When the facts aren’t on your side, go with fear. It’s a sad reality of our modern politics.
I am embarrassed that my physician colleagues have turned to scare tactics in opposing Senate Bill 1336. This legislation provides for a very modest but necessary update to Arizona’s nearly century-old statutes governing Certified Registered Nurse Anesthetists (CRNAs).
You may not be familiar with these health care specialists. In many facilities, it is a CRNA – not a physician or even an anesthesiologist – who makes certain that pain associated with surgical and other procedures is managed safely and effectively.
I’m a surgical specialist who worked with countless CRNAs over the course of my 50-year career. For many years, I practiced in a rural setting, and I relied upon their expertise and skill when there was no anesthesiologist within a hundred miles. The CRNA’s knowledge about anesthesia far exceeded my own – not unusual, considering there is no specific requirement that an MD have any significant anesthesia training.
Outdated State Regulations Hamper Care
Unfortunately, antiquated state law is hurting these nursing professionals and hampering the delivery of patient care in Arizona.
In the most egregious example, Arizona since 2013 has been one of the only states in the nation in which CRNAs cannot obtain federal DEA numbers. These are the numbers the law requires pharmacists to see before they can fill the medications CRNA’s use to keep patients comfortable and safe during surgery. All of this was due to an inadvertent legislative mix-up in which the term “order,” rather than “prescribe,” was used in an earlier Arizona statute.
SB1336 would fix this problem. What’s more, it would finally bring reasonable definition to the shared roles and responsibilities between CRNAs and physicians by stipulating that they must coordinate and communicate with each other in providing patient services.
This will strengthen the health care team and resolve a mistaken but long-held concern among doctors that they are legally liable for the work of the CRNA. Current statute “negatively affects surgeon and physician recruitment due to the perception of liability created by the statute,” writes St. Luke’s Medical Center CEO Jim Flinn in supporting SB1336. “While no evidence of liability exists, by hurting surgeon recruitment, the perception of liability hurts access to care, especially for hospitals with large AHCCCS populations.”
Rural hospital executives support SB1336 for the same reason. In a letter to legislators, Vickie Clark of La Paz Regional Hospital, in Parker, wrote that her facility “has exclusively used CRNA services for over 20 years with no adverse outcome.”
My own experience in rural Northern Arizona verifies the claims of these hospital administrators.
The fact is, nurse anesthetists have been providing safe care in this country for 150 years. They were on the battlefields of the Civil War and have been the primary providers of anesthesia care for U.S. servicemen and women on the front lines since WWI. Numerous independent studies have found no quantifiable difference between the quality of care provided by CRNAs and their physician counterparts, anesthesiologists.
MDs raise the specter of opioid abuse in opposing SB1336. This is shameful. The legislation specifically bars CRNAs from prescribing opioids for use outside of the operative setting.
My 50 years in medicine have taught me that a health provider’s individual skill and talent are more important than the degree behind their name. Depending upon the case, there have been times when I actually preferred a certain CRNA to a certain MD. I, and members of my family, have entrusted our own lives to CRNAs when we needed surgery.
Wild claims about patient-safety risks posed by SB1336 are baseless. Consciously or unconsciously, I think that opponents of this legislation fear marketplace competition from a lower-priced provider. That the State of Arizona has for so long favored one health care provider over another in this area is wrong and should not continue.
I urge legislators and Governor Ducey to continue busting unwarranted barriers to care and artificial limits on the work of trained health professionals. Please support SB1336.
Murray Feldstein, M.D., is a visiting fellow at the Goldwater Institute. He is on the emeritus staff and a retired assistant professor of urology at the Mayo Clinic Arizona.
The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.