AZANA President submits official letter requesting signature on SB 1336

The Arizona Association of Nurse Anesthetists

7949 E. Acoma Drive, Suite 207
Scottsdale, AZ 85260

Office of the Governor

The Honorable Governor Doug Ducey

1700 W Washington, Phoenix, AZ 85007

Dear Governor Ducey,

The Arizona Association of Nurse Anesthetists (AZANA) is dedicated to patient safety and anesthesia care of the highest quality, and we focus on building teams that make anesthesia care both cost-effective and accessible.  As the only organization representing over 800 Certified Registered Nurse Anesthetists (CRNAs) in the state of Arizona, we kindly ask you to sign into law SB 1336, which is an incremental step towards modernizing the laws regarding CRNA practice.

CRNAs are full-service, independent anesthesia professionals who have practiced anesthesia for over 150 years.  CRNAs ensure access to anesthesia services throughout Arizona, especially in rural and underserved populations, and they provide anesthesia services for every type of patient, in every setting and model of care.  There are approximately equal numbers of CRNAs and physicians that administer anesthesia in Arizona.

The statute for CRNAs requiring “surgeon direction” - in addition to being unnecessary, burdensome, and outdated - creates a false, but present, perception of liability.  This false perception was only compounded when in 2016 an influential malpractice insurance company stated, despite all legal evidence to the contrary, that surgeons were indeed liable for CRNA anesthesia services. SB 1336, by clarifying that surgeons are not liable for acts or omissions of CRNAs, addresses this issue in state law. 

The statute regulating CRNAs is just another example of rules and regulations which have not been properly updated, and now are creating unnecessary barriers, both for CRNAs and more importantly – for patients.  These outdated laws increase costs to patients by hindering competition, and are barriers to economic opportunities for CRNAs.  When CRNAs are not able to offer their services, access to care is limited in places where care is needed most: rural and underserved populations. 

The evidence and support for removing outdated regulations, for CRNAs is – in a word – immense.  Nationally, organizations interested in patient care from across the spectrum have supported similar efforts for reduced regulations for CRNAs and an appropriate scope of practice.  The Institute of Medicine, AARP, The American Hospital Association, RAND Corporation have all supported similar efforts nationally.  Locally, SB 1336 enjoyed the support of The Goldwater Institute, The Arizona Public Health Association, The Arizona Nurses Association, and unprecedented support from the physician community – with nearly 100 physicians, surgeons and dentists officially registering their support for our effort. 

While the impact of outdated regulations is reduced by SB 1336, more work remains to be done.  SB 1336 mainly addresses one aspect – false perceptions of liability – for CRNA anesthesia care.  When burdensome regulations are removed, unsurprisingly, access to care increases, competition increases, and costs trend down. 

SB 1336 is a step forward for our patients, and for all Arizona citizens, and we kindly ask for your consideration. 



Joseph Rodriguez, MSN, CRNA,

President of the Arizona Association of Nurse Anesthetists