The American Society of Anesthesiologists (ASA) and Arkansas Society of Anesthesiologists (ARSA) strongly oppose state legislation SB 184 and HB 1283, which would dismantle the anesthesia care team model in Arkansas by allowing nurse anesthetists to administer anesthesia without physician supervision.
HB1283 also would allow nurse anesthetists to provide analgesics, opening the door for nurses to provide powerful pain-relieving drugs such as opioids, the ASA and ARSA report. Further, the groups conducted a survey of 600 registered voters in the state and say that 86% of these respondents want a physician involved in administering anesthesia or responding to anesthesia emergencies during surgery. The survey additionally revealed that:
- When provided with the education and training associated with a physician anesthesiologist and a nurse anesthetist, 80% said they would want to have the physician anesthesiologist administer anesthesia.
- 71% of respondents said they were extremely or very concerned about the anesthesia they would receive and who would be responding to anesthesia emergencies if they needed surgery.
- 78% noted that it is extremely or very important that a nurse administering anesthesia or responding to an emergency during surgery work with a physician.
- When thinking about the possibility of being treated for long-term pain, 77% of respondents want a physician trained in pain medicine to care for them.
The ASA and ARSA urge the Arkansas House Public Health, Welfare and Labor Committee to vote no on SB 184 and HB 1283. These bills are in direct opposition to what Arkansas voters want from their healthcare system, the groups say, adding that the bills also will lower the standard of care and jeopardize the lives of Arkansans receiving anesthesia and pain medicine.
“Despite advances in medicine and patient safety, surgery and anesthesia are inherently dangerous,” said ASA president Linda Mason, MD, FASA. “Physician anesthesiologists are highly skilled medical experts who have the education and training to make critical decisions in an emergency. People want a physician to administer their anesthesia or respond in an emergency.”
“At a time when the country is combating a prescription drug and opioid abuse epidemic, this does not seem to be the time to expand the number of healthcare providers administering pain medicine in our state, especially those who may be undertrained and unsupervised,” said ARSA president Joshua Chance, MD.
Physician anesthesiologists have up to 14 years of postgraduate medical education and residency training, which includes 12,000 to 16,000 hours of clinical training, which is nearly seven times more training than nurse anesthetists. Current laws in 45 states and the District of Columbia all require physician involvement for anesthesia care.
Also, the United States Department of Veterans Affairs (VA) decided to maintain its physician-led, team-based model of care. The VA’s Quality Enhancement Research Initiative could not discern whether more complex surgeries can be safely managed by certified registered nurse anesthetists, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal.
Furthermore, there are no cost savings for patients in Arkansas to receive anesthesia care solely by a nurse anesthetist, the ASA and ARSA report. Physician supervision of anesthesia ensures patients receive safe, high-quality care, the groups say, urging the state not to lower the standard of care in Arkansas.
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