CHICAGO — The American Society of Anesthesiologists (ASA) recently submitted an amicus curiae (friend of the court) brief supporting the U.S. Department of Health and Human Services’ (HHS) efforts to dismiss the AANA complaint. The brief offers the perspective of anesthesiologists and corrects numerous erroneous assertions in AANA’s complaint.
According to ASA’s brief, in its complaint the AANA makes blanket assertions regarding the scope of licenses, contending there are no differences between anesthesiologists and certified registered nurse anesthetists (CRNAs).
Incorrect assertions by the AANA:
- CRNAs routinely administer anesthesia independently without the need for supervision.”
- Correction: 45 states, including the 25 subject to the federal Medicare supervision requirement, require physician oversight or other involvement in the services provided by nurse anesthetists. The “independent” or the nurse-only model of anesthesia is rare.
- “There are no material distinctions between the educational experience of a CRNA and a physician anesthesia provider when it comes to the safe administration of anesthesia.”
- Correction: Anesthesiologists have almost five times the hours of clinical training and nearly double the education of nurse anesthetists. There is no comparison.
- CRNAs and anesthesiologists do the same thing at the same level.
- Correction: Anesthesiologists and nurse anesthetists are not interchangeable. Anesthesiologists, who complete medical school (4 years) and an anesthesiology residency program (4 years) have extensive medical education and training. Nurse anesthetists attend undergraduate nursing school and nurse anesthesia school (2-3 years). These education and training differences directly impact the ability to comprehensively manage the medical care and emergent needs of patients.
ASA’s brief further explains that the nondiscrimination provision recognizes that health care professionals’ licenses are defined by state law, not federal law, and what nurse anesthetists do and are allowed to do depends on that specific state’s laws, which varies widely from state to state. The brief continues, “These generalizations that the practice of nurse anesthetists is the same as that of anesthesiologists are, as a matter of law, incorrect.”
ASA’s brief cited examples of license differences:
- Nurse anesthetist licenses differ from anesthesiologists as to the need for supervision. For example, in Michigan, a qualified health care professional (physician, dentist or podiatric physician), must be immediately available to address any urgent or emergent clinical concerns. In Ohio, to provide anesthesia services, a certified registered nurse anesthetist must be supervised and in the immediate presence of a physician.
- Nurse anesthetist licenses differ from anesthesiologists as to their authority to make medical diagnoses and to prescribe medicine. For example, in Ohio, medical diagnosis, prescription of medical measures by nurse anesthetists are prohibited.
- For nurse anesthetists to be allowed to administer anesthesia in Illinois, Arkansas and Oklahoma, a physician must be available for diagnosis, consultation and treatment of medical conditions.
- Nurse anesthetists’ licenses differ as to the authority to make an anesthesia care plan, while anesthesiologists are fully responsible and without limits to develop and implement an anesthesia care plan. For example, nurse anesthetists can develop a plan “within an established protocol” in Florida, “under approved written guidelines” in South Carolina, under “board-approved guidelines” in Mississippi and under “office-based settings with physician-approved anesthesia plans” in Virginia.
- Nurse anesthetists’ licenses differ as to the range and settings of anesthesia services they may provide. For example, in Alabama, only a physician or anesthesiologist is authorized to order clinical laboratory services in ambulatory surgical facilities. In Indiana, nurse anesthetists must be supervised by a physician and do not have prescriptive authority. In Kansas, in ambulatory surgical centers before undergoing general anesthesia, a physician, not a nurse anesthetist, must enter into a patient’s record a history and physical examination of the patient. Similarly in New York, a physician must examine each patient immediately prior to surgery to evaluate the risk of anesthesia. In New Jersey hospitals, an anesthesiologist must be present during induction, emergence and critical change in status.
- Finally, and in general, most states require in one way or another that a physician supervise, direct, collaborate, set guidelines or provide some other type of oversight for nurse anesthetists.
The brief concludes that “for these reasons, Amicus respectfully asks the court to grant HHS’s motion to dismiss.”
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 59,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on X.
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