SLP’s.

On August 11, 2010, the special meeting was held in reference to the Guidance Document 30-7.  Prior to public comment, the BASLP reviewed the history that led to the initial decision. Public comment followed. Our presenters who agreed to present for SHAV (although some are not Members of SHAV) were:

Lynda Lee Lunday, Sentara Obici Hospital, Suffolk
Frani Jamieson, INOVA Mt. Vernon Hospital, Alexandria
Catherine Reynolds, UVA Hospital, Charlottesville
Renee Bricker, UVA Hospital, Charlottesville
Lynne Fleming, UVA Hospital, Charlottesville.

Other presenters who came and spoke for the FEES cause were:

Susan Ward, Virginia Hospital & Health Association
Diane Rodil, Medical Facilities of America.

The BASLP members asked many questions. After all the comments were completed, the BASLP made a motion, which was seconded and the Guidance Document 30-7 was re-worded.  The new Guidance Document now states:

Policy on Fiberoptic Endoscopic Evaluation of Swallowing (FEES)    
It is the opinion of the Board of Audiology and Speech-Language Pathology that a speech-language pathologist (SLP), who is specially trained, may perform FEES pursuant to a physician order and under the general supervision of a physician provided there are protocols in place for emergency response.  An SLP is not authorized to possess or administer prescription drugs except as provided in § 54.1-3408B.     http://www.dhp.virginia.gov/aud/aud_guidelines.htm

SHAV and interested SLPs were invited to begin a dialogue with the VSO in order to continue with any regulation changes. Future meetings with the VSO will be held to ensure a joint and unified effort is formed to manage any additional regulation changes.

I want to thank everyone involved for your support.  I am very grateful for everyone who participated in developing this initial, successful response. I want to thank Janet Deppe and Janice Brannon from ASHA for their guidance and support. I would have been lost without David Bailey’s expertise on how to work within the political climate. I would like to thank the members of the Virginia Board of Audiology and Speech-Language Pathology for arranging this special meeting.  A special thank you for those who presented at the meeting as listed above and to those who sent letters and read the countless emails from me.

This just shows us that “Yes we can!” And we did!!

Scott D. Rankins, M.S., CCC-SLP
SHAV President