Division of Governmental Affairs
Morris Auster, Esq.    
Senior Vice President 
Chief Legislative Counsel

                                                                     MEMORANDUM IN OPPOSITION 

ON ASSEMBLY WAYS & MEANS                      A.442 (PAULIN)

      COMMITTEE AGENDA

IN SENATE HIGHER                                        S.1385 (GALLIVAN)
EDUCATION COMMITTEE

     AN ACT to amend the education law, in relation to certification of certified registered nurse anesthetists

This measure would provide for the certification by the education department of certified registered nurse anesthetists (CRNAs).  The Medical Society of the State of New York strongly opposes this bill.

This legislation is nearly identical to a bill that was already VETOED BY GOVERNOR CUOMO in 2012 due to “critical issues such as scope of practice, supervision, and the oversight role and regulatory jurisdiction of the affected agencies, namely the State Education Department and the Department of Health. These omissions create a risk of inconsistent standards and confusion to consumers.” We agree with the Governor that this legislation fails to define a scope of practice consistent with existing New York State standards —standards which have significantly improved anesthesia outcomes in surgical procedures over the last 20 years.

Whereas, anesthesiologists function as their patient’s primary care physician in the operating room, PACU, and intensive care units, and are uniquely qualified to oversee the delivery of anesthetics to their patients, CRNAs do not. Anesthesiologists have graduated from four years of medical school, completed 3-8 years in residency and fellowship training, and will have spent between 12,000-16,000 hours treating patients before practicing as specialists in their field.  While the Medical Society recognizes and endorses the important role that nurse anesthetists play in the integrated anesthesia care team, we caution that a serious danger to the well-being of patients will be created if non-physicians, such as nurse anesthetists, competent within their own fields, are permitted to work in areas beyond their competencies and training.

Under NYS Health Code (10 NYCRR 700.2), CRNAs are already required to register with the NYS Education Department and are prohibited from practicing nurse anesthesia without meeting specific education and testing requirements.  Taken together with existing NYS Education Law, CRNAs are already adequately regulated as employees of Article 28 facilities or of the physicians who are charged with supervising them. Under existing law, physicians are ultimately responsible and liable for any CRNA provision of anesthesia services. 

CRNAs have sought for years to be able to practice independently of a physician.  While the amended A-version explicitly states that “[n]othing in this section shall be construed to…permit independent practice for certified registered nurse anesthetists” this bill is major step in that direction. While this bill purports to be a “title protection” for CRNAs it actually establishes the certification necessary for CRNAs to be directly reimbursed by health insurance companies, as would be provided in S.1465/A.115, which is currently before both the Senate & Assembly Insurance Committees.

 We believe that this legislation will be used to support CRNA’s efforts to encourage the State to apply to the Centers for Medicaid and Medicare Services (CMS) for CMS approval of an exemption from the requirement for physician supervision of CRNAs. We do not believe that NYSED “title certification” of CRNAs should be used as a basis upon which CRNAs will argue for physician supervision exemptions.

 This bill fails to define and address the scope of practice of nurse anesthetists, especially in the broader context of the roles and scope of practice of anesthesiologists and operating physicians.   As such, these responsibilities are inconsistent with the education and very specific, task oriented training of nurse anesthetists.

 For these reasons, the Medical Society of the State of New York opposes this bill and urges its defeat.

 

                                                                  Respectfully submitted,

6/1/17 – Oppose                                       MSSNY DIVISION OF GOVERNMENTAL AFFAIRS

MMA