You have a way of making yourself believe that an MDA is looking over every drug that is pushed during a procedure and standing there while the AA is doing so...and you know that this is not true... yet you repeatedly state that it is fact. Competent means adequate;suitable;capable;sufficient. AA's are competent people. There AGAIN is your moot point. Because they have to work under an MDA does not make them incompetent. Secondly, if the only point that you can bring out of my whole post to rant about is the same mess that you have BEEN ranting on, then you obviously don't have too much to stand on. Why would any CRNA spend soo much time spinning in circles over the same crap.......oh, I know,...the same reason a dog licks himself.....because he can!!!