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On April 21, 2017, Governor Doug Ducey (R-AZ) signed into law legislation (SB 1336) that preserves physician direction of anesthesia in the state. Additionally, the new law maintains physician presence when anesthesia is delivered by a nurse anesthetist. The physician directing anesthesia must be within the same health care institution or office and available as necessary. The new law also includes language providing immunity to physicians or surgeons working with nurse anesthetists; the language states that “a physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics…” This language renders nurse anesthetists liable for their actions when ordering or administering anesthesia.
The Arizona Society of Anesthesiologists was heavily engaged in this legislation. The original version of SB 1336, as passed by the Arizona Senate, would have redefined physician “direction” to mean “coordination and communication,” which is a lower standard of physician involvement in anesthesia than Arizona patients currently enjoy. During discussions in the Arizona House Health Committee, Rep. Heather Carter, the Chair of the Committee, offered an amendment to retain Arizona’s current requirement for physician involvement in anesthesia, and the amendment was accepted. The House and Senate then passed the improved language, and it was sent to Governor Ducey.
While the final version of the legislation grants nurse anesthetists limited prescriptive authority, the signing of SB 1336 is an important achievement for Arizona patient safety in that this new law maintains physician direction and presence wherever anesthesia is provided.
