Home / Opinion / Commentary / Wild claims about patient-safety risks posed by SB1336 are baseless

Wild claims about patient-safety risks posed by SB1336 are baseless



Murray Feldstein

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Outdated State Regulations Hamper Care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.

Overblown Concerns

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.

Anti-competitive Concerns

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.


  1. Thank you for taking the time to understand and show support for CRNAs and what they do. You so beautifully expressed what SB1336 is and isn’t. Thank Dr Feldstein!

  2. Thank you for your support of this bill and CRNAs, Dr Feldstein! #SB1336

  3. You are disgraceful of medicine. You want to make a money out of patients by let CRNA work without physician supervision. They are cheap but you have no right to compromise the patient safety. I am attending colorectal surgeon at Sinai health system. You have no credential to talk about anesthesiology because you have no training in anesthesiology. Just like me, I have a training in surgery and I always get an input from anesthesiologist on the floor. Also, should disclosure your position in Arizona Association of Nurse Anesthetist.

  4. Arizona Capitol Times:
    thank you for sharing facts. Arizona deserves the truth.

  5. Joseph Adam Rodriguez

    Bravo to Dr. Feldstein for having the courage to take on his colleagues on behalf of Arizona patients. This is the most honest thing I’ve seen on SB 1336.

  6. Joseph Adam Rodriguez

    JP, don’t you want to reveal your name?

    Some facts:

    Surgeons don’t make money by CRNAs working without supervision or with supervision. CRNAs can bill QZ (part B Medicare, professional fee) independently regardless of this law or Medicare Part A Supervision.

    Patient safety is not compromised by CRNA care; quite the opposite. I know this anecdotally in my own practice and career, and 3rd party research has repeatedly borne this out. RAND Corp, Institute of Medicine, and so on – all reached the same conclusion. CRNA full scope of practice (not in this bill, FYI) is good for patients, it’s good for healthcare.

    Dr. Feldstein has absolutely no position, official or unofficial, in the Arizona Association of Nurse Anesthetists.

    Joe Rodriguez, President, Arizona Association of Nurse Anesthetists.

  7. Dear Dr. Feldstein,

    Thank you for taking the time to share your opinion. It is important to define the roles in the operating room. As a physician anesthesiologist myself, I do recognize the importance and usefulness of CRNAs. But it is also important to be fair to all parties involved. What really matters at the end is patients’ safety.

    I’m a bit surprised to read some of your comments about the lack of difference between the care provided from CRNA’s vs. physician anesthesiologists. I’m troubled by the fact that you equate CRNA’s to physician anesthesiologists.

    As you know, or may not know, the physician anesthesiologist job starts far before surgery starts. We review the patients’ chart and order the necessary diagnostic tests and interpret the data. Then we come up with an anesthesia plan…and thats just a small piece of it!

    Then comes surgery. Surgery rarely goes as expected. There are almost always unexpected events that take place in the operating rooms. In most cases, the anesthesiologist physician has minutes or seconds to react to save the patient. Of course this is done in close collaboration and communication with the surgical team and other OR team members.

    To save patients in the operating rooms, it takes more than just the technical skills to place the breathing tube in the correct place! That’s why physician anesthesiologists go through pre-med, medical school, prelim, residencies, sometimes fellowships, and endless tests and exams to be board certified. Most anesthesiology physicians have done prelim surgical training to better be a team player in the operating room. In short, the amount of education and its quality is second to none.

    Anesthesiology physicians do not just care for patients in the operating rooms. We co-staff the pre-op clinics, the labor and delivery floors, the ICU’s, acute pain services, and chronic pain clinics among other areas of medicine.

    It is actually saddening to see that you feel our concern stems from fear of losing potential income. In fact, I find this insulting. Most physicians did NOT go into medicine to make money. We sacrifice more than most people even imagine to be at those peoples’ service. “We” here is not just in reference to Anesthesiology physicians, but includes most physicians. So please do not cloud the picture by trivializing and diverting attention from the real issues facing health care.

    I do not view CRNAs as a competition, nor should they be. Rather, they are an important and integral part of the health care team who serve a complimentary role.

    The days of “One Man Show” are far-gone. Welcome to the new age of medicine.

    At the end, while you are entitled to your opinion, I categorically disagree with your opinion because the facts tells us that patients’ safety is the most important factor in making any decision. Opinions do not matter…Facts do!

  8. Joe:

    “Patient safety is not compromised by CRNA care; quite the opposite”

    You’re saying patients are SAFER in the hands of a CRNA than an anesthesiologist? In what wild universe are you basing your anecdotal evidence? And please tell me what quack journal would support this.

  9. Hi JP,

    No, not my meaning. Just that both professionals are excellent.



  10. MI,

    CRNAs do in fact compete for anesthesia contracts; this is common knowledge; I would know, I’m a small practice owner and I’ve done it.

    Also in many cases CRNAs and anesthesiologists are absolutely interchangeable. I’ve seen this personally, it is reflected in data. And I’ve worked in every type of model out there.

    With that said, I have immense respect for physician anesthesiologists. I’ve worked with many brilliant anesthesiologists. I’ve also seen some that likely have not opened a journal since they passed boards.

    ON the other hand – I do not respect the unsubstantiated statements often made by the ASA or the state societies. The *fact* is both professions are excellent and are equal in terms of outcomes. That does not mean the MDAs I work with or the CRNAs you work with are equal; those are individual, local cases.

    I’m a big supporter of local facilities being able to choose their model, thus I support the way you’ve designed your team, based on the skills of those you work with. However, that’s not a standard nor is it the best for everyone.

    Honestly, I’ve found great variation among professionals and recognize the future of anesthesia care is both professions working together, generally speaking. However here in Arizona, the medical society is trying to push a very specific type of model – one that is both costly and without proven benefit, except to those who can bill for 200% of their fee (physicians).

    Why do you not share your name, btw?

Leave a Reply

Your email address will not be published. Required fields are marked *




Check Also

In this Aug. 9, 2011, photo, the sun emits a gigantic burst of radiation. (Photo courtesy of NASA)

Solar group: Prop. 127 is ‘reckless, restrictive and inflexible’

The Distributed Energy Resource Alliance (DERA), composed of solar industry companies, professionals and educators, urges Arizonans to vote no on Proposition 127.