2013 was a busy year for state-level legislative, regulatory and legal efforts affecting the medical specialty of anesthesiology. The Department of State Affairs is already gearing up for 2014 and reviewing what happened in 2013 is the perfect place to begin.
States with legislation that would require physician supervision of anesthesia included New Jersey, New York, North Carolina, Pennsylvania and Tennessee. Additionally, many states considered Truth in Advertising legislation with Maine, Maryland, Nevada and Texas seeing their Truth in Advertising bills signed into law earlier this year. It is exciting to see so many states finding success with this legislation that helps keep patients informed about the health care professionals providing their care.
Several states, including California, Indiana, Kentucky, New Mexico, New York, Oregon, Texas and Utah considered anesthesiologist assistant (AA) legislation. Colorado implemented regulations regarding the licensure of AAs earlier this year.
Nurse anesthetists are an important part of the anesthesia care team, and it has been disconcerting to see efforts in some states to remove nurse anesthetists from the team model. Several states, such as Arkansas, Massachusetts, Michigan, Nevada and Oregon, introduced legislation to allow independent practice for nurse anesthetists, removing them from a team relationship with a physician. Florida, Kansas and Oklahoma were a few states that considered changing the physician supervision relationship with a nurse anesthetist to that of a collaborative relationship, while Rhode Island passed legislation to do just that.
This year, Illinois and Iowa introduced legislation that would limit those authorized to provide pain medicine services to physicians. Alternatively, the Texas legislature considered two pieces of legislation that would have allowed advanced practice nurses to engage in pain medicine. However, the Texas Society of Anesthesiologists was able to prevent one of the bills from going forward and successfully worked to have the pain medicine language removed from the other legislation before it passed the legislature. The Montana Board of Nursing promulgated a regulation adding “the management of acute and chronic pain” to the definition of nurse anesthetists, despite the Montana Society of Anesthesiologists’ active contention that chronic pain management is the practice of medicine. Only one state other than Montana has a slightly similar regulation (Hawaii). The Montana Society of Anesthesiologists is working with the Montana Medical Association to address this regulation.
2013 also saw some wins and losses in the courtroom. In May, the Iowa Supreme Court issued a decision that upholds rules allowing advanced registered nurse practitioners to supervise radiologic technologists in their use of fluoroscopy machines. In October, the Colorado Supreme Court announced that it would accept an appeal from the Colorado Society of Anesthesiologists and Colorado Medical Society in their joint lawsuit seeking to overturn the 2010 rural opt-out. While this will not be the final ruling on the matter, the court’s acceptance to hear an appeal is an important step in overturning previous unfavorable decisions.
The Department of State Affairs is very thankful to have worked with the leadership and members of so many different state component societies this year, and we look forward to assisting our excellent state component societies in the endeavors they choose to pursue in the coming year.