Why Addressing"Surgeon Liability" was Paramount

SB 1336 was a multi-year effort and began in 2016 as SB 1473.  Here is Dr. Rob Schuster, MD FACS,  testifying on the problem of surgeon liability and the high quality care CRNAs offer.  

The AZANA decided to address the false perception of surgeon liability for CRNAs for one primary reason - it affects every patient we care for.  And that's because the false perception was affecting every CRNA, regardless of practice model.  

We've always known that courts apply the same standard to judge whether surgeons are liable for the acts of the anesthesia professional whether it is a CRNA or physician administering the anesthesia, and that it was the the false perception of liability that weighed heavy on surgeon's minds, with nearly 100 supporting SB 1336 and it's more progressive predecessor in 2016.  

This false perception of liability the issue disproportionately affects the fastest growing segment of our membership: those practicing in independent/autonomous/consultative models.  The most recent membership survey data (2013) - indicates that nearly half (42.5%) of CRNAs practice in models where the practice did not mandate direct supervision/medical direction.  We expect this number has grown and will only continue to grow as healthcare demands increase, and as CRNAs and physician anesthesiologists continue to realize that neither teamwork nor leadership is not built on hierachy-based words like "supervision" or "direction" - but on knowledge, teamwork, and competence. 

The primary indirect benefit of SB 1336 removing the false perception of surgeon liability is that many other outdated and burdensome regulations have been rendered essentially obsolete.

Removing the false perception of surgeon liability has a number of direct and indirect effects.  The direct effects include benefits for patients, surgeons, anesthesiologists and CRNAs.  The indirect benefits, while not as immediately apparent, remain important for all stakeholders involved in surgical and anesthesia delivery. 

The primary indirect benefit of SB 1336 removing the false perception of surgeon liability is that many other outdated and burdensome regulations have been rendered essentially obsolete.  Since liability is the main problem with outdated words - removing liability from the equation renders remaining outdated words (ie direction, supervision, etc) - effectively moot.

The AZANA decided to address the false perception of surgeon liability for CRNAs for one primary reason - it affects every patient we care for.

Of course, facilities can always choose to be more restrictive than state law - but they can never choose to be less restrictive.  Now that Governor Ducey has made clear that surgeons and physicians working with CRNAs cannot be held liable for the acts or omissions of CRNAs administering anesthesia - the negative impact on patient care that the word "direction" created - is no longer present. 

"Direction" remains undefined in state statute.  The definition of this word caused a great deal of tension between the Arizona Society of Anesthesiologists (AzSA) and the Arizona Association of Nurse Anesthetists.  Essentially, AzSA tried to define it as something restrictive and controlling (which in fairness, was the experience of some of their members).  AZANA's position was that "direction" did not actually occur at all - and if it did, it was because of facility policy (agreeing with AzSA on their local perspective) - not because of state law.  AZANA's position was supported both by our state membership, national membership data, and the fact that we know, empirically and through data simulation, that the requirements of the medical direction practice model are rarely met.  With the liability issue addressed - the question remains without a definitive answer and largely irrelevant.  

State law is the primary determiner of scope of practice, with both CMS and facilities deferring to state scope of practice laws.  As such, while more work remains to be done to bring policies up to date with what is actually occurring in practice, while leaving the flexibility for local facilities to choose the type of anesthesia model they desire.