CMS’s rule prevents these well‐trained, specialized nurses from providing anesthesia independently and freeing up physician anesthesiologists so more patients can receive care.
Arizona, where I practice general surgery, became the 18th state to opt out in 2020. ThenGovernor Ducey issued the opt‐out letter in order to expand access to anesthesia services to people in rural and other underserved areas of the state who need surgical and obstetrical care.
As a general surgeon, I have worked with CRNAs for years. They have provided excellent anesthesia care to my critically ill and challenging surgical patients. As a professional, when I encounter patients with surgical a problem for which I lack expertise, I call in or refer them to surgeons with more knowledge and experience with the problem. CRNAs are bound by their professional ethics to do the same in such situations. There is no evidence that CRNAs have not adhered to these same ethical precepts in the 24 states that currently permit them to practice independently. Research shows there is no evidence of any harm to patients when CRNAs work independently of physicians.i
In 1999, Texas Attorney General John Cornyn issued an opinion, reaffirmed by Attorney General John Paxton in 2021, that the Texas law does not require physicians to supervise CRNAs. For Texas to opt out of the CMS rule, the governor must send a letter to the agency attesting that he has consulted with the state’s boards of medicine and nursing on the access and quality of anesthesia services, that opting out is consistent with state law, and that he has determined it is in the best interest of the citizens of his state to opt‐out.
As shortages continue to worsen in all areas of health care delivery amidst an aging population and increasing physician retirements, I encourage you to take a step toward mitigating the problem by opting out of the CMS rule.ii
Sincerely,
