Nurse anesthetists in North Carolina battle bill to put doctor supervision requirements into law

relder@newsobserver.comMarch 20, 2013 

— Nurse anesthetists from across the state packed a hearing room at the N.C. General Assembly on Wednesday to show their dislike of a bill that calls for a physician to formally supervise their work.

Certified registered nurse anesthetists now may work either “in collaboration with” or “under supervision of” doctors, an arrangement that bill sponsors say leaves the CRNA-physician relationship vulnerable to interpretation and possible litigation.

The goal is to put into state law “a fundamental patient-safety standard,” said Rep. Nelson Dollar, a Republican from Cary who is one of four primary sponsors of the bill.

“We’re not doing anything to change what happens in the operating room,” Dollar said.

But opponents maintain the bill shifts accountability for anesthesia care to physicians, who may not be willing to take on the added responsibility or possible increases in liability insurance costs.

“It does nothing for patient safety, but creates the potential for increased cost and decreased access to care,” said Vaughna B. Galvin, a CRNA who drove up from New Bern for Wednesday’s meeting.

CRNAs typically work under supervision of an anesthesiologist where one is on staff, such as at a hospital. In such cases, the anesthesiologist also gets paid, Galvin said. CRNAs also may work independently and bill for their services at sites such as out-patient clinics, where they perform their duties in collaboration with surgeons or other physicians.

The aging U.S. population and impending increased demand for health care services created by the federal Affordable Care Act have raised concerns about potential health care provider shortages and bolstered efforts to remove barriers for some of them.

The federal government has given states leeway to opt out of physician supervision requirements for nurse anesthetists without sacrificing payments from Medicare. More than 15 states have done so. Others are rethinking supervisory requirements for various types of advance-practice nurses, such as nurse anesthetists, nurse-midwives and nurse practitioners, as a way to reach more patients, especially in underserved rural areas.

A House bill proposes to remove the physician supervision requirement for certified nurse-midwives. Rep. of Sarah Stevens, a Republican from Mt. Airy and one of the primary sponsors, said it was introduced after a number of CNMs reported problems finding doctors willing to supervise their practices. That bill has been referred to the House health care committee, and a Senate version is in the works.

Patrick Ballantine, a lobbyist for the N.C. Association of Nurse Anesthetists, told members of the House subcommittee on regulatory reform Wednesday to consider their mission:

“You are here to reduce unnecessary regulations, not invent new ones,” Ballantine said

Dana Simpson, lobbyist for the N.C. Society of Anesthesiologists, which is backing the bill, said “supervision” simply means that the “physician ultimately is responsible for the patient’s care.”

Rep. Jean Farmer-Butterfield, a Democrat from Wilson, said she has been told some doctors do not want that responsibility.

“I’m concerned,” she said. “Some doctors may not be comfortable providing oversight while doing surgery.”

Such wariness could become “a slippery slope,” said Rep. Donny Lambeth, a Republican from Winston-Salem.

“Anesthesiologists could take all the business, leaving CRNAs out in the cold,” Lambeth said.

The regulatory reform committee approved the bill Wednesday by voice vote. It has already been approved by the health and human services committee and now goes to the House floor. A similar bill in the Senate is still waiting to be heard in committee.

Elder: 919-829-4528

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