The Massachusetts
Medical Society (MMS) wishes to be recorded in opposition to H.2452/S.658, “An act
to remove the restrictions on the licenses of CRNAs. These identical bills would allow certified
registered nurse anesthetists (“CRNA”) to practice independently. Specifically, the bills would allow CRNAs to
order and interpret tests, and to prescribe, dispense, distribute and conduct
research on controlled substances – without any physician supervision.
Anesthesia
is the practice of medicine – critical
care medicine. It is often the patient’s medical problems that convey
greatest risk during even routine surgery, and proper recognition and treatment
of these medical conditions are even more important in complex surgeries. CRNAs’
education and clinical training does not include any significant time studying
and training in the diagnosis and treatment of these conditions. Physician anesthesiologists have at
least 12,000 – 16,000 hours of supervised clinical patient care during
training, while CRNAs have a median of 1,650 hours of supervised clinical
experience. Under this legislation a CRNAs with only 1,650 hours of clinical
training would be able to practice independently without any physician
supervision or oversight.
The MMS
considers this an issue of patient safety. If passed, a CRNA would no longer be
required to ensure a physician is immediately available to assist them in case
of emergency such as cardiac standstill or cardiac arrhythmia. In an emergency, where seconds
count, having a physician anesthesiologist or other qualified physician
immediately available, working with and overseeing the NA reduces risk and
ensures the safe delivery of quality anesthesia care.
The MMS
continues to support the physician-led, team-based model as the gold standard
of care. Physician led
team-based care promotes integrated, coordinated care that utilizes all
appropriate health care professionals while ensuring that physicians are
available for consultation or collaboration when necessary to promote the
highest quality and safety of care for patients. Physicians’ extensive medical
education, required medical residencies, and often post-residency fellowships
provide them with unique expertise and qualifications to manage care for the
sickest, most complex patients. Moreover, surveys indicate that patients prefer
health care teams led by physicians when care becomes complex and as patients
age.
The
legislature, in fulfilling its duty to protect patients of the Commonwealth,
has established a thoughtful, patient-focused framework of policies and
statutory requirements that apply to physicians in light of their ability to
independently provide medical care. Legislation that authorizes new independent
practice for any health care practitioners must include the same patient protections.
Specifically, the Medical Society points to the medical residency requirement,
to the 100 credit/hour per license cycle continuing medical education
requirement, and to the online physician profile as important means by which
the legislature has acted in the name of patient protection and transparency.
Additionally, the Board of Registration in Medicine, with its unparalleled
requirements and thoroughness in the licensure process, and through the
unmatched sophistication and resources of its investigatory unit, also provides
important patient protections to independently practicing physicians. The MMS believes
that these and other enhancements should be considered before allowing for the
independent practice of non-physician practitioners.
The Medical
Society urges the Committee on Health Care Financing to reject H.2452/S.658.