Nursing Board Authorizes Nurse Anesthetists to Practice Pain Management Procedures

Lisa Percy, J.D., Manager
State Legislative and Regulatory Affairs


he Louisiana State Nursing Board adopted a statement that authorizes nurse anesthetists to practice “pain management” procedures. A nurse anesthetist petitioned the nursing board to issue an advisory opinion on whether it is within the scope of practice of a nurse anesthetist to administer certain pain management procedures. The nursing board addressed this issue at its meeting in December. In spite of the objections by two nonvoting physician members, the nursing board unanimously followed its practice committee recommendation and authorized a nurse anesthetist “to perform pain management procedures, including but not limited to, peripheral nerve blocks, epidural injections, and spinal facet joint injections when the CRNA can document education, training, and experience in such procedures and has the knowledge, skills, and abilities to perform the procedures based on a physician’s order.”

The Spine Diagnostic Center of Baton Rouge (The Center) brought a lawsuit that seeks an injunction to prevent the nurse anesthetist from continuing pain management procedures. The lawsuit also seeks a declaratory statement that “pain management procedures” constitute the practice of medicine and that the nursing board exceeded its authority in authorizing nurse anesthetists to practice these procedures. A complaint also has been filed with the medical board against the nurse anesthetists for unauthorized practice of medicine. The Center also petitioned the nursing board to repeal or amend its ruling.

The lawsuit contends that the nursing board has allowed nurses to practice medicine in violation of the Medical Practice Act. The Center refers to the medical board’s opinion that the administration of regional anesthesia (including intrathecal, extrathecal, epidural and peridural nerve injections) constitutes “the practice of medicine” and may be performed only by a physician or under the personal direction and immediate (on-premises) supervision of a physician.

Subsequent to the filing of this lawsuit, the medical board issued an advisory statement on interventional pain management. The opinion states that “the injection of local anesthetics, steroids, and analgesics, peripheral nerve blocks, epidural injections and spinal facet joint injections when used for interventional pain management of patients suffering from chronic pain, constitutes the practice of medicine and may only be performed by a physician ….” The medical board disagreed with the nursing board’s conclusion that interventional pain management is within the scope of practice of a nurse anesthetist. To allow a nurse anesthetist to diagnose, manage or treat chronic pain patients would permit the nurse anesthetist “to exercise independent medical judgment, perform diagnostic testing, render diagnoses, and provide treatment or recommendations for treatment of patients suffering with chronic pain.” The opinion concludes that such determinations are reserved solely to physicians and are not “delegable to a non-physician by physician prescription, direction or supervision.”

A hearing on the injunction was heard on January 30-31, at which time the Louisiana Society of Anesthesiologists, American Society of Interventional Pain Physicians and ASA submitted documents opposing the nursing board’s statement.

Kansas — Legislation titled the “Pain Patient’s Bill of Rights” has been introduced into the Kansas Legislature. H.B. 2649 would provide that all Kansans have their pain thoroughly assessed and promptly treated. Pain patients would actively participate in decisions concerning how to manage their pain and could refuse a particular type of treatment. Patients who suffer from moderate to severe pain could request or reject the use of any or all modalities to relieve pain and could choose from appropriate pharmacologic treatment options to relieve such pain without submitting first to an invasive medical procedure.

Office-Based Surgery
Tennessee — The Tennessee Hospital Association (THA) submitted a Petition for a Declaratory Order from the medical board in order to have the office-based surgery rules declared invalid. THA argues that the board exceeded its statutory authority when it promulgated the rules. THA challenged the rules upon approval by the state attorney general and before its October 2005 effective date. The court dismissed the lawsuit at that time on the grounds that THA had not yet exhausted its administrative remedies as required by the Uniform Administrative Procedures Act. In response, THA has sought a declaratory order. A hearing before the medical board to discuss this petition was held in late January.