On October 25, the Ohio Academy of Family Physicians joined with a number of other physician organizations to express continued opposition to House Bill 191, legislation that would grant independent practice to Certified Registered Nurse Anesthetists (CRNAs) and broadly expand their scope of practice. House Health Committee members received the letter immediately following proponent testimony on October 25.
- Independent Practice – Both the introduced version and the substitute bill continue to grant independent practice to CRNAs, despite the fact that no other advanced practice registered nurse has independent practice in Ohio. There are no documented problems involving the current supervisory model for administering anesthesia during the surgical period.
- Broad Ordering Expansion – Both the introduced version and the substitute bill continue to grant broad authority for the CRNA to order drugs, tests, treatments, and fluids for the patient. The bill does not specify what types of drugs, tests, and treatments can be ordered, which could result in unnecessary increased costs for the patient.
- Ability to Order Pain Medications – Both the introduced version and substitute bill allow the CRNA to order pain relief therapies for the patient. During Ohio’s dire opioid crisis, we oppose introducing CRNAs as another prescriber of pain medications.
- Conflicting Orders – If the CRNA orders a drug, test, or treatment that conflicts with a physician’s order for the patient, the bill does not address how the conflicting order will be handled. This adds yet another layer of confusion during the critical surgical period that does not currently exist under the care team model.
- Where is the CRNA? – The substitute bill does not require the CRNA to be with the patient or even in the facility when ordering a drug, test, or treatment for the patient. As many CRNAs are not employees of an institution but independent contractors who move from facility to facility, patient care can be compromised which such broad authority and no boundaries.
While physician organizations are committed to resolving any issues affecting the anesthesia care team model, we continue to ask why the bill is even necessary. Patient care cannot be compromised by expanding scope of practice. Both the introduced version and substitute bill dismantle the care team model, are broad in their application and could jeopardize patient care.