First you should find a surgeon who is willing and able to put your PD in under local anesthesia.
Once you have this surgeons name and contact information then you can file a written request to have her do your surgery.
Make sure to include in your letter the reasons you desire your PD to be place under local rather then general anesthesia.
Of course if placement of your PD catheter is time critical you may not have the luxury of waiting for the appeals process to work in your favor.
Another option, of course, would be go have a private surgeon do this for you....but I can imagine that this would be fairly expensive.
Does this make sense to you?
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Dr. Rick MD FACS
I was typing when you just posted ;-)