Supervision v. collaboration: Bill on anesthetist-doctor relationship passes committee

OKLAHOMA CITY - A bill that would change one word in a statute defining the relationship between doctors and the anesthetists that work with them conquered a hurdle Monday.

Senate Bill 801 is one of two bills, the other being House Bill 1027, seeking to update the language in the current state law.

"This bill just changes one word in the statute from 'doctor supervision' to 'doctor collaboration,' because that’s what actually happens in the operating room," said Representative Marcus McEntire, author of HB 1027. "This is going on every day in Oklahoma; 80% of anesthesia care in this state is performed by nurse anesthetists. Our state statute is going to reflect a model where the doctor is not the captain of a ship."

Anesthetists, or CRNAs (Certified Registered Nurse Anesthetists) currently handle a number of medical needs before and after a surgeon or physician performs a procedure. Rep. McEntire says the change also allows CRNAs to shoulder some of the liability currently held solely by physicians. But not everyone reads the change the same way.

Dr. Jay Cunningham, an anesthesiologist who is also part of the Oklahoma Society of Anesthesiologists (OSA), says not only will liability not shift, but calls the bill itself is "bad healthcare policy" that can reduce the quality of a patient's care.

"As it is right now, if there’s a surgery, there's a surgeon there. The surgeon is the physician in the room, so the physician is responsible for the patient," said Dr. Cunningham. "If we remove that word, that 'supervision,' then the CRNA is practicing independently and not necessarily being underneath the supervision of the physician. We feel like that decreases patient safety."

Meanwhile, a number of CRNAs were at the Capitol Monday afternoon to witness the vote.

"CRNAs are wanting to modernize our nurse practice act to reflect whats truly happening in Oklahoma," said Jenny Schmitt, president of the Oklahoma Association of Nurse Anesthetists (OANA). "The surgeon isn’t supervising our practice, they're performing the operation, they're trusting the CRNAs to be the anesthesia expert in the room. That’s what this law is looking to change."

Schmitt and McEntire point to access to healthcare in rural Oklahoma as a major reason to support the bill.

"It’s a big rural care issue," said McEntire. "When you look at rural Oklahoma we don’t have anesthesiologists, we have anesthetists."

Schmitt pointed out the role anesthetists play for pregnant women, saying if there is no independence for anesthetists, medical facilities are rendered useless without the presence of that physician to play the supervisory role. But she emphasizes, the bill would not change what CRNAs do.

"If this law were to pass tomorrow, and I go to work, nothing about the way I practice anesthesia would be different," said Schmitt. "It really is about access. CRNAs provide safe anesthesia all over Oklahoma."

But Dr. Cunningham says the change in language would have no effect on that access for rural Oklahomans due to the necessary presence of a surgeon or physician for any operation.

The OSA launched a campaign pointing out the difference in training between physicians, even those who do not specialize in anesthesiology, and CRNAs. Dr. Cunningham says that difference in training could lead to a difference in outcomes.

"Don't get me wrong, CRNAs are very well-trained and they're a vital cog in the healthcare wheel," he said. "But the amount of education that people have, namely physicians versus nurses, is significant."

The OSA joins the Oklahoma State Medical Association (OSMA) in opposition of the twin bills. The OSMA launched an ad campaign, the commercial advocating for the presence of a physician at all times, and urging taxpayers to contact their lawmakers to urge them not to support the bills.

"If they don’t want lose physicians in charge of their healthcare team, they need to contact their legislators and let them know," said Dr. Cunningham.

Schmitt and McEntire both mentioned Gov. Stitt's desire to make Oklahoma a top ten state as reasoning to change the bill, citing a number of states that have already made the change.

"Every single state that is top ten in healthcare has this law in place," said Schmitt.

Rep. McEntire says he believes the governor would be inclined to back the bill.

"He wants to make Oklahoma a top ten state and have adequate rural healthcare would get us there," he said. "All it's going to do is reflect reality."

Now that the bill has passed committee, it will then go to the Senate floor. From there, it will head to the House. Should it pass, it will likely not become law until around November.

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