SB 1336: A Modest Healthcare Proposal

Currently, state laws unreasonably prevent medical professionals from using their full education and training to care for patients. SB 1336 takes a very small, but positive, step in the right direction.

Certified Registered Nurse Anesthetists (CRNA) are educated and trained to provide anesthesia and administer fluids, such as IVs. They are required to have a master’s degree, at minimum, or a doctoral degree. And they are an essential part of the healthcare team, especially in the state’s rural areas where the next-closest medical facility can be hours away.

Legislative changes

• SB 1336 would allow CRNAs to practice without a physician or surgeon in the same room, so long as one is present in the same medical facility or office.
• SB 1336 would clarify that “direction” simply means that a CRNA must coordinate and communicate with the physician before, during, and after surgery.
• SB 1336 would allow CRNAs to prescribe anesthesia and other medications that are needed to care for the patient, but would only allow those prescriptions to be filled and administered in the healthcare facility. It would not allow CRNAs to write prescriptions for opiates or other narcotics, for example, that patients to fill at a pharmacy.

Objections to the proposal

The concerns that the proposal would allow unskilled practitioners to engage in dangerously-complex practices for the treatment of chronic pain management and that the proposal could make the narcotic abuse problem worse are patently false.

As someone (Dr. Feldstein) with broad experience in treating complex pain disorders at the Mayo Clinic, and who has lectured about this difficult problem requiring a multi-disciplinary approach, anesthetic nerve blocks are only a small part of a chronic pain management program. The blocks, which are given for either diagnosis or ongoing treatment, could be done equally well by anesthesiologists or CRNA’s if they have had the proper training and were certified to do so.

Nothing in the proposal changes those standards. Furthermore, SB 1336 explicitly limits CRNA’s to prescribe medication specifically only in the operating room setting.

Putting patients first

Rather than engage in scare tactics and turf battles, let’s focus on the very limited and narrow changes the bill actually proposes. These incremental changes would bring Arizona one small step closer to providing much-needed flexibility to deliver healthcare services, especially those in underserved areas ─ and it would put patients first.

More than ten peer-reviewed research studies examining anesthesia quality, safety, and access since 2000 confirm that CRNAs are not only as safe as anesthesiologists, but are important providers of care in medically underserved areas. The prestigious Institute of Medicine recommends that “nurses should practice to the full extent of their education and training.”

Too often our state laws protect the special interests of medical professionals rather than the interests of the public that is suffering from high prices and a lack of healthcare services. It is time for Arizona lawmakers to remove barriers that artificially limit the availability of healthcare facilities, procedures, and providers. SB 1336 is a good place to start.