Seven organizations representing Illinois physicians and dentists have banded together to protest proposed legislation that would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the physical presence of a medical doctor or dentist.
Among the changes Illinois House Bill 2813 would make to the Nurse Practice Act include a provision that states when a CRNA administers anesthesia, it would have to be as part of an agreed-upon plan with an anesthesiologist, surgeon, dentist or podiatrist who would have to remain “available” during the procedure. Current regulations call for a CRNA to perform such procedures only under the physical supervision of such a professional.
The proposed changes are supported by the Illinois Association of Nurse Anesthetists but opposed by a new coalition that calls itself Preserve the Anesthesia Care Team (PACT) that includes the Metro Chicago Chapter of the American College of Surgeons, American Society of Anesthesiologists, Illinois Dermatological Society, Illinois Society of Anesthesiologists, Illinois State Dental Society, Illinois Society of Eye Physicians and Surgeons, and the Illinois State Medical Society. In a recently issued press release, PACT called the proposed new regulations part of “growing efforts to erode anesthesia care standards” and said it was launching a campaign to dispute what it characterizes as “myths” propagated by the other side. It also set up a new informational website.
"[The bill's intention] is really to break away or depart from working as a team,” said Dr. Lisa Solomon, a member of the Illinois Society of Anesthesiologists. "What we're trying to maintain is that in order to be able to deliver safe anesthesia, it takes a physician to be included within that anesthesia team. Our role really is to protect the patients of Illinois from what they don't know, and there is very distinct training from a physician who undergoes medical school and has residency and fellowship [that differs] from the path you get training from the nurse anesthetist. This bill will actually set up a different kind of standard of care that is against what the World Health Organization recommends.”
Lisa Solomon http://raallc.com/raa-physicians/25-lisa-p-solomon-d-o
That sentiment is echoed in a position paper from the Illinois Medical Society.
“The delivery of anesthesia, as well as pain management is considered critical care, not primary care, and has its own set of complications," the paper states. "When adverse events arise, they require immediate medical attention by physicians to prevent serious injury or death.”
Proponents of the bill make the argument that poor and underserved residents of the state would benefit from the relaxed regulations, a position Solomon disputes. For one thing, she says, anesthesia accompanies surgery and is centered where surgeries are performed, largely near cities and hospitals. For another, she says that while there need to be changes in how services are delivered to the underserved, providing what PACT considers a lesser standard of care, essentially creating a two-tier system, should not be one of them.
Currently the bill has been sent back to the House Rules Committee and so was not voted on during the last legislative session, but PACT says it wants to be prepared when the next session opens.