According to Governor Doug Ducey, state officials have been working closely with medical boards and healthcare facilities to address ways to bolster the number of medical professionals available to address the COVID-19 pandemic. But one of those ideas has not set well with a prestigious group of Arizona physicians.
More than 50 physicians affiliated with Chandler Anesthesia Consultants recently signed a letter to Ducey, noting they are “extremely disappointed” with his March 24 decision to do away with the requirement that certified registered nurse anesthetists be supervised by a physician. The physicians have asked Ducey to reconsider the decision.
“This is not a time for hurried decisions,” their letter states. “This is a drastic change that we believe will affect the quality of patient case and safety in the immediate future as well as far beyond the next few months.”
Anesthesiologists are medical doctors who chose to specialize in the practice of anesthesia, just as some doctors specialize in surgery, cardiology, or neurology, according to the American Society of Anesthesiologists (ASA).
“They specialize in anesthesia care, pain management and critical care medicine, and have the necessary knowledge to understand and treat the entire human body,” according to the ASA website. “The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient’s condition prior to, during and after surgery.”
Meanwhile, certified registered nurse anesthetists (CRNAs) are graduate degree-level nurses. Some states allow CRNAs to practice without physician supervision, but until Ducey signed the executive order Arizona wasn’t one of them.
In announcing the exemption, Ducey called it a “reform” that will allow physicians to concentrate on other services while also expanding access to care, particularly in rural areas. The exemption currently has no end date.
“Arizona’s hospitals and medical professionals need all the help and resources they can get right now,” Ducey said. “I am confident that this exemption will enhance access to high quality care, provide additional options to our rural hospitals, and is in the best interest of the citizens of Arizona.”
But the doctors at Chandler Anesthesia Consultants believe it is a dangerous decision.
“Physician led anesthesia is the safest and best form of anesthetic care, and the COVID-19 crisis should not lead to a permanent change in that practice,” their letter states. “We respectfully ask that you reconsider this executive order of exemption as written.”
In explaining why he signed the letter to Ducey, Ronald Price M.D. says he hoped it would prompt the governor to change course on the exemption issue due to the important patient safety and care concerns.
“The physician-led model remains the gold standard for anesthesia care,” said Price, a partner with Chandler Anesthesia Consultants. “As the population grows in Arizona -particularly among seniors- we need this standard to remain strong.”
According to the website for the American Association of Nurse Anesthetists, when anesthesia is administered by a certified nurse anesthetist, “it is considered nursing practice. If administered by an anesthesiologist, it is considered practicing medicine. However, anesthesia is administered the same way by both professionals.”
Governor Ducey’s office did not respond before press time to the ADI’s request for comment.