Michigan House OKs bill lifting supervisory rules for nurse anesthetists

Beth LeBlanc
The Detroit News

A bill that would allow nurse anesthetists to administer anesthesia without physician supervision passed the House 82-25 Wednesday amid strong objections from the state's largest doctors association. 

The legislation introduced by Rep. Mary Whiteford, R-Casco Township, would expand the scope of practice for certified nurse anesthetists to administer anesthesia without the supervision a physician if the CRNA were part of a patient-centered care team. 

The bill is part of a larger House legislative package aiming to make health care more affordable and accessible. 

The proposal has pitted hospitals against doctors on the heels of a year-long pandemic that prompted the temporary lifting of the supervision requirement for nurse anesthetists to allow for swifter treatment of patients. 

Certified Registered Nurse Anesthetist Lisa Downs sets up this operating room for the next surgery at Mount Clemens General Hospital.

"Everyone knew that we needed educated trained health care professionals available across the state,” Michigan Association of Nurse Anesthetists President Toni Schmittling told lawmakers earlier this month. "When we are at our worst and we need our very best on the front lines, the state of Michigan turned to CRNAs and suspended the needless barriers to access."

But the Michigan State Medical Society has come out strongly against the legislation and urged lawmakers not to make a pandemic exception permanent.

"We will find ourselves in the dangerous situation of having the most qualified person in these emergencies, the anesthesiologist, nowhere to be found," said Dr. Bobby Mukkamala, a Flint-area otolaryngologist who is president for the Michigan State Medical Society. 

Michigan law currently requires that the state's roughly 2,600 CRNAs are supervised by a physician while administering anesthesia. That physician could be an anesthesiologist or a different physician overseeing a procedure including podiatrists, surgeons or dentists. 

Whiteford said she's heard from rural hospitals that don't have anesthesiologists or are too short-staffed to provide a physician to oversee minor anesthesia procedures. Additionally, some surgeons in rural areas are worried about having to supervise nurse anesthetists "whose practice is outside their physician specialty," the Michigan Health and Hospital Association said. 

"The cost associated with having an anesthesiologist on call 24 hours a day is a contributing factor to the shortage in rural areas," said John Karasinski, a spokesman for the association. The House bill passed Wednesday, he said, "allows the flexibility for each hospital to choose their anesthesia care model that fits best their location, staffing and resources to offer safe, effective patient care." 

About 42 states have lifted physician supervision requirements to some extent with 19 of those opting out of the federal Medicare physician supervision rule altogether, said Whiteford.

"Michigan cannot opt-out because the state's definition of nursing practice does not include nurses giving anesthesia independently," Whiteford said. "Updating this law would allow this.”

The Michigan State Medical Society has argued nurse anesthetists do not have the training or experience to react quickly when something goes wrong during anesthesia. States that have removed supervisory requirements have not resolved rural access issues and the legislation does not guarantee a decrease in cost, Mukkamala said. 

He said the current law allowing any physician to serve as supervisor for a nurse anesthetist is not ideal either. 

"We've already gone one step from the ideal by saying a plastic surgeon who’s taking care of an ulcer on someone’s leg needs to be responsible for the anesthesia being provided on the other side of the curtain," he said. 

The proposed legislation "removes by one further step proper supervision," Mukkamala said.

An amendment offered by Rep. Jim Haadsma, D-Battle Creek, Tuesday would have clarified liability and expected standards of care for nurse anesthetists. But the amendment was not adopted.