ith all 50 states and the District of Columbia in session, the amount of legislation affecting anesthesiology has increased from last year. Specifically the number of states that could remove physician involvement in the administration of anesthesia has increased. Connecticut, Illinois, New York, Pennsylvania and Utah are facing challenges to existing law that would weaken their laws governing the administration of anesthesia. State component societies in each of these states are actively opposing the legislation described below.

As introduced, Utah S.B. 45 would have removed physician oversight and granted prescriptive authority to nurse anesthetists who had completed an advanced course work in patient assessment, diagnosis, treatment and pharmacotherapeutics. The Utah Society of Anesthesiologists and Utah Medical Association (UMA) worked hard to remove such sections from the bill. As a result, the sponsor amended the bill to delete prescriptive authority and to retain physician oversight. Congratulations to the anesthesiologists in Utah and UMA on their success!

Connecticut law currently requires advanced-practice registered nurses (APRNs) to work in collaboration with a physician. Nurse anesthetists who prescribe and administer medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present. H.B. 7161 would remove both requirements to allow APRNs to work collaboratively with health care providers, which include audiologists, chiropractors, dentists, dental hygienists, podiatrists, radiographers, radiologic technologists, respiratory care practitioners and speech pathologists. The Connecticut Society of Anesthesiologists has submitted written comments in opposition to these changes.

As in previous years, legislation has been introduced in Pennsylvania and New York that would amend existing law in order to expand the scope of practice of a nurse anesthetist. In Pennsylvania, a nurse anesthetist would administer anesthesia in cooperation with a physician, dentist or podiatrist. S.B. 341 defines “cooperation” as each professional working together contributing expertise at his or her individual and respective levels of education and training. Nurse anesthetists would be under the overall direction of the chief or director of anesthesia services, provided that in situations or facilities where anesthesia services are not mandatory the nurse anesthetist would be under the overall direction of the physician, dentist or podiatrist responsible for the patient’s care. If the anesthesia team consists entirely of nonphysicians, the nurse anesthetist would have available, by physical presence or electronic communication, an anesthesiologist or consulting physician of the nurse anesthetist’s choice. The Pennsylvania Society of Anesthesiologists is closely monitoring this bill.

In New York, A.B. 5201 would codify into statute nurse anesthetist scope of practice, which is currently only found in the hospital and ambulatory surgical center regulations. Their scope of practice would include anesthetic induction, maintenance, emergence, postanesthesia care and pain management in collaboration with a physician and pursuant to a written practice agreement and practice protocol. Nurse anesthetists who successfully complete an anesthesia program, including an appropriate pharmacology component (or its equivalent), could prescribe drugs, devices and anesthetic agents. The practice protocol would reflect current accepted medical and nursing practice. Physicians would not enter into practice agreements with more than four nurse anesthetists who are not located on the same physical premises as the collaborating physician.

Lastly, legislation has been introduced that would amend the Illinois Nursing and Advanced Practice Nursing Act in order to remove physician involvement.

Wisconsin
Immediately following the opt-out by Governor Jim Doyle in June 2005, the Wisconsin Society of Anesthesiologists (WSA) challenged its validity by petitioning the medical board for a declaratory ruling that Wisconsin law requires physician supervision of nurse anesthetists. An administrative law judge recently issued a proposed decision and order regarding WSA’s petition. The judge’s recommendation, which is not binding at this time, would require physician supervision and direction of nurse anesthetists. The proposed recommendation, however, would allow nurse anesthetists who received a certificate to prescribe (advance-practice nurse prescriber) to work in a collaborative relationship with a physician. WSA has filed documents with the court objecting to the judge’s recommendations. WSA contends that while Wisconsin law allows those individuals holding such certificate to prescribe (APNP-CRNA) in collaboration with a physician, this law does not extend to the administration of anesthesia. Collaboration applies only to prescriptive authority. Once the judge reviews the objections and issues a final proposed decision, the medical board will issue a binding final decision and order.

Lisa Percy, J.D., manages state affairs for ASA’s Office of Governmental and Legal Affairs in Washington, D.C.