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 (L-R) State Senator Joe Scarnati and Dr. Rich O'Flynn

 (L-R) Dr. Meg Tarpey and State Senator Jay Costa

By Joseph F. Talarico, D.O.

Former PSA President, Margaret Tarpey, M.D., met with Rep. Matt Baker, chair of the state Health Committee. The PSA educates legislators on issues important to all anesthesiologists.
The Pennsylvania legislature has made a number of attempts to amend the Nursing Practice Act and define their scope of practice so as to, in effect, permit independent practice. The most recent failed attempt came during the 2011-2012 session (HB 212).

Certified Registered Nurse Anesthetists (CRNAs) claim that passage of such bills would merely give statutory recognition to current practice and would not change their scope of practice. That is incorrect. They also claim that passage would increase access to care and decrease costs. The Pennsylvania Society of Anesthesiologists (PSA) disputes all of these claims on the following grounds:
  • Physician supervision is the standard in hospitals under PA Department of Health Regulations and its meaning is well understood. “Overall direction” is undefined, appears to relate more to administrative than to professional responsibility, and can be expected to be defined by the Pennsylvania Board of Nursing in ways that would make it akin to independent practice. There is no substitute for an M.D. or D.O. degree followed by an anesthesia residency, and the practice of anesthesiology is the practice of medicine.
  • While PSA strongly encourages supervision by an anesthesiologist, we realize there are situations where an anesthesiologist cannot be immediately available in every case. Passage of bills such as HB 212 would not result in any improvement in access to anesthesia care in Pennsylvania.
  • Currently, anesthesia claims are paid based on the service provided, not on who provides the service. Unsupervised CRNA reimbursement would be identical to the reimbursement paid when the service is performed by an anesthesiologist personally or by the anesthesia care team.

In past legislative sessions, our efforts to block similar bills have been successful. As a matter of fact, of the numerous bills increasing nursing scope of practice for ancillary medical personnel (CRNPs, nurse midwives, etc.) introduced in 2008, HB 1274 was the only piece of legislation defeated.

A major threat in the immediate future, however, is the inordinate number of freshman legislators. The Pennsylvania Legislature has undergone dramatic turnover in the past few elections.

Judging from the apparent support of relatively junior legislators, the CRNAs have been effective in their recent lobbying efforts. In addition to the efforts of the PSA Board of Directors, grassroots one-on-one lobbying of your legislator by an anesthesiologist/constituent is the most effective means of preserving physician supervision of CRNAs, and ensuring the safe practice of anesthesiology in Pennsylvania.

We have found that, since we have the facts on our side, legislators are extremely likely to support our objectives after they have been effectively educated about the inherent risk of anesthesia and the benefits of having anesthesia care delivered personally by or under the direct supervision of a physician.


Physicians Protecting Patients