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Nurse-anesthetist supervision change squeaks through Senate vote

by Michael R. Wickline | March 18, 2021 at 4:17 a.m.

A bill that would allow certified registered nurse anesthetists to operate without the supervision of a doctor narrowly escaped the Arkansas Senate on Wednesday.

After about 20 minutes of debate, the Senate voted 18-12 to send House Bill 1198 by Rep. Clint Penzo, R-Springdale, to Republican Gov. Asa Hutchinson.

Eighteen votes are required in the 35-member Senate for approval.

Afterward, Hutchinson spokeswoman Katie Beck said the governor is still reviewing the legislation and will decide what to do when it reaches his desk.

The bill would change the definition of "practice of certified registered nurse anesthesia," which now says the job is done "under the supervision of" the physician, dentist or other medical professional who orders the use of anesthesia.

[RELATED: See complete Democrat-Gazette coverage of the Arkansas Legislature at arkansasonline.com/legislature]

Under the bill, the nurse's job would be done "in consultation with" that medical professional. In current law and under the bill, the medical professional's presence is not required.

The medical professional who ordered anesthesia would not be liable for any act or omission by the nurse anesthetist, under HB1198.

Sen. Dave Wallace, R-Leachville, who is the Senate sponsor of HB1198, said, "What is happening in our rural areas and our rural hospitals is we are having surgical groups not wanting to come to our small rural hospitals because they don't want to be responsible legally for the actions" of the nurse anesthetists.

"So our small hospitals are drying up," he said.

Wallace said the lack of local access to surgeons affects patients who need surgery but are physically unable to travel to another town for an operation.

The U.S. Centers for Medicare and Medicaid Services removed the requirement of supervision over nurse anesthetists, so they "have been doing what I am asking to do in this bill ever since March 20, 2020," and "the wheel has not fallen off," he said. Nineteen other states already do this, he said.

But Sen. Missy Irvin, R-Mountain View, countered, "The purpose of this bill is not about rural Arkansas or access to surgeries in rural Arkansas.

"It is about CRNAs wanting to do independent pain management clinics," she said. "That's a very different scenario."

Irvin said it is important to have a surgeon supervise nurse anesthetists.

"This bill does not address what has been already the practice in rural Arkansas with surgeons forever practicing and doing surgery with CRNAs," Irvin said. "That has been working. This doesn't change that."

Sen. Gary Stubblefield, R-Branch, said he presented information to lawmakers two years ago and four years ago that showed each state that passed a similar law lowered its medical costs and improved its medical care. He said the bill would help the state.

Wallace said he doesn't believe the bill would allow the certified registered nurse anesthetists to start their own pain management clinics.

On March 8, the bill fell a single vote short of passage in the 100-member House, with representatives voting 50-37 in favor of it.

After narrowly approving a motion to reconsider the bill, the House on March 9 voted 55-31 for the bill.

Information for this article was contributed by John Moritz of the Arkansas Democrat-Gazette.

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