Mississippi Governor Denies Nurse Anesthetist Supervision Opt-Out Request

On September 3, 2019, Mississippi Governor Phil Bryant (R) protected Mississippi patient safety and denied a request that the State of Mississippi “opt-out” of the federal supervision requirements for nurse anesthetists. The governor agreed with numerous medical organizations that opting-out would not be in the best interests of patient safety and would be inconsistent with state law. The American Society of Anesthesiologists (ASA) worked closely with the Mississippi Society of Anesthesiologists and the Mississippi State Medical Association to strongly urge the governor to protect Mississippi patients and oppose an opt-out in Mississippi. 
 
In July, Governor Bryant issued a fourteen day comment period to the state’s boards of medicine and nursing seeking input on whether to opt-out. The September 3 letter referenced the “nearly one thousand pieces of correspondence received” on the issue. The Mississippi State Board of Medical Licensure, American Society of Anesthesiologists, Mississippi Society of Anesthesiologists, Mississippi State Medical Association, American College of Surgeons, American College of Emergency Physicians, American Psychiatric Association, American Society of Plastic Surgeons, American Medical Association, American Osteopathic Associations, and many other organizations and members of the public sent letters of opposition to the governor on this critical patient safety matter. ASA also thanks Mississippi State Medical Association Executive Director and ASA member Claude Brunson, M.D., FASA for his leadership in coordinating medicine’s response.
 
Governor Bryant’s letter:

• Highlighted that the opt-out would not be consistent with existing state law and would not be in the best interests of the citizens of Mississippi. 
• “Deferred to the judgment and experience of the expert physician boards and associations on matters of public health and safety.” 
• Stated that the plain meaning of “collaborative/consultative relationship” would appear to be coextensive with supervision.”
• Noted that multitude of boards and physician organizations that unanimously opposed opt-out on the basis that it would not be in the best interest of citizens.  

45 states plus the District of Columbia require some level of physician involvement during anesthesia care. In 2001, the Bush Administration published a final rule regarding the Medicare and Medicaid anesthesia Conditions of Participation (COP) for hospitals, critical access hospitals (CAHs) and ambulatory surgical centers (ASCs). The rule retains the current requirement for physician supervision of nurse anesthetists, but allows state governors to opt out of this requirement under certain circumstances. Physician anesthesiologists strongly oppose gubernatorial opt-outs as a matter of patient safety. Removing physician supervision from anesthesia in surgery lowers the standard of care and jeopardizes patients’ lives. The World Health Organization’s (WHO) standards for anesthesia “highly recommend” that anesthesia should be provided, led, or overseen by an anesthesiologist. 
 
ASA applauds Governor Bryant for his protection of Mississippi patients and MSA’s members impressive grassroots efforts on this patient safety initiative.